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.
- 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.
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.
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.