1 What happens after successful EMDR? Post Traumatic Growth becomes ‘Network Growth’ David Blore PhD student School of Health and Population Sciences College of Medical and Dental Sciences, University of Birmingham, England 10 th EMDR Europe Conference, Beurs van Berlage, Amsterdam 2009

2 Observation Because clients are discharged when ‘symptom free’, EMDR clinicians rarely get to see what actually happens in the weeks, months and even years following the installation of positive cognitions… …this is hardly surprising given the understandable objective of healthcare to reduce the suffering of negative symptomatology… but this has given rise to a ‘lop-sided’ view… recognised over 50 years ago…

3 Maslow’s criticism of the ‘negative only’ view of mental health: “The science of psychology has been far more successful on the negative than on the positive side. It has revealed to us much about man’s shortcomings, his illness, his sins, but little about his potentialities, his virtues, his achievable aspirations, or his full psychological height. It is as if psychology has voluntarily restricted itself to only half its rightful jurisdiction, and that, the darker, meaner half.” (Maslow 1954 p.354)

4 Research questions What is the lived experience of clients who have been in a traumatic experience, subsequently undergone a course of EMDR and experienced ‘positive’ outcomes? How did they get there? What can be learnt about the role of EMDR in that process?

5 Methodology Phenomenological investigation of Road Traffic Crash victims, who had reported ‘positive’ outcomes subsequent to receiving EMDR Snowball recruitment of participants via treating EMDR clinician resulted in n=12 interviews of “experiential experts” An Interpretative Phenomenological Analysis (IPA) framework for data analysis to facilitate the generation of hypotheses

6 6

7 Results 1589 Second hermeneutic ‘summary phrases’ Generating 19 ‘Sub themes’ Clustering into: –2 ‘Super-ordinate’ themes and –1 ‘Over-arching theme’

8 Collated findings grouped by super-ordinate theme 8

9 Why ‘Navigational Struggle’ ? Because the themes that make this category effectively describe the individual’s ‘battle’ to get from the traumatic event to some semblance of normality and the ‘route’ taken had to be ‘navigated’

10 Why ‘Network Growth’ ? Because channels of associations (networks) are expanding, or as Maslow would put it: “his potentialities, his virtues, his achievable aspirations and his full psychological height” are being achieved

11 ‘Figurative Language Use (FLU)’ “Metaphor depends largely on encyclopaedic knowledge” (Griffiths 2006) Encyclopaedic knowledge = myriads of networks The individual who has been traumatised finds their existing networks unable to cope with the reality of what has happened (see Solomon 2004) To comprehend what has happened, the individual generates new networks (about 20% of FLU related directly to the RTC/ driving/roads etc.…)

12 ‘Figurative Language Use (FLU)’ But isn’t that exactly what EMDR does… –Every time a traumatic memory is linked into an adaptive network? –Every time a cognitive interweave works? –Every time the client describes an insight? –Every time the client uses a metaphor so as to understand the traumatic event and its aftermath? Metaphor is a neural phenomenon… neurons that fire together wire together“ Metaphor is a neural phenomenon… neurons that fire together wire together ” (Lakoff & Johnson 1980)

13 Where to next? 8 Conceptual models of positive change (O’Leary et al 1998) were reviewed to see if they could describe the positive changes reported after EMDR – none fitted – most had helpful elements. A model is thus needed to adequately describe the lived experience of positive outcomes after EMDR for psychological trauma – preferably one that uses Adaptive Information Processing (AIP) as a foundation… The ‘Network Growth’ model ‘takes root’ here…

14 Figurative Language Use RTA The ‘Network Growth’ model to explain positive outcomes following EMDR (Blore 2009)

15 Conclusions and implications for EMDR practice considerably more EMDR treatment outcomes are considerably more than merely a reduction in negative symptomatology or resolution of diagnostic entities positive assets Assessment of positive assets should be included as routine in history-taking Secondary traumas Secondary traumas were frequently cited in the ‘navigational struggle’ after the road crash by those developing positive growth. 20% of metaphor use as per AIP model growth started within treatment 20% of metaphor use related to the trauma itself suggesting adaptive meaning- making as per AIP model and therefore growth started within treatment itself incremental at the end of the first cycle of the installation phase PCs could be usefully viewed as ‘incremental’ in nature to facilitate further reassessment of the PC at the end of the first cycle of the installation phase. Installation should continue until this process is exhausted. This may result in the need for an ‘incomplete session’ protocol for Phase 5. too restricting a label NetworkGrowth invisible visible ‘Post Traumatic Growth’ (PTG) is too restricting a label to fully describe the lived experienced of positive outcomes following EMDR…instead ‘Network Growth’ is proposed to describes the ‘invisible’ (i.e. adaptive network expansion occurring during EMDR) and ‘visible’ (akin to the ‘visibility’ of PTG thereafter) processes involved in EMDR positive outcomes

16 Thank you for listening Past presentations relating to this research: E: T: