EMDR An Overview

Outline of Today’s Presentation What is EMDR What is the goal How does it work The phases of EMDR The client’s experience of EMDR The Populations EMDR works with Special populations Considerations Group exercise

What is EMDR?

What is it? A psychological method for treating experientially based disorders It includes various orientations to treatment An eight phase approach that views pathology as based upon perceptual information that was maladaptively stored

What’s the Goal? To facilitate resolution of traumatic early life experiences Desensitize stimuli that causes present day distress Incorporate adaptive attitudes, skills, and desired behaviors for enhanced future functioning

How does it work?

How does it work? When the brain is upset it does not process the same way as when it is in a stable state The average daily information is stored in the midbrain (amygdala) and then shifted into the neocortex during REM sleep When trauma occurs, it is “too big” to be processed and stays in the Amygdala where it can be felt Similar memories form in clusters so others will attach to like memories in both the neocortex and the amygdala

How does it work? (continued) EMDR works to break up this information and process it into the long term memory… So you can REMEMBER but not RE-EXPERIENCE. The Neurobiological effect created during EMDR is not fully understood, however, it is currently theorized that EMDR recreates the processing similar to what happens during REM sleep.

The Eight Phases

1. Taking History Genograms Thorough Assessments Following your instincts Other methods??? Balancing Trauma with Strengths

2. Preparation A Strong skill for the EMDR therapist, as well as, therapists not working with EMDR. It will be emphasized both in presentation and group exercise Containment Grounding Safe/Calm Place Allies/Protectors Inner advisor IFS

3. Assessment This goes hand in hand with Desensitization Setting up the target image Assessing emotions Assessing Somatic/Sensations Assessing the Negative Cognition Uncovering the desired positive cognition SUDS VOC

4. Desensitization Introducing Bilateral Stimulation Checking in on awareness of experience Auditory Tactile Visual (research based)

5. Installing The desired positive cognition Installation Checking the client’s belief in the positive cognition Past Present Future Contain

6. Body Scan Checking for full clearing Sometimes finding new information/feelings Emphasizing the experiental nature

7. Closure Safe/Calm Place Containment

8. Re-evaluation The next session Checking the SUDS and the VOC May find more information/feelings Sometimes find feeder memories

QUESTIONS? ???

What is the experience like for the client???

History Taking Can feel unearthing Can be moderately disruptive Therapist is to emphasize the data collection and not encourage the client to re-experience Experienced clinician decreases disruptions and increases hope

Preparation A period where the client learns better skills for coping Usually a period marked with self soothing (for some the first time) Empowered and/or recognizing strengths Sometimes frustrating

Assessment Agitating Intense emotions Awareness of physical sensations

Desensitization A myriad of sensations and emotions The goal is to keep the sensations moving and changing Therefore creating multiple shifts for the client Eventually ending in a lack of emotion and sensation around the target memory

Installation (and closure) The Fun Part! Usually marked by smiles and sometimes laughter The client often experiences empowerment, relief, and joy

Body Scan Usually very little to no discomfort Sometimes additional issues and “feeder memories” found here

Re-evaluation Usually very little to no discomfort Sometimes additional issues and “feeder memories” found here

QUESTIONS? ???

NLP Eye Movement Integration with a Vietnam Veteran Video of EMDR Session NLP Eye Movement Integration with a Vietnam Veteran http://www.youtube.com/watch?v=GnoqWqijYvQ

What different kinds of clients does EMDR work for Target Populations What different kinds of clients does EMDR work for

The EMDR Population Personality Disorders Panic Attacks Complicated Grief Dissociative Disorders Phobias Pain Disorders Eating Disorders Performance Anxiety Stress reduction Addictions Disturbing Memories Body Dysmorphic Disorders Post Traumatic Stress Disorder Sexual/Physical/Verbal Abuse

Special Populations Chronic Pain Conjoint Couples Therapy Children and Adolescents Sports and performance

Ascertaining Duration Single incident trauma Multiple incident trauma Big T and Small t Trauma Feeder Memories The importance of taking a thorough history

Considerations and when to beware Power of the technique Disruptive to Pregnant women Legal Involvement

Group Exercise

Practicing Resource Building Research indicates we learn to execute actions through doing more than we do through listening or seeing Some clinicians become tentative around using a technique due to a lack of experience Today’s exercise is an effort to become more comfortable enacting some of the resource building discussed thus far today

Practicing Resource Building Please take one of the handouts being passed around Then break up into groups of three Once settled choose one of the three exercises (one person acting as therapist, the other as client, and the final as observer) “Therapist” will walk the client through the exercise with the “client”, once finished move onto the next Therapist, client, observer Please take about five minutes per exercise and then at the end take another five minutes to discuss your experience (total 20 minutes)

Practicing Resource Building Take your time as there is no need to rush through Feel free to add to the exercise with processes you feel comfortable with Choose a the one you feel would be most challenging for you to approach with a client

Internal Family Systems  Internal Family Systems

The Anatomy of our “Selves” The child or exile The critic or manager The firefighter (this is when we get to see most people) The Self

The Internal Family Dynamics The effects “Parts” have on one another Common Dynamics Child/Critic cycle Firefighter Intervention Firefighter engaging the critic, hence the child

Common Early Communication Dynamics Self to child Anger Abandonment Lack of trust in the Self to maintain contact Relief and assurance Calming The importance of consistency

Common Early Communication Dynamics Self to Critic Resistance to stopping communication with the child Struggle for power Relief from the critic role Calm around a true leader

Fire Fighters Addictions Anger Behavioral Issues Eating Disorders Others???

Methods to Work with Clients Journaling Meditating In Session discussions Empty chair with internal parts Internal discussions Talking out loud

Intervention in Cases of Extreme Emotional Distress Panic attacks (child) Waves of depression (critic) Extreme Confusion (various) Rage (child)

Story of Debra and IFS Trauma History One year of therapy Daily Journaling Imprisonment

Story of Sherri and EMDR Home Invasion Panic with Agoraphobia Pre and post treatment

IFS Exercise Journal: If you were a child, how old would you be? Ask the child “what is your favorite thing to eat?” and let the child answer Ask the child “How do you feel right now?” let the child answer candidly Reassure the child if experiencing difficulty Ask the child “Would you like me to write with or talk with you more often?” Go from there!! What would you ask if you wanted to get to know any child