1 Blind to therapist (B2T) EMDR Protocol Blore & Holmshaw 2009a; b

2 Some uses for the B2T Clients wishing to maintain or reassert control (e.g. Thompson 1981 Blore 1997, 2005; Blore & Holmshaw 2009b) Clients experiencing acute embarrassment or shame (Blore & Holmshaw 2009b) Where there is a risk of vicarious traumatisation of the therapist In translator-situations where the client is reluctant to divulge material because of fear of real or imagined retaliation ‘back home’ MoD clients wishing to preserve ‘confidentiality’ and thus not compromise adherence to the Official Secrets Act Clients with serious speech impediments that may result in stalling the flow of processing

3 Underpinning of B2T B2T provides a client-centred solution to problems largely of behavioural avoidance B2T facilitates compliance by ‘meeting the client half way’ B2T facilitates therapist’s adherence to client-centred work

4 B2T Phase 1 –Identify non-disclosure as an issue during suitability assessment/ history-taking –Explanation that treatment will not suffer if material cannot be disclosed Phase 2 –Coach client to recognise change, using simple descriptions –Simple descriptions may need further explanation: ‘leading’ the client or setting expectations? –Subtlety of change metaphor

5 B2T Phase 3 –Negotiate a cue word to refer to target image –Check that image is static –If not static then ‘freeze frame’ at most distressing point –Make no attempt to obtain NC, PC or take VoC Phase 4 –Commence first set: Notice (cue word) Notice emotion Notice where the emotion is located –Process as normal but feedback only ‘change’ or ‘no change’

6 B2T Phase 4 (cont) –If no change, distinguish between end of channel of association and blocking/looping: Ask “is (cue word) distressing neutral or positive” (as an experience) If distressing then assume blocked/ looping If neutral/positive then two consecutive instances assume end of channel of association > return to (cue word) If assumed blocked/ looping then: –Use basic strategies (change speed direction modality of BLS). If these don’t work then go to visual interweaves: –‘morphing’/ stretching image, or two image strategy –Keep repeating until ‘change’ indicated

7 B2T Phase 4 (cont) –Disclosure may never occur. Disclosure not needed for resolution –If disclosure occurs continue with the standard protocol –PCs tend to emerge spontaneously – don’t ‘make’ PCs happen! –Never attempt to identify a NC retrospectively particularly if obvious from an emerging PC –Phase 4 complete when SUDs = 0 Phase 5 –Install PCs that have emerged –If still no PC go to body scan (phase 6) Phase 6 –If no phase 5 then be prepared for further dysfunction material to arise and then return to phase 4 (B2T version)

8 B2T Phase 7 –Be aware that the incomplete protocol for the B2T protocol may differ considerably from normal If SUDS not 0 treat as a normal incomplete session and allow extra time for phase 7 If no PC emerges and/or body scan can’t be completed then treat this as an incomplete session to –Two ‘yeses rule’: Yes client safe to leave clinic Yes, client has required resources AND will use them between now and next session Phase 8 –Reassess as usual, don’t forget cue words if disclosure hasn’t occurred