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.
Intimate partner violence (IPV) and sexual assault are common violent crimes perpetrated on women. Obstetric (OB) complications associated with trauma include miscarriage, preterm labor, and placental abruption. Ongoing mental health issues, including depression and anxiety, are more prevalent in pregnant women subjected to any form of IPV, whether or not direct physical violence is involved. One study showed that pregnant women subjected to verbal threats were twice as likely to deliver low-birth-weight infants. All women who present to an OB triage unit or an emergency department (not just those who present with an injury or complication) must be screened for IPV. An organized plan for providing the victim with resources must be readily available when a screen is positive. This chapter discusses presenting symptomatology, history and data collection, physical examination, laboratory and imaging studies, differential diagnosis, clinical management and follow-up care of IPV and sexual assault.
Humans thrive on relationships. Positive interactions are the essence of one’s happiness. Connecting to others, in a positive way, is affirming. There is no more important time for people to feel connected to and supported by others as when they face a serious illness or trauma. When entering the health care system, patients move through seemingly countless encounters with a variety of personnel. Interactions that strain patient-provider relationships are costly for the patient than for the caregiver. Patients who are perceived to be difficult are at greater risk for experiencing nontherapeutic encounters. In order to provide patient-centered care, clinicians need guidelines for how they can consistently assume the kind of demeanor that makes such care part of a conscious choice, a way of being in the health care world. The power of positive regard, conveyed to patients through even the shortest of encounters, can be life changing and life saving.
- Go to chapter: Chronic Brain Impairment: A Reason to Withdraw Patients From Long-Term Exposure to Psychiatric Medications
Chronic Brain Impairment: A Reason to Withdraw Patients From Long-Term Exposure to Psychiatric Medications
The syndrome of chronic brain impairment (CBI) can be caused by any trauma to the brain, including months or years of exposure to one or more psychiatric medications. Although all psychiatric drugs have specific initial biochemical effects, over time other neurotransmitter systems then react to the initial drug effects and, as a result, broader changes begin to take place in the brain and in mental functioning. Psychiatric drug CBI, like all CBI, is associated with generalized brain dysfunction and/or damage, and therefore manifests itself in an overall compromise of mental function. The concept of CBI also resembles the concept of organic brain syndrome (OBS). The only effective treatment for CBI is a carefully conducted withdrawal from all psychiatric drugs, as well as all other psychoactive substances. A variety of stressors and trauma can cause chronic brain impairment or CBI. Long-term exposure to psychiatric drugs frequently results in CBI.
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.
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: Life Course Systems Power Analysis: Understanding Health and Justice Disparities for Forensic Assessment and Intervention
Life Course Systems Power Analysis: Understanding Health and Justice Disparities for Forensic Assessment and Intervention
This chapter describes the life course pathways of cumulative health and justice disparities experienced by historical and emerging diverse groups, which is often found among forensic populations. It helps readers articulate a life course systems power analysis strategy for use with forensic populations and in forensic settings. The chapter demonstrates how a data-driven and evidence-based assessment and intervention plan can be used to address clinical and legal issues using case examples of an aging prison population. It uses older people in prison to illustrate the complex life course of health and social structural barriers and needs of incarcerated people who have histories of victimization and criminal convictions. Information about trauma and justice, especially related to the trauma of incarceration, which in itself is often a form of abuse, especially when frail elders are involved and they are at increased risk for victimization, medical neglect, and “resource” exploitation is presented.
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.
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.