Practicing Ahimsa in EMDR Therapy: Yoga Skills for EMDR Therapists by Anna Schott, MA, MSW, LISW-S, ERYT-200
“Violence is a reaction to fear - a key symptom of the dominance that egoism and ignorance have over mind. Violence is not defined by any destructive act but by the desire to see another harmed. That is why nonviolence includes refraining from harm in thought as well as deed...Perfecting nonviolence requires patience, courage, strength, faith, and deep understanding.”
- Inside the Yoga Sutras
“We spend our days badgered by voices that tell us to judge others, fear others, harm others, or harm ourselves. But we are not obligated to listen to those voices, or even to take responsibility for them. They may be where we come from, but they are not where we are going. There is another voice, a voice that shines. Ahimsa is the practice of listening to that voice of lightness, cultivating that voice, trusting that voice, acting upon that voice.”
- Rolf Gates, Meditations from the Mat
Practicing ahimsa, non-harming, is intrinsic to EMDR therapy and can be woven into the 8 phases of EMDR therapy as a tool to help clients re-regulate and treat themselves with loving kindness. Ahimsa is defined within the context of yoga as having respect for all living things and avoiding violence towards others and self. Ahimsa falls under the Yamas, or moral restraints, in the eight-limb path of yoga. Yoga includes not only the physical postures, but also mindfulness, mindful breathing, meditation, and a moral guide to use within the context of yoga and in life in general. The Yamas are part of this moral guide and are yoga’s self-regulating behaviors that teach us how to relate to others and take care of ourselves. Yoga, as a whole practice, aids in healing trauma and when used in conjunction with EMDR therapy, miraculous changes can occur.
Ahimsa does not just inform our work with clients but also how we take care of ourselves as therapists. In the clinical setting, we practice Ahimsa in the words and actions we use with our clients to create a trauma-sensitive setting. We also counteract the effects of our own countertransference, vicarious trauma, and burnout as we take a non-harming approach with ourselves. The whole framework and modality of EMDR therapy embodies Ahimsa as we help our clients heal from trauma and cultivate a peaceful therapeutic setting.
Practicing Ahimsa in phase 1 of EMDR therapy influences the process of history taking with our clients. As clinicians, we must be mindful of how we conduct a mental health assessment and talk to our clients about their past to avoid retraumatization through asking about unnecessary details in regards to their traumas. Because of the fragmented nature of how trauma memories are stored, clients may not be able to identify an accurate timeline, or when they do start recounting specific memories, the proverbial can of worms opens and clients become flooded with trauma memories. We can avoid this by slowly exploring clients’ histories and not worrying about getting the exact historical details. We must remember what matters in history taking is the client’s perspective of their experiences and how they’ve integrated these memories into their view of themselves. Because of the triggering nature of our clients’ pasts, we may need to wait to obtain a full history (and this may not ever come to full fruition) and allow the conversation to be client directed. Though there are certain nuggets of information necessary to obtain to form a diagnosis and identify a treatment plan, it is more important for the wellbeing of our clients to practice Ahimsa by not asking for too much information too fast.
As we move into phase 2 of EMDR therapy, we can work with our clients to identify resources they can utilize throughout the therapeutic process and which embodies a way to direct our clients to practice Ahimsa. This can start as early as the first session as we explore the resources clients already have in place and can utilize in therapy. Exploring resources in addition to history taking can help counteract possible retraumatization in phase 1. The main purpose of resourcing is to help clients tolerate processing the traumas identified during history taking. During this phase of treatment, we can teach our clients coping skills and resources that will help them stay in their window of tolerance without self injury in thought or deed. Through guided visualizations of the Light Stream, the Calm Safe Place, and the Container Exercise installed with BLS, we strengthen our clients’ internal resources to enhance Ahimsa. As a further way to practice Ahimsa, we can also offer to install other individualized positive resources with bilateral stimulation, such as positive experiences, relationships, and achievements.
In phases 3-6 in EMDR therapy, we help clients practice Ahimsa by identifying targets to process and then engaging in bilateral stimulation to desensitize the memories and reprocess the associated negative beliefs. These beliefs perpetuate internal self-injury in the messages clients tell themselves and external self-injury in the form of harmful coping mechanisms, drug and alcohol abuse, and even cutting. Flooding and abreactions can occur during processing with clients who are extremely traumatized, pushing them outside their window of tolerance. Though we want to keep pushing forward to help clients move through these memories, we must practice Ahimsa to help them stay within the space of being comfortably uncomfortable. This can occur by drawing upon their previously installed positive resources, utilizing different cognitive interweaves, and knowing when to slow the processing train down. It also involves an understanding of when to integrate modifications into phases 3-6, such as having a client open their eyes during processing, integrating grounding techniques in between sets, and utilizing the container when clients are flooded by memories. By desensitizing these target memories, our clients practice Ahimsa by living peacefully in the present instead of through the lens of past traumas.
