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April 17 - September 17, 2019
It seems that when a person experiences a trauma, either a “t” or “T,” it becomes locked into its own memory network as it was experienced—the images, physical sensations, tastes and smells, sounds, and beliefs—as if frozen in time in the body and the mind.
objective forgiveness results from the complete reprocessing of a traumatic event and signifies that the psychological memory has shifted to objective memory.
In EMDR therapy clients develop and strengthen their sense of truth or inner wisdom. For example, a woman who was processing a disturbing situation with her elderly father reported after a set, “The truth is he is dying. Seeing that, I know what I have to do now. I feel more distant, more objective about the situation.”
These networks are webs of associations radiating from key experiences called nodes. The strands that make up the web can be smells, sounds, cognitions, body sensations, and emotions. Shapiro (1995, 2001) refers to the strands as channels.
KEY CONCEPTS OF EMDR Accelerated Information Processing “T” and “t” traumas Adaptive Information Processing Moves Information from Dysfunctional to Functional Clears Emotional Charge Transforms Psychological Memory to Objective Memory Fosters Objective Forgiveness Creates a Felt Sense of Truth Reveals Memory Networks Integrates Networks Differentiates Networks
Trauma memory is stored differently than ordinary memory—in the right hemisphere in fragmented unintegrated form, separate from
the brain’s language center—which explains why traditional talk therapy is inevitably limited and inadequate to effectively resolve early trauma.
Psychological trauma causes disassociation of hemispheric processing.
Memory remains in fragmented form as somatic sensations and intense affect states and is not collated and transcribed into personal narratives.
Researchers have found that there is diminished hippocampal volume in chronic PTSD (van der Kolk et al., 1997).
“When you think of the accident, what is the worst part of it?” Targeting the most charged part of the incident creates a generalization effect through the entire memory, often making it possible for clients to process all of it without having to direct them to different parts.
When working with an issue or behavior, we want to target the earliest or strongest memory associated with it.
For clients who lose their observing egos and become overwhelmed by the old traumatic memories, it can be helpful for therapists to encourage and strengthen the observing parts. This process of BLS and check-ins continues during the sessions, with therapists occasionally rechecking the original images and measuring the SUDS.
Therapists advise clients that the processing of material may continue on its own between EMDR sessions and that any new material that arises between sessions can be worked on in the next session. Clients can help to facilitate this natural processing by recording their dreams and insights in a journal, as well as drawing, painting, or engaging in other kinds of artwork.
Clients still feel upset, or the SUDS is above 1 and the VoC is less than 6. If this is the case, body scans are not done, especially if it is obvious that there is still material to be processed.
When clients come in for the next session, the therapists inquire about anything of importance that has come up related to the issues that were worked on in the previous sessions.
Clients sometimes enter into cognitive or emotional loops, repeating the same images, thoughts, emotions, and body sensations without a reduction in the SUDS level. This looping is like a broken record, with the clients stuck in a groove going over and over the same material.
interweaves are a proactive EMDR strategy that serves to jump-start blocked processing by introducing information from therapists, rather than depending solely on what arises from clients. The statements therapists offer weave together memory networks and associations that clients were not able to connect. Interweaves introduce a new perspective, new information, or information that clients “know” but do not have access to in the states of mind that are activated.
In theory, when a traumatic memory is targeted with EMDR, what is dysfunctional from the system is cleared, allowing what is adaptive to come to the foreground in awareness.
The number of saccades can range anywhere from 6 to 12 or more depending upon the clients.
For many clients with severe childhood trauma suffering from complex PTSD, therapy typically proceeds over three phases (Parnell, 1999). The phases are (a) the beginning phase; (b) the middle phase; and (c) the end phase. The beginning phase, comprised of assessment, preparation, and ego strengthening, includes Shapiro’s phases 1 (history-taking) and 2 (preparation).
