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.
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 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.
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.
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 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).
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 chapter highlights 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. As the midbrain defense centers hold the capacity for stress-induced analgesia (SIA), the tendency to dissociation, which is established with disorganized attachment in very early life, is considered to be secondary to modifications of their sensitivity. Trauma survivors have a default setting that keeps them in threat mode, whether triggered easily by memories of physical danger or separation distress. In a secure attachment relationship, the child can learn the rewards of interaction without threat. The frozen indecision is replaced by a disconnection from the experience of the moment, which relieves the distress. Environmental stress alters the nursing behavior of the mother rat so that she ceases to do so much licking/grooming.
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.
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.
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.
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: 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.
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. These scripts are conveniently outlined in an easy-to-use, manual style template for therapists, allowing them to have a reliable, consistent form and procedure when using EMDR with clients. There is a self-awareness questionnaire to assist clinicians in identifying potential problems that often arise in treatment, allowing for strategies to deal with them. Some clients may be able to talk about their trauma; however, the thought of processing it with the Standard EMDR Protocol may seem too overwhelming. In cases such as these, having the client develop a resource to address the “fear of the fear” may reduce the anxiety of reprocessing the traumatic memory.
- 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.
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. These scripts are conveniently outlined in an easy-to-use, manual style template for therapists, allowing them to have a reliable, consistent form and procedure when using EMDR with clients. For some clients finding a Safe/Calm Place is very difficult, either because of their life experiences or their difficulty in using their imagination. In cases such as these, construction of a container to hold traumatic material, both during desensitization and between sessions, may be an alternative strategy to help the client develop a sense of safety. Constructing a container follows the same basic setup protocol as establishing the Safe/Calm Place.
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. These scripts are conveniently outlined in an easy-to-use, manual style template for therapists, allowing them to have a reliable, consistent form and procedure when using EMDR with clients. The idea of the safe place has been a staple in practices of Clinical Hypnosis practitioners. The first known use of the Safe Place with EMDR was when Dr. Neal Daniels, an EMDR practitioner working at the Veterans Administration Hospital in Philadelphia, adopted this resource to assist the veterans with whom he worked to ground themselves and contain their affect before doing trauma work. Dr. Francine Shapiro saw the merit of this intervention and by 1995 included a formalized version into the first EMDR text.
The purpose of remembering trauma is to help us get free from the past. The amygdala is a small part of the brain that aids in processing highly charged emotional memories. Trauma memories seem to be encoded differently than regular memories. Memory is a complex topic with many ongoing controversies in the scientific field. Sexual trauma makes an imprint on the psyche that can permeate one’s very being. Holographic reprocessing (HR) involves discovering and exploring personal holograms by working to identify the patterns in our life. These experiences form the basis of limiting or negative beliefs, as well as protective behaviors or coping strategies. Experiential hologram refers to a theme of experiences that emerge and are reenacted in people’s relationships. Trigger is an anxiety response or the activation of the fight, flight, or freeze system in order to mobilize the person to get out of danger.
This chapter presents a summary of the Single Traumatic Event Protocol. For single traumatic events, the Standard Eye Movement Desensitization and Reprocessing (EMDR) Protocol should be applied to the certain targets, including the past, present, and future templates. The chapter serves as a one-stop resource where therapists can access a wide range of word-for-word scripted protocols for EMDR practice. These scripts are conveniently outlined in an easy-to-use, manual style template for therapists, allowing them to have a reliable, consistent form and procedure when using EMDR with clients. Encourage clients to imagine themselves coping effectively in the face of specific challenges, triggers, or snafus. Therapists can make some suggestions of things in order to help inoculate them with future problems. It is helpful to use imaginal rehearsing type of future template after clients have received needed education concerning social skills and customs, assertiveness, and any other newly learned skills.
Studies have evaluated the usefulness of Eye Movement Desensitization and Reprocessing (EMDR) following disaster events finding that this approach could be effective in significantly reducing post-traumatic symptoms. EMDR has been reported as effective in the treatment of children following a hurricane in Hawaii. Group therapy is a well-proven form of treatment for traumatized children and adolescents. The EMDR-Integrative Group Treatment Protocol (IGTP) was developed by members of AMAMECRISIS when they were overwhelmed by the extensive need for mental health services after Hurricane Pauline ravaged the western coast of Mexico in 1997. This protocol combines the Standard EMDR Treatment Phases 1 through 8. Designed initially for work with children, the EMDR-IGTP has also been found suitable for group work with adults. The protocol is structured within a play therapy format and has been used with disaster victims ages 7 to 50 +.