Traditionally, in the practice of Ahimsa, we tend to think of non-harming in the physical sense. This is certainly a reality for many of our clients who engage in physical self-harm through cutting, drug and alcohol addiction, and eating disorders. However, self-harm can present as an internal self-injury through negative self-talk. As clients desensitize their traumatic memories, the associated negative cognitions reprocess, allowing for the integration of positive cognitions, which is then installed with bilateral stimulation. This allows clients to let go of negative cognitions that do not serve them and minimizes negative self-talk and coincidental internal self-injury. Through this, our clients are actively practicing Ahimsa by listening to their positive internal voice.
A further practice of physical non-harming occurs in the body scan phase in EMDR therapy. We ask our clients to scan their body and notice any disturbances while thinking about the target memory and positive cognition. Any residual disturbances they may report can be lingering somatic experiences of the traumatic memories, and reprocessing these can lead to further healing. Though this phase of EMDR therapy may seem extraneous, it allows for some of the deepest processing due to trauma memories being stored at a very base body level. It is often the very last fibrous roots of trauma memories that need to be weeded out. The body scan offers an in-depth way to heal physically from the traumas, leading to a continued state of peace and calm in which to continue practicing Ahimsa.
EMDR therapy is based on the three pronged model of addressing and reprocessing past, present, and future targets to help clients reach optimal functioning. Reprocessing past and present targets offers a way for clients to heal. Installing a future template lays the groundwork for an ongoing mindset of practicing Ahimsa. By visualizing positive ways to handle related situations, clients automatically create an internal positive environment to respond to new and different situations. This is also a way to carry their installed positive cognitions into future scenarios to which they will respond. This will help them to strengthen their practice of Ahimsa as they continue to install and strengthen their positive cognitions and strengths.
As EMDR therapists, we hear trauma all day long. Reprocessing these memories leads to so much healing for our clients but can take a toll on us as therapists through countertransference, vicarious trauma, and burnout. It is imperative as clinicians to practice Ahimsa ourselves. This may manifest as taking a mental health day, limiting the number of clients seen back to back, making sure to take a quick break in between sessions to eat, drink water, and to answer the call of nature. It should also include a rigorous self-care routine outside of work in which you engage in activities that ground and replenish you. In sessions, staying grounded and mindful while practicing Ahimsa will help you to stay present with your clients without absorbing all of the emotions and energies they are outputting as they process their own trauma. Having a self-practice of Ahimsa will enhance your abilities as a clinician and assist in staying engaged with your clients.
Practicing Ahimsa guides us in living in a peaceful way within ourselves and within the world. Not only does non-harming refer to refraining from physically and verbally hurting someone else, it also applies to how we treat and speak to ourselves. As EMDR clinicians, we are teaching our clients to practice non-harming through reprocessing their traumas in the 8 phases and installing positive cognitions that inform how they live their lives moving forward. Through Ahimsa we discover the light within ourselves that directs us in our lives.
To Write or Not to Write: Utilizing the Future Template to Manifest Our Dreams by Anna Schott, LISW-S
I know I’m not the only one grappling with transitioning from full time therapist to other professional pursuits, such as consultation, training, writing, etc. I’ve had plenty of conversations with friends and colleagues about this very topic and our woes are very similar: there are too many clients to see, too many family obligations to juggle, not enough time in the day, etc. I don’t have the answer, but I figured the more I share my intentions for this transition, the more likely it is to manifest (and please feel free to share any ideas you may have in the comments section below!).
I feel an internal drive to grow professionally by developing trainings and writing, but this conflicts with my present obligations. As I think of all the challenges I face in making this transition, the biggest one is the overall feeling of guilt. I have a full caseload of clients, and they need to see me. If I schedule time out of my workday, which I have tried to do with little success, I feel like I’m not doing enough for my clients by not seeing them as often as needed or not taking on new clients. About three months ago, I blocked off Fridays on my schedule to dedicate time to manifesting my goals; ask me how many Fridays I haven’t seen clients, and the answer would be not very many. If I try to set aside time at home in the evenings or weekends, I wrestle with the guilt of not doing enough for my kids and family. If I tell them to leave me alone for an hour...well, it’s just not feasible. I get one or both of the kids looking of my shoulder, asking me what I’m doing and am I done yet - that was my night last night. Again, it brings up the feelings of guilt and the belief “I’m not doing enough”.
We do have this amazing ability as EMDR therapists to process through blocks that keep us from realizing our greatest potential. We can come up with every excuse in the book not to take steps forward, but at the end of the day, we have to push out of our comfort zones and address the fact that we are scared our greatest fear will be realized and reinforce the negative beliefs of “I’m not good enough”, “I’m a failure”, “I’m not doing enough”, etc. By using the three-pronged model, we can identify and reprocess the origins of our negative beliefs, reprocess any current triggers, and install a future template to help us push through to achieve our goals. Installing a future template is often a part of EMDR therapy that is overlooked and minimized, but it can be extremely transformative. By being able to visualize an image of how you want to handle situations in the future, such as writing a book or conducting a training, with a positive cognition, such as “I am good enough” or “I am successful” can open us to manifesting these positive visualizations. It allows us to have a firm grasp on what we want in our future moving forward and gives us the momentum to take the first tentative steps.