According to Shapiro, “flexibility and creativity on the part of the clinician are often central to clinical success” (2004, p. 311). From my experience as therapist, consultant, and EMDR trainer, and from a review of the literature, I have found that EMDR can be distilled into four essential elements that I call the essential EMDR protocol.
The memory network where the trauma is stored can be stimulated in a variety of ways. Asking the client for a picture that represents the worst part of an incident, and the associated negative beliefs, emotions, and body sensations can activate the memory network. Drawing a picture of the conflict or problem can also stimulate memory networks, as can creating a sand tray. Sometimes a smell, sound, or taste can stimulate a network. Moving in a particular way can activate networks. EMDR therapists have used a variety of creative methods to activate memory networks.
But, because of its subjectivity, it is not really a valid measurement. And, since the PC that arises at the end of the session is often different from the one chosen in the beginning, the client is measuring the validity of two different cognitions. What does this mean? In my experience clients can express in words the change they have experienced without the use of the VoC.
The most important elements are an image, body sensations, and emotions, along with some kind
cognitive component combined with the BLS. It is possible to begin processing with only body sensations, but the processing is more likely to be diffuse and go into many different channels.
In this procedure after we have determined what memory we are going to target I ask clients to close their eyes and go inside. Then I ask them what picture represents the worst part. Next I ask them what emotions they feel. Then I ask what they notice in their body. I then ask for what they believe about themselves now. After the NC I may or may not ask for the SUDS.
(See Appendix 1 for the Modified EMDR Procedural Steps Checklist and the Sample Vignette.)
With a symptom-focused approach therapists try to ascertain what in the clients’ past are causing the symptoms in the present. After clients are sufficiently stabilized, the early contributors are targeted and reprocessed with EMDR.
What is the presenting problem? What are the symptoms? What negative self-beliefs are associated with the problem? What experiences in the past are linked to the symptoms?
begin EMDR immediately, some people are not happy with this. They may choose not to work with me. Getting to know clients and establishing a good therapeutic relationship are fundamental to creating a safe container within the EMDR processing work.
Information about triggers, dreams, body memories, and flashback images should be noted for use as potential EMDR targets. Many adults who have been sexually abused don’t have clear visual memories of abuse but have symptoms indicating that abuse may have occurred.
As a rule, avoid eye movements with clients with histories of seizures and eye problems. Alternate forms of BLS can be used effectively. Clients with neurological impairment can be treated with EMDR (Shapiro, 2001), but if you have any concerns, consult a neurologist.
You may want to screen your clients for dissociative disorder by using evaluative tools. The dissociative experiences scale (DES) developed by Bernstein and Putnam (1986) is the most popular of such instruments. The structured clinical interview for DSM-IV Dissociative Disorders-Revised (SCID-D-R) developed by Steinberg (1994) is a widely used diagnostic interview that allows the therapist to assess the severity of five dissociative symptoms and diagnose the DSM dissociative disorders and acute stress disorder.
For that reason, it is best not to begin EMDR processing immediately before the therapist or client will have to miss sessions due to a vacation or other break. For clients processing large traumas, I might suggest that they have someone drive them to and pick them up from the session. Some clients might want to be sure to have their supports available.
I generally tell clients that I cannot give them a time frame before I take a thorough history, get to know them, and have a first session to see if they will be able to process. Oftentimes problems that seem simple initially are linked to earlier incidents that take much more time to clear.
Some clients lack the necessary internal resources for successful EMDR processing of traumatic memories. This is especially true for those with histories of abuse or neglect or both.
Their stored negative life experiences overwhelm their internal reservoir of positive experiences, self-esteem, and resilience. They have difficulty with emotional self-regulation.
As mentioned earlier, people who have been subjected to early trauma or neglect experience what Schore (1994, 1998) calls synaptic pruning, which makes them more vulnerable to PTSD, overly attentive to adverse stimuli, and hypersensitive to their environments.
they scan the environment for what might be dangerous (McFarlane, Weber, & Clark, 1993).
resource development and installation (RDI)