The Emergency Response Procedure (ERP) was initially developed to help victims within hours of a terrorist attack, but can be applied in the immediate aftermath of any trauma. Patients may present with “silent terror”, shaking and inability to speak, often they are in a highly agitated state. The procedure has been used in the emergency room and during hospitalization. While taking an initial history, prior to the Preparation Phase of Eye Movement Desensitization and Reprocessing (EMDR), ERP can be put into effect if patients suddenly abreact. Clinicians highly experienced in dealing with patients after a traumatic event will still benefit from this report. If patients cannot communicate, information about the incident is reported to the clinician by the ambulance or hospital staff. A more complete history regarding the immediate trauma can be done after the patient becomes verbal, once the ERP has been effective at establishing a present orientation.
Eye Movement Desensitization and Reprocessing (EMDR) Scripted Protocols: Basics and Special Situations
Scripting is a way to inform and remind the Eye Movement Desensitization and Reprocessing (EMDR) practitioner of the component parts, sequence, and language used to create an effective outcome. As EMDR is a fairly complicated process, this book provides step-by-step scripts that will enable beginning practitioners to enhance their expertise more quickly. The book is separated into nine parts. The Client History part represents the first of the eight phases of EMDR treatment. The ability to gather, formulate, and then use the material in the intake part of treatment is crucial to an optimal outcome in any therapist’s work. Part II includes an important element of the Preparation Phase that addresses ways to introduce and explain EMDR, trauma, and the adaptive information processing (AIP) model. The importance of teaching clients how to create personal resources is the topic of Part III. Here, an essential element of the Preparation/Second Phase of EMDR work is addressed to ensure clients’ abilities to contain their affect and remain stable as they move through the EMDR process. Part IV shows how to work with clients concerning the targeting of their presenting problems when the usual ways do not work such as usage of drawings to concretize clients’ conceptualization of their issues and usage of an alternative initial targeting method. Part V includes protocols that have been scripted based on the material that appears in Francine Shapiro’s EMDR textbook. Parts VI and VII address EMDR and early intervention procedures for man-made and natural catastrophes for individuals and groups. Performance enhancement and clinician’s self-care are dealt with in the final two parts of the book.
- Go to chapter: Introducing Adaptive Information Processing (AIP) and EMDR: Affect Management and Self-Mastery of Triggers
Introducing Adaptive Information Processing (AIP) and EMDR: Affect Management and Self-Mastery of Triggers
It is helpful to introduce the concept of Adaptive Information Processing, to help Eye Movement Desensitization and Reprocessing (EMDR) clients understand the nature of how our brains work. The second phase of EMDR is called the Preparation Phase. When EMDR first started, practitioners often went from Phase 1-Client History Taking to Phase 3-Assessment Phase with just a brief moment to introduce the client to the specifics such as the mechanics of EMDR, including bilateral stimulation (BLS), sitting position, and stop signals. For some clients, this has worked well, however, as time went on, practitioners often reported that something more was needed before beginning desensitization and reprocessing. The idea of tapping into the client’s natural resources began within the Standard EMDR Protocol itself. In the face of man-made or natural catastrophes, practitioners have found that building resources are essential aspects of working with recent trauma, especially for children.
- 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.
Early group Eye Movement Desensitization and Reprocessing (EMDR) intervention following trauma may facilitate adaptive processing of traumatic event(s) and help prevent consolidation of traumatic memories following large-scale natural or man-made disaster. Group EMDR may also be usefully applied with homogenous groups, and where professionals are exposed to high levels of work-related stress. Writing is a useful clinical tool in narrative therapy, bibliotherapy and writing therapy. Written journaling to monitor behavior is commonly practiced between sessions of cognitive behavioral therapy. The Written Workbook Protocol allows close adherence to the EMDR Standard 3-Pronged Protocol at all steps until the end of the processing phase, when constraints of the group format come more dramatically into play. Cognitive interweaves necessary to clear potential blocks to processing are more difficult to tailor and implement in group. The potential power of “group cognitive interweaves” emerged spontaneously during multifamily group EMDR with tsunami survivors in Thailand.
The Eye Movement Desensitization and Reprocessing Performance Enhancement Psychology Protocol (EMDR-PEP) addresses performance anxiety, self-defeating beliefs, behavioral inhibition, posttraumatic stress, and psychological recovery from injury for creative and performing artists, workplace employees, and athletes. The EMDR-PEP can be very useful with everyday nonpathological complaints such as procrastination, fear of failure, setbacks, and life transitions. The EMDR-PEP encompasses a full spectrum viewpoint regarding optimal functioning at work and in life. This perspective inspires clients to identify their strengths as well as areas to improve and to prioritize their work accordingly. Reduced anxiety and increased self-confidence were reported for mature performing artists launching an existing repertoire into a new arena and in a controlled study of master swimmers. The following forms are included in the clinical intake for performance work: Trauma History and EMDR Readiness, Relationship History, School History, Employment History, Problem History, and a Performance Inventory.