This feels like one of those leap of faith moments, and I have to remember that I’ve been here before. I took a leap of faith when I went into private practice after working at a nonprofit with salary, benefits, vacation time, and a sense of stability. Though working at the agency was beneficial in many different ways, I outgrew it and knew I had to let go of that old familiar sense of safety to venture out to start my own holistic private practice. It’s the same driving feeling now as before - this is just something I have to do in order to be true to my authentic self. When I went through that transition before, I had to trust my instincts that this is the right move and remember that new opportunities won’t present themselves if I’m still holding on to old stuff. I have to take my own advice, let go of the old to embrace the new. This is my promise that I make to myself, to be intentional about my goals and not waver in the face the fear, and I hope you make this same promise to yourself. We counsel our clients to trust the process and learn to let go. Now it’s our turn.
Too Cautious or Not Cautious Enough: Thoughts on the Need for Dissociation Training for EMDR Therapists by Teresa Allen, MFT
Since dissociation is the essence of trauma, it’s not possible to treat trauma without understanding dissociation. As EMDR therapists, we need to understand it. In my view, there are two opposite issues with EMDR therapists and dissociation, and therefore with how to approach education about it.
Some of us find dissociation intimidating and see it as too risky to work with, to the point of being spooked when it emerges in training practicums or in a session. Some of us refer out immediately when we see it. I’m calling this the Too Cautious group, sending clients to another clinician at the first indication of dissociative process, and thus missing an opportunity to help people with all that we know about the Adaptive Information Processing model and EMDR.
While some may be too cautious with dissociation, others know too little about it and so are not cautious enough. This group is not always aware of the potential risks that come with inadequate history taking and preparation. I’m calling this group the Not Cautious Enough group. While I realize there are different views on this subject, my belief is that premature, unprepared processing of memories can result in destabilization and put a client in serious jeopardy resulting in the need for significant therapeutic repair.
Both the Too Cautious group and the Not Cautious Enough group--all of us--need more information about working with persons with dissociative symptoms. What’s needed is training that normalizes and demystifies the subject, while at the same time informing us about ways to recognize and effectively work with it, using Adaptive Information Processing principles and EMDR Therapy Standard Protocol modifications.
Dissociation training should include direction in learning about our own dissociative tendencies and ego states. Reflecting and learning about ourselves in this way can help to make this important subject less “other.” In this way, we can approach learning about dissociation with much less fear. It is after all, something our brains were built to do. One problem is the question of what exactly is dissociation.
One group of authors in treating complex trauma, describes dissociation as “a continuum of non-realization: not real, not true, not mine, not me.” Kathy Steele identifies four ways dissociation is defined in the literature.
Steele points out that alterations in awareness and consciousness are treated with mindfulness; shutting down is treated with physical reactivation; and depersonalization (the most challenging) can be treated with mindfulness. Dissociation of self is treated with mindfulness, reactivation, and system, or “parts,” work.
So, I’m proposing that, as EMDR therapists, we find ourselves sometimes too put off by dissociation and think we cannot work with clients who dissociate. Or, in the opposite direction, a lack of caution with dissociative clients can lead to significant risk, since memory work might be done without proper preparation and stabilization.
Training about dissociation is needed for both groups of us--and everyone in between. The question is how to deliver training in a way that normalizes dissociation as something we all do, and in a way that empowers clinicians to feel we are competent in assessing and treating more serious dissociation and its many attendant issues. With proper preparation and modifications, EMDR Therapy and the Adaptive Information Processing model are powerful tools for helping persons with dissociative symptoms to heal and lead healthy lives. With adequate attention paid to preparation techniques and Standard Protocol modifications, we as EMDR therapists can more effectively treat clients with complex trauma backgrounds and dissociative symptoms.
Gonzalez, Anabel and Dolores, Mosquera, EMDR and Dissociation: The Progressive Approach, First Edition (Revised), 2012.
Knipe, Jim, EMDR Toolbox: Theory and Treatment of Complex PTSD and Dissociation, Second Edition, 2019.
“Dissociation: Sharing From a Personal Place, An Interview with Jamie Marich,” in Go With That, EMDRIA Magazine, June, 2019, pp. 5-6.
Jamie Marich, “Session 424: Demystifying and Humanizing Dissociation in EMDR Therapy Practice” EMDRIA Conference, 2019.
Kathy Steele, Suzette Boon, Onno Van der Hart, Treating Trauma-Related Dissociation: a Practical, Integrative Approach. W.W. Norton & Company, 2017, p. 4.Kathy Steele, “Advanced Issues: Chronic Shame, Resistance, and Traumatic Memory,” Presentation at EMDRIA Kansas City Regional Network, March 1-2, 2019, Kansas City.
Kathy Steele, Webinar on Dissociation, May 25, 2019.
Mosquera, Dolores, Working with Voices and Dissociative Parts Disorders, Institute for the Treatment of Trauma and Personality Disorders, 2019.
