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.
One way of thinking about procrastination is to regard it as a form of addiction; an addiction to putting things off. As with other addictive patterns, the client will choose a short-term gratification instead of going for a long-term result that might, in the end, be more satisfying or empowering. As with other addictions, a procrastinating client often suffers ongoing erosion of her self-esteem. Quite often, procrastination may function as a defense as a way to avoid other life issues that are disturbing. With this type of problem, we can use a variation of Popky’s addiction protocol, and the level of urge to avoid (LoUA) procedure. It is also important to use resource installation procedures to help the client develop an image of the benefits that would come with being free of this problem.
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 focuses on office automation and systems that are useful in the mental health field, along with principles to be aware of when considering the use or purchase of such systems. Most managers have to rely on input from outside in order to form an opinion about how to resolve complex issues. The complexity of the issue increases significantly when the current federal health care laws are incorporated into the task of choosing appropriate clinical information management software. The significance of Health Insurance Portability and Accountability Act (HIPAA) would seem to dictate at least a brief foray into its content because it lays the foundation for virtually everything that is happening in the clinical information management (CIM) realm. The information provided in the chapter can give a backdrop by which current practices can be examined for goodness of fit with the available client information management systems.
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 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.
This chapter focuses on the assessment phase and importance of negative cognitions (NCs) drawing heavily on illustrative case vignettes. Janoff-Bulman introduced the notion of an “Assumptive World Theory” to describe how individuals make assumptions about themselves and the world they live in. According to McCann and Pearlman’s Constructionist Self-Development Theory (CSDT), people give meaning to traumatic events depending on how, as individuals, they interpret them. Person-centered counseling refers to “self-concept” describing the individual’s self-image largely based on life experience and attitudes expressed by significant others, such as family, teachers, and friends. Therapists should familiarize the client at an early stage with the mechanics of DAS and allow them some control in choosing the technique to be used. In choosing the target memory, the therapist and client need to determine the touchstone event, that is, the earliest memory linked to the current pathology.
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.
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 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 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 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.
Clients with dissociative identity disorder (DID) or dissociative disorder not otherwise specified (DDNOS) live with a multiple reality disorder where parts are often living in the past and are not aware of where they are, the current date, or the time. The goal of this resource is to reduce the anxiety of parts living in the past and increase the client’s ability to differentiate the past from the present. Beginning with the host, adult, or other oriented parts, make a list of information that the disoriented parts need to be oriented and to decrease anxiety. Once the list is developed, install the list using dual attention stimulation (DAS). Useful items tend to be concrete and help differentiate the past from the present. If the client is being abused in some way in the present, often there are ways to differentiate the past from the present.
- 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.
- Go to chapter: The Method of Constant Installation of Present Orientation and Safety (CIPOS) for Children
The Method of Constant Installation of Present Orientation and Safety (CIPOS) for Children. The fundamental idea of the Method of Constant Installation of Present Orientation and Safety (CIPOS) is to reinforce a client’s current sense of security and stability using bilateral stimulation. The CIPOS method is helpful in assisting children to overcome their fear of their traumatic memories. Drawing and active movement is helpful when working with younger children and for the older, active child as well. Alternatives to catching the ball in the CIPOS Protocol for Children could be using the Safe Place to interrupt the process, or drawing a Safe Place and using the picture. The CIPOS method can motivate the child to tolerate stressful memories or fear of the future and can be a very helpful bridge between resource work and trauma work.
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.
- 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 author is interested in the idea of consolidating information in an accessible form throughout her career. The Eye Movement Desensitization and Reprocessing (EMDR) Summary Sheet was the result of a need on her part to have access to all of the relevant information concerning client information and EMDR interventions at a glance. This EMDR Summary Sheet is a way to consolidate important client information quickly and succinctly. It contains details such as the name of the patient, diagnosis, paper and pencil test results, goals, presenting problem, touchstone event, and experiences of childhood, adolescence, adulthood, and any anticipatory anxiety. Major themes/cognitive interweaves and present resources are also noted.
- Go to chapter: EMDR Assessment and Desensitization Phases With Children: Step-by-Step Session Directions
This chapter describes the procedural steps of the Assessment Phase and Desensitization Phase of the Eye Movement Desensitization and Reprocessing (EMDR) Standard Protocol with detailed scripts for steering a child through each phase. It includes summary sheets to facilitate gathering information, client documentation, and quick retrieval of salient information while formulating a treatment plan. Assessment phase note section starts with Target Identification; this is a continuation of what began during the Client History and Treatment Planning Phase. The therapist should already have some idea of what the child may choose given previous target identification procedures such as Mapping and Graphing or other procedures for eliciting targets with children. Once the target has been selected, the therapist continues with Image, negative cognition (NC), positive cognition (PC), validity of cognition (VOC), emotion, subjective units of disturbance (SUD), and body sensation to move on to the desensitization 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. 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: Protocol for Releasing Stuck Negative Cognitions in Childhood-Onset Complex Post-Traumatic Stress Disorder (C-PTSD)
Protocol for Releasing Stuck Negative Cognitions in Childhood-Onset Complex Post-Traumatic Stress Disorder (C-PTSD)
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.
- 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.