Since people with dissociative disorders (DD) rely on autohypnotic defenses, this version of Safe Space Imagery (SSI) uses hypnotic language to teach the client to block out intrusive thoughts and feelings and learn how to get their body to a state of deep relaxation. Regular practice of SSI supports the client’s stability and becomes a coping skill used for self-soothing, symptom management, and eventually as an integral part of trauma processing. The SSI method is different from the Safe Place Protocol that is routinely taught in the eye movement desensitization and reprocessing (EMDR) Institute Basic Training. The SSI protocol is useful for many clients with trauma histories and for those with DDs. In SSI exercise one part volunteers to go first while the others watch. This approach works well when one want to teach a client SSI and there are protective or suspicious parts that need to stay hypervigilan.
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.
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. These scripts are conveniently outlined in an easy-to-use, manual style template for therapists, allowing them to have a reliable, consistent form and procedure when using EMDR with clients. In a small number of clients, developing a calm place may increase levels of distress. For some clients, bilateral stimulation (BLS), paired with the development of the calm place, may quickly bring the client to intense negative affect. Therefore, it is helpful to find what skill, resource clients need and help them access those experiences to assist them in preparing for the trauma work. Have the client notice the difference in the feelings and sensations associated with the skill, strength, or resource. Guide the client through the process until the positive emotions and sensations are experienced.
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.
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. These scripts are conveniently outlined in an easy-to-use, manual style template for therapists, allowing them to have a reliable, consistent form and procedure when using EMDR with clients. When a client seems too overwhelmed by the trauma and cannot focus on anything else, having them focus on positive things in their lives may help them regain a more appropriate and positive perspective. Once stabilized, clients may be ready to address the trauma with the Standard EMDR Protocol. If the client brings up a negative thought, redirect to the last positive thought and continue focusing on more positives. Repeat this process until the client feels strong enough to begin addressing the traumatic issue. This may take several sessions.
This chapter illustrates three important elements such as individual and institutional betrayal trauma, and reparative individual and institutional experiences. Military sexual trauma (
MST) survivors receive psychological care from a wide swath of mental health professionals, within the context of both veteran and civilian institutions. The therapeutic orientations draws a combination of cognitive, dialectical behavioral, and relational-cultural theories, will influence the way we conceive of MST. A caregiver having cognitive, emotional, and physiological reactions of love, protectiveness, affiliation, and nurturing toward an infant buffers against the huge responsibility and effort it takes to provide sufficient care. Therapists may be able to gain clinical traction with MST survivors by understanding that MST almost always includes experiences of both individual and institutional betrayal. A therapeutic environment where mutual empathy and empowerment are present can provide an antidote to the patient’s previous environments, lacking in empathy and rife with disempowerment.Source:
Psychotic disorders are a category of illnesses classified as mental illness. A mental illness is a medical condition that disrupts a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. Mental illnesses can affect anyone regardless of age, race, ethnicity, gender, socioeconomic status, education level, religion, or sexual orientation. The term psychotic disorder refers to a continuum of illness that encompasses a variety of different symptoms. The Diagnostic and Statistical Manual of Mental Disorders classifies all psychotic disorders under the umbrella of schizophrenia spectrum disorders to account for the differences that occur within and between psychotic disorders. Experiencing stress or trauma also increases the likelihood that someone may develop a schizophrenia spectrum disorder. Group therapy has shown to be highly effective in addressing symptoms and stressors associated with psychotic disorders.
The incidence of sexual assault and harassment experienced by members of the U.S. Armed Forces has reached epidemic proportions. Its victims often suffer from devastating, lifelong consequences to their careers, health, relationships, and psychological well-being. This book is written for mental health clinicians to help in understanding and treating military sexual trauma (
MST). It addresses the complex circumstances of victims of sexual abuse in the military and how clinicians can meet the unique challenges of treating these clients. The book describes how MST differs from other forms of military trauma such as combat, and discusses its prevalence, neurobiology, and social contexts as well as unique stressors of betrayal, injustice, struggles with issues of reporting and disclosure, and impact on relationships and sexuality. It reviews current evidence-based interventions and offers insights on treating specific symptoms within MST, such as post-traumatic stress disorder (PTSD), anxiety, substance abuse, sleep disorders, and sexual dysfunction. Chapters discuss how a variety of psychotherapies can be used to treat MST, including prolonged exposure, cognitive processing, Eye Movement Desensitization and Reprocessing ( EMDR), Seeking Safety, acceptance and commitment therapy, and somatic experiencing, as well as the Warrior Renew MST group therapy program. Clinicians who work with veterans and active duty personnel will find the book an essential guide to working with MST survivors.