“EMDR Adult, Complex Trauma & Dissociation Specialist Intensive Program
An Integrative Progressive Approach to Developmental Trauma: Working with Complex PTSD and Dissociative Disorders,” Dolores Mosquera and Kathy Steele, Agate Institute, Phoenix, July, 2019.
Over the years I’ve been met with, “Oh, you do qualitative research,” in a tone that suggests: That’s cute, but what does it really prove? The findings from qualitative research won’t really help to advance the scientific aspects of trauma therapy. The field and the people making the decisions about what constitutes evidence-based practice want the numbers, the empirical data. Especially when we promote approaches like EMDR therapy. We have to prove it works with science to the naysayers!
What if the important things just can’t be measured with numbers?
At heart, I am a phenomenologist and I believe that they can’t be. Phenomenology is more than just the study and observation of “phenomena,” as people often surmise. Edmund Husserl (1859-1938), the father of phenomenology, emphasized the importance of lived experience. He rejected the Galilean notion that the human experience could be quantified. When I first studied Husserl during my doctoral program, it seemed as though my whole existence had been validated. When I absorbed that specific teaching, an audible, “Yes! This!,” came out of my mouth during a late night reading session on the couch. My declaration was so loud, it woke up my partner at the time.
Having been raised by a math teacher mother and cheered on by her math teacher father, I was encouraged to study science and math with top priority when I was in school.
“That’s where all the jobs of the future are,” my mother reasoned.
I advanced to organic chemistry and calculus II in my undergraduate studies, forcing myself to get A’s. And yet I truly failed to see how any of it mattered in making me a better person. To be clear, I’m not one of those anti-science types. I recognize the massive importance of empirical inquiry and believe that quantitative thinkers are necessary in an enlightened world. Yet they do not hold all the pieces of the puzzle as the black-and-white ethic that keeps us stuck in the fearfulness of modern times would have us believe. Sometimes what they measure in numbers doesn’t reflect the reality of others’ lived experiences. Intoning the wisdom of a professor in my doctorate program, quantitative inquiry may be like the skeleton of a system, but qualitative offers the muscles, the blood supply, and the vital organs. We need the entire system in order to move forward.
I’ve always seen the world in themes, colors, emotions, and stories. Savoring and reinventing communication is my favorite art form. When I was in school trying to make people believe I was good at math and science, I excelled the most in social studies, English, and the performing arts. They seemed to make my miserable life brighter and worth living. Oddly, I managed to qualify for the International Science and Engineering Fair my junior year of high school. Even my teammates wondered how the content of my project was strong enough to make it through the Ohio selection process. Quite frankly, it was on the power of my presentation skills and connecting the dots of relevance of the science to modern consumers. Indeed, in the field of counseling studies, empirical inquiry is often described as being able to prove that something works, whereas qualitative inquiry shows us how something works. Even as a kid, that was my strong suit!
When I “came out” to my mother during college to tell her I was not going to go the pre-med track, but rather, had decided to study History and English/Pop Culture, I thought she was going to have a heart attack.
“But math… science… that’s where the future is at.”
I told her I was willing to take the risk.
The flow of life brought me to a career in clinical counseling and I became a doctor, although not the type she wanted me to be. I quickly became the kind of counselor who knew I could not be guided by research alone. Client preference, context, culture, and clinical judgment emerging from my own lived experiences (all components of evidenced based practice according to the American Psychological Association[i]) also guided me. Working to heal and to understand myself translated into my enhanced clinical efficacy, as shown by more favorable client outcomes. I took to qualitative phenomenological research like a duck to water. Especially as someone with a mind that has always felt like a mosaic, in it I found beautiful lenses through which to study the world and the people in it.
During the 2008 EMDR International Association (EMDRIA) conference, I won first prize in the research poster competition for my dissertation pilot study on the use of EMDR therapy in addiction continuing care. I was the only qualitative study in the competition, and both research committee chairs, almost through gritted teeth, told me that I was the first qualitative project to ever win the award.
“What can I say, the methodology was solid,” one of them said.
That is an important point to emphasize. Qualitative research is not about pulling concepts out of mid-air or fishing for the lived experience of others’ just to prove your point. There is a systematized way to analyze themes in order to draw conclusions. For instance, Amadeo Giorgi’s Descriptive Phenomenological Psychological Method is a simple yet effective process for reading data—people’s descriptions of their lived experience with the phenomenon being investigated—to extrapolate the common threads. Elisabeth Kübler-Ross used a similar style of research in her work. Brené Brown, who is single-handedly changing the world with her teachings of overcoming shame through vulnerability and courage, is a qualitative researcher known for using such methods. The rich lessons of humanity reveal themselves in themes and stories in a way numbers may never do them justice.
So, that dissertation research went on to get me two publications in major journals of the American Psychological Association, Psychology of Addictive Behaviors and The Journal of Humanistic Psychology. Yet these studies from 2010 and 2012 are rarely, if ever, cited in literature reviews on EMDR therapy. Indeed, one of my major criticisms with Dr. Shapiro’s final edition of EMDR Therapy: Principles, Protocols, and Procedures (2018) was that aside from mentioning a few case studies in passing, not a single, substantial qualitative study was cited. And a lovely collection of qualitative literature exists on EMDR therapy that goes beyond case studies, yet the community at large rarely seems to look at them. In our desperation to prove that EMDR works, we may be missing vital information on why it works and how it brings about transformation in the lives of people we serve. I venture to guess this experience is not unique to the field of EMDR therapy.