- Go to chapter: Evidence-Based Interventions to Support Youth Following Natural Disasters: Evidence-Based Principles and Practices
Evidence-Based Interventions to Support Youth Following Natural Disasters: Evidence-Based Principles and Practices
This chapter discusses issues associated with specific natural disasters, generalized issues associated with most natural disasters, and evidence-based principles and practices for supporting youth following a natural disaster. La Greca highlighted three phases of recovery following natural disasters and offers evidence-based interventions associated with each phase. These include the postimpact phase, short-term recovery and reconstruction phase, and the long-term recovery phase. The chapter outlines the effects of natural disasters on children and provides an overview of strategies for supporting children and adolescents following traumatic events. Posttraumatic stress disorder (PTSD) is characterized as an anxiety reaction that emerges after witnessing or experiencing a traumatic event. The chapter summarizes three evidence-based approaches to support children in the aftermath of a potentially traumatic event, such as a natural disaster: trauma-focused cognitive-behavioral therapy (TF-CBT), mindfulness-based stress reduction (MBSR), and the Mourning Child Grief Support Curriculum (MCGC).
Many children experience the death of someone close to them before the age of 18 years. This chapter reviews the effects of bereavement on children’s functioning and the risk and protective factors that exacerbate or mitigate grief-related problems. It provides step-by-step instructions for two evidence-based interventions for school-aged children and adolescents. Childhood traumatic grief refers to a condition in which children develop trauma-related symptoms that interfere with their ability to appropriately mourn a death. The Family Bereavement Program (FBP) is a theory-based intervention for parentally bereaved children and their surviving caregivers. The child component focuses on increasing self-esteem, reducing negative appraisals of stressful events, strengthening youths’ relationships with their caregivers, strengthening coping skills, and increasing adaptive emotional expression. The Grief and Trauma Intervention (GTI) is commonly implemented in schools and community-based settings after children’s exposure to a traumatic, violent, or disastrous event.
- Go to chapter: Evidence-Based Interventions for Posttraumatic Stress Disorder in Children and Adolescents
This chapter presents an overview of posttraumatic stress disorder (PTSD) in childhood and adolescence, including how symptoms may present and what factors are associated with risk of developing PTSD. It provides a review of the research literature and a step-by-step guide for practice for two empirically validated treatments for youth PTSD. The symptoms of PTSD are grouped into four clusters: intrusion symptoms, avoidance symptoms, cognition and mood symptoms, and arousal and reactivity symptoms. Trauma-focused cognitive behavioral therapy (TF-CBT) was initially developed to address trauma associated with child sexual abuse and has subsequently been adapted for use with children who have experienced other trauma types. Research indicates that TF-CBT is effective in treating PTSD, depression, and related behavioral problems in children exposed to traumatic events. The chapter provides a step-by-step breakdown of TF-CBT and Prolonged Exposure for Adolescents (PE-A) interventions, including descriptions of core components and standard implementation practices.
This chapter explores the management of medical trauma in the outpatient, specialist level of care. It examines how integrative models of disease management make for successful and effective programs, exploring the role that adjunct support services play in filling gaps left when treatment has a singular focus on the body. Many chronic illnesses have the potential to threaten the lives of patients if they are not managed effectively. Nurses also play a key role in the care of patients with chronic illness. Registered nurses (RNs) can specialize according to the specific patient population with which they work, whereas nurse practitioners (NPs) specialize according to setting and level of care. Specialized treatment centers, which may or may not be affiliated with larger health care organizations, have become a desirable treatment option for millions of people living with chronic and potentially life-threatening diseases such as diabetes and cancer.
This chapter examines the environmental factors that can contribute to the experience of medical trauma by increasing patients’ distress, impairing their sleep, and by becoming part of the trauma picture encoded in patient memory. It explores the areas of the hospital most associated with medical trauma, the emergency department (ED) and intensive care unit (ICU) as well as the many factors that create the sensory experience of the hospital. The high percentage of patients experiencing intense psychological distress has prompted many researchers to explore what exactly about treatment in the ICU leads to posttraumatic stress disorder (PTSD). When patients experience a traumatic medical event such as a heart attack, stroke, or obstetrical trauma that requires a lengthy stay in the hospital, they are at risk of experiencing psychological distress that can lead to depression, anxiety, and even PTSD.