Indeed, in another area of psychology that interests me greatly, the study of dissociation, I observe similar problems. My lived experience with dissociation is truly lived experience. As followers of my work know, I’ve talked and written openly about my own struggles with dissociation. I gently tested the waters as early as 2011 and in 2018, I came out very fully and unapologetically. I challenged people interested in dissociation to look beyond the heavy textbooks and the numeric inventories like the Dissociative Experiences Scale (DES) and the clunky Multidimensional Inventory of Dissociation (MID) and into their own lived experiences as a treasure trove of inquiry. Being dissociative is a fundamentally protective mechanism of humanity that we’ve all experienced in one form or another. There is nothing fundamentally wrong with using quantitative measures and other people’s scholarly writing to help yourself and the people you work with better understand dissociation, especially if it helps the client. Yet if you are only using the quantitative and other people’s citations to advance your study, you are missing big parts of the picture.
At the 2019 EMDRIA Annual Conference, my identity as a qualitative thinker connected to the beautiful circle that began eleven years earlier as an eager doctoral student. I won EMDRIA’s Advocacy Award for my willingness to be out about my own struggles and use platforms like YouTube and blogging to translate the how and why of EMDR therapy to the masses. Two other happenings at the conference, however, helped me further connect to why I love being a qualitative phenomenologist so much. First, Dr. Derek Farrell, an English EMDR scholar and only EMDR trainer in the world to offer a master’s degree specific to EMDR therapy, endorsed the importance of qualitative research during his Sunday keynote address. He expressed that quantitative research is very top-down in its orientation, whereas qualitative research is bottom-up.
I squealed with the same enthusiasm that woke my partner up back when I first read Edmund Husserl. Finally, a member of the EMDR establishment was making such a bold pitch for the necessity of what thinkers like me can do. In trauma therapy, we generally teach that top-down interventions are very cerebral, whereas bottom up interventions primarily address the body, emotions, and visceral experiences. In sum, we need both top-down and bottom-up, yet what EMDR therapist have long identified as missing from traditional talk therapy is the bottom up. This bottom-up has also been missing from psychotherapy research or dismissed as not that important. That attitude must change if we are going to maintain the soul of our work while also pushing for empirical data. People are holistic beings, so why can’t science be total and integrative as well? Qualitative is artful yet it is not just art. Rather, it is art with power to illuminate the science and make it more relevant and applicable to the people it serves.
Later that day I went on to give a ninety minute talk on my own lived experience as a woman in recovery from a dissociative disorder and how that’s informed my work as a clinician. Every other time I heard a presentation on dissociation at the EMDRIA conference, while not doubting its content and relevance, I felt offended that people like me were being talked about in such cold and technical terms. Something vital has been missing that couldn’t be measured by any score on the DES or the MID, both of which can be very difficult and even impractical for people with dissociative minds to take. Not only that, they attempt to measure in numbers a phenomenon that is experienced in qualitative layers. During the Q & A period I fielded a criticism that my presentation did not rely enough on the citations of others and that perhaps I misunderstood the intent of someone whom I did cite. I answered that by framing this presentation as a true sharing of phenomenology, I wanted to shift the paradigm, or at least open up another portal of inquiry. Some people are not ready for that, which I expected. And yet for the people who are, you are in for a treat.
A few questions later another individual came up to the microphone and asked about a case he was working on where an emerging seven-year old part perplexed him. I asked him a few questions back about his own lived experience as a seven-year old and as the parent of a seven-year old. I wish that other members of the audience could have seen on the big screen just how much his face let up when he realized the answer was with him all along. And when he realized that, he knew exactly how to proceed with his case.
In response, I said, “No citation will teach you that.”
While citations and research, even qualitative research, is important, what life as a phenomenologist has taught me is that your own lived experience have more to teach you than you’ve ever imagined. Learning about the lived experiences of others, with an open mind and heart, and letting them communicate with your own will change the world. That is the future of which I want to play a colorful, thematic, multifaceted, holistic part.
So Mom, I love you, and I respectfully disagree with your career guidance. My present—and my future—is qualitative.
[i] American Psychological Association Presidential Task Force on Evidence-Based Practice, “Evidence-Based Practice in Psychology,” American Psychologist, 61, no. 4 (2005), 271-285.
Photo Credit: Paula Lavocat
One of the most common questions I receive from consultees is how to make EMDR therapy their main modality and transition into being an EMDR therapist. They see the ease and comfort I have in my own practice as an EMDR therapist as well as in the group practice I co-founded. They want to emulate this and are stuck, not knowing the steps to take. However, what they don’t see are the years of work, education, training, consultation, client sessions, blood, sweat, and tears that went into building my clinical practice into what it is today. Cultivating a culture of EMDR therapy in your individual work with clients as well as your clinical setting is possible by being mindful of the following considerations.
Jump right in. A challenge I hear from new EMDR therapists is how to get themselves on board with EMDR therapy. Especially after part 1 of the basic training, many clinicians are completely overwhelmed by all of the new information presented and have a difficult time shifting their clinical framework from the old way of doing things to this new, seemingly mystical clinical framework. My best advice is to not wait. Jump right into to it as soon as you leave the training. Come Monday morning, start phase 1 with your clients and look for targets you can process. Also, schedule consultation soon after part 1 to further discuss and consult on how to implement the 8 phase protocol with your current clients. Schedule part 2 within a few months of completing part 1 even if you haven’t completed many consultation hours or started really using EMDR therapy much within your practice. If you wait, you will lose momentum as well as get lost in the new information. Months may pass before you tiptoe into using any bilateral stimulation, even just for resourcing. It’s okay if you have to read from a script during the first 100 sessions or ask the steps out of order periodically. Your EMDR sessions will be messier than what was demonstrated in the trainings; just keep jumping into it over and over again. Practice makes perfect and your clients will forgive you or not even know the difference if you asked for the VOC before the SUDs.
Shift your focus from clinical tool to clinical modality. Since its conception, the view on EMDR therapy shifted from a tool to use within therapy to an all-encompassing treatment modality. By viewing it as such, the approach is altered from having specific EMDR sessions in which you wave your fingers in front of your clients to engaging in EMDR therapy from day one with a client even without bilateral stimulation. Working through the 8 phases of EMDR therapy and understanding the effects of traumas/adverse experiences, further integrates EMDR therapy as a clinical modality. There are many insights and breakthroughs that occur in identifying the origins of negative beliefs and their associated traumas/adverse experiences. Knowing the power of these insights takes the pressure off of rushing into phase 3-6 when a client is not fully prepared and resourced and further highlights the benefits that occur even outside of reprocessing sessions emphasizing a culture of EMDR therapy within your practice.
Have the motto “we can process that!” I constantly have my ears open to potential targets and am known to say, to a bit of chagrin of my clients, “we can process that!”. Not all traumas/adverse experiences are disclosed at the beginning of treatment. Sometimes they are slow to reveal themselves because a client isn’t ready or is just ignorant that these potential targets are affecting their current functioning. With all the advanced EMDR topic trainings targeting specific symptoms and issues, there is potential for an endless number of special protocols. However, you do not have to be specially trained if you have a strong understanding of the basic EMDR therapy protocol and are competent in working with the specific population. Though there may be special considerations with different populations, you can target and process anything that proves to be a trauma/adverse experience. Attend consultation sessions and EMDR networking groups to listen to other clinicians’ experiences in identifying shrouded targets. The more you practice your EMDR skills, the more you will hone your intuition about what constitutes a good target.
Identify yourself as an EMDR Therapist. It is a self-fulfilling prophecy; if you identify as one, you are one. Introduce yourself as an EMDR therapist, which will give you ample opportunity to discuss your treatment approach with potential clients and referral sources. As you become more established, clients will seek you out specifically for EMDR therapy further cultivating the culture of EMDR therapy within your practice. I regularly receive requests from potential clients looking specifically for EMDR therapy indicating a familiarity with this modality. Initially after being trained in EMDR therapy, however, I had to convince all my clients to try this new-fangled therapy. It was a shift from their conceptualization of traditional talk therapy to a culture of EMDR therapy in which we identified potential trauma targets and used bilateral stimulation to desensitize and reprocess these targets. Despite my immediate enthusiasm for EMDR therapy, not all of my clients were as convinced, and it took some time, effort, educating, and demonstrating to create a culture of EMDR therapy within my own practice.
Get the word out. The more publicity and discussions about EMDR therapy, the more mainstream it becomes as a treatment modality. We can cultivate a culture of EMDR therapy in our clinical settings by addressing the effects of traumas/adverse experiences on the brain and explaining the Adaptive Information Processing model. Share the EMDR love with your friends and family. Post information and articles about the effects of trauma/adverse experiences and EMDR therapy on your social media. Host informational sessions at your practice or place of employment and work EMDR therapy into any presentations you are giving as a mental health provider. Network with other EMDR therapists by joining EMDRIA and regional network groups. If you are at an agency, hosting an informational session as a brown bag lunch can help education your colleagues in EMDR therapy. Also, ask your clients to provide testimonials about their experiences with EMDR therapy to their other healthcare providers..
Cultivating a culture of EMDR therapy can be an arduous process. You will constantly have to explain, reinforce, and reframe people’s beliefs about EMDR as a whole therapy framework. By jumping right into the 8 phases and identifying yourself as an EMDR therapist though, you will quickly begin to shift your practice to an EMDR therapy framework. Looking for potential targets within the therapeutic setting and getting the word out about EMDR therapy whether it is within your personal circle or at your practice or agency further cultivates a culture of EMDR therapy within your individual clinical practice as well as within your practice or agency. It will be well worth the effort as you process your clients’ traumas/adverse experiences helping them to achieve a higher level of healing.
I was sitting in front of a client one afternoon as she talked to me about the rape she had experienced a few months ago. As the tears streamed down her face, I began to feel my hands shake, not that she could see, but enough that I definitely noticed. She continued in details of what happened and I remember floating to the top of the room. As she cried, I could only observe her and watch without feeling as I had left my body and floated above myself. I could see my clipboard, writing nothing, see the steaming coffee beside me, hear her sobs and comments; what I could not do was feel anything…until I came back inside myself. The session was concluding and I was able to offer some superficial comfort as I escorted her to the door. When I closed the door behind her, I could see the bathroom door as I opened it. I saw my best friend standing there with another male friend of ours as they had this coy look on their faces. I recall thinking I was in trouble but did not seem able to react until they began to pull me along, down the hall, and into the bedroom. Once I was thrown to the bed and my clothes were being torn off, I could feel the tears on my cheeks, just like my clients. I slowly started to float above this scene and watched in horror. When I noticed I was still in my office and I was staring at the door, I came back to the present awareness, went to my desk chair and wept. I knew it was time to reach out for help. I could not control these memories, these feelings any longer.
I reached out to a colleague who was an EMDR therapist. She agreed to see me to help with anxiety issues I was having from work. My agenda was to be able to trust her enough to share this secret and work through it, but I remember being terrified to talk about it. The longer I met with her, however, the more comfortable I became and it did not take too long before I was able to tell her about the experience. That was hard enough, but as I sat in her office, I wondered how I would ever be able to release all the pain of the rape. How do you even begin to talk about this? How do you let go of this? How can you possibly ever trust again? Be whole again? She was very patient with me and, as I could, I began to share what happened with her. I was able to ask some of the questions I had been thinking and she began to tell me what she thought would help.
She introduced to me a procedure known as EMDR therapy. She explained that EMDR works to help resolve traumas and she talked about what we would actually “do” while in sessions. She said I would watch a light bar, following the light with my eyes, and this would begin to let these emotions process in my brain. I thought it was weird and probably would not work, but desperate for healing, I agreed to try. We talked about some of the negative beliefs I had about myself as a result of the sexual assault and how it had altered the way I see myself. I would have flashbacks and nightmares often and we talked about these as well. We took things slowly, as I could not handle too much at a time. She knew that and while pushing me somewhat, she also respected the boundaries, the lines I could not yet cross.
During the sessions, I watched the light bar and also wore headphones, which sounded a rotating “beep” back and forth in unison with the light. With both these forms of bilateral stimulation being conducted, I would picture things in my mind, feel what was going on in my body, and notice what memories or thoughts would come. Often a lot of emotion came out, sometimes I was not sure about what. This was all part of the process. We would target in on a belief due to a situation and then would let me “process” that, meaning I would watch the light, listen to the beeps and notice what happened in my body and mind. It only took a few times to realize something was happening with this process. I was beginning to deal with my past.
We continued to use this therapy to help process other areas of my life as well. Some of the other situations involved other sexual traumas I had not recalled with this great a detail. Although I was having these memories surface, I felt safe knowing we were working through this together.
I cannot say I enjoyed the therapy and remember many times leaving her office emotionally drained; yet I knew I was healing slowly. I recall one of the scariest times of the processing was when she had me hold the picture I was seeing of the rape in my mind and watch the light to begin to process this. Immediately I began to feel anxious as I pictured the scene. Although there was fear, what I realized was I was having these feelings anyway, but it was different this time. I could begin to feel myself releasing some of the pain through this process. I could feel some of the anxiety go from inside my soul. I was tearful as I followed this light and at times would sob. What was important to me, however, was that these images were beginning to change. I was able to see the incidents and not float away; I could stay inside myself and feel what I had pushed down for the first time in years. I was allowing myself to heal. Through the pain of the trauma, I was being led down a safe avenue to process this with the care and safety of my therapist right there, guiding me. I did not have to be alone in these memories anymore.
Sharing the story of the rape was one of the hardest things I ever had to do. To let someone else in to see my pain, shame, embarrassment, anger, and vulnerability was like an ache I had never before felt. But as my therapist always said, in order for true healing to happen, someone has to witness your grief. Until we can share that pain with another person, we will never truly be free of it. This made all the sense in the world to me as I had carried that grief around for years. Being free of it used to just be an unobtainable thought, but now through EMDR therapy, I could see real hope.
As I mentioned previously, I also began to recall with more memories and details a few other incidents that occurred in my childhood. Had I not been doing the bilateral stimulation that EMDR utilizes, I do not think I would have been able to recall some of the specifics that made all the pieces come together. I was able to remember what happened to me in that day care, in that school office and in that neighbor’s home. I was also able to share these experiences with my therapist and we worked through these as well. When I say working through it, it does not mean just forgetting and moving on. With EMDR, I was able to feel the emotions I had pushed down in regards to these events and begin to let the emotions go. It was as if all the years of pain came up and passed through me again. However, in order to be able to truly integrate this as part of me, this had to occur. I never knew what “processing it” meant until I discovered the EMDR journey. It was like a life saver to me. I was able to be free of the pain, not just pushing it away. I could recall the memories, but allow them to stay in the past where they belonged. I did not have to let them hurt me anymore in my present life. I could be free.
Not So Much of a Rebel: Making Peace with the Standard EMDR Protocol by Jamie Marich, Ph.D., LPCC-S, LICDC-CS, REAT, RYT-200
When EMDR clinicians learn that one of my specialties is addiction, I usually get asked, “Which protocol do you use? FSAP? DeTUR?”
I’m often met with surprised looks when I respond, “I use the standard protocol mixed with good common sense about how addiction works, which informs my preparation approach. I don’t find any of the specialty protocols particularly useful.”
I realize you may be gasping right now since, in EMDR circles, lots of buzz can be heard about the specialty protocols and methods that EMDR practitioners are developing. I participate in several Facebook EMDR groups and almost every day I read a question to the tune of, “What protocol do you use for addiction?,” “What about dissociation?,” or, “Is there a specialty protocol for condition x, y, z?”
So many times I have bluntly responded, “Um, the standard protocol mixed with clinical judgment about preparation needs and how to use appropriate interweaves.”
One of the reasons I decided to write this piece is so that I can cogently share my position as an EMDR therapy trainer, author, long-time clinician, and notorious EMDR therapy rebel. What’s funny is that when I wrote EMDR Made Simple in 2011 I called out many problems that I saw with party line EMDR. Yet as I’ve matured as a person, a clinician, and a trainer, I’ve realized that maybe I’m not so much of a rebel after all. For me, the standard protocol really is where it’s at. Learn the standard protocol well within the context of the client’s goals for treatment and know where to point the targeting sequences, and you really have all you need to do successful EMDR with a wide variety of presentations. The adaptive information processing model will guide you, as will the larger breadth and depth of what we as trauma-focused clinicians are learning about the importance of embodied, somatically-informed affect regulation skills.
In this piece I further explore my position by explaining my approach as a trainer to client context and adequate preparation. Then I explore my thematic perspective on client history, which allows me to direct the standard protocol in the direction it needs to go in order to work with a particular client presentation. Finally, I look at where interweaves and modifications may be appropriate depending on the complexity of the case involved. Since addiction and dissociation are my two main specialties in EMDR therapy (and the two main conditions for which I have been personally treated), I will draw on several case conceptualization strategies for these special populations.
One of the first pieces of wisdom I internalized from reading Dr. Shapiro’s early works is not to do EMDR with a client you wouldn’t normally feel comfortable treating anyway. In my interpretation, this means that the task falls on us as clinicians to learn more about a particular condition that may be stumping us as a general best practice. One of my biggest concerns with the rising popularity of addiction protocols is that well-intentioned EMDR clinicians who know little about addiction are simply pulling out the protocols and hoping for the best. When this happens absent the larger knowledge about the various models of addiction, the interplay between trauma and addiction, and the impact of the stages of change, inadequate care can be delivered. In one of her first books Shapiro wrote that “addiction should not be treated in a vacuum,” (Shapiro & Forrest, 1997) yet I fear this is what happens when EMDR therapists just pull out one of the specialty protocols without educating themselves more on the intricacies of addiction first. The same applies for dissociation and dissociative disorders, or any other specialty presentations that may puzzle you—start by reading up or furthering your continuing education on the generalities of that population and their needs.
Adequate preparation in EMDR therapy involves much more than just doing one Calm Safe Place exercise. Although I train the skill in my program, I discuss its limitations, and it’s one of only many strategies that I teach. While the classic skills of Calm Safe Place (which often involves changing up the descriptive adjectives to meet the client’s needs), Light Stream and Container are still very useful, they can all be very visually biased if not modified. Furthermore, to truly help a client manage affect, tolerate distress and be prepared for what may arise during trauma reprocessing (Phases 3-6), we must explore other skills.
In our program, we teach a wide variety of mindfulness strategies in a trauma-focused way (i.e., allow for modifications, emphasize not just reading the skills out of the book, rather, having a personal practice yourself as a clinician and teach from that experience). Mindfulness strategies can include traditional sitting meditation, moving meditations, mindful exploration of the expressive arts, and learning how to turn all activities of daily living into chances to practice present-moment awareness. Teaching a client breathing strategies and body scanning skills in a trauma-focused way is also imperative. Existing skills or approaches that you utilize in other modalities like dialectical behavior therapy, 12-step facilitation, or yoga can all be very helpful in teaching principles of lifestyle change and grounding. In the spirit of true trauma-focused care, the needs will vary from client-to-client depending on their existing experience with such skills and the intricacies of their presentation. I’ve learned that the more complex the client, attending to preparation in this total matter is more helpful than any specialty protocol just slapped into the treatment process. You can visit a comprehensive library of these skills and watch how I use trauma-focused language in apply them by visiting the resource site Trauma Made Simple by clicking HERE.
And no, I cannot give you a script about how many of these skills you’ll need and in what dosage. That is where clinical judgment and having done your own personal work comes in to make you as effective as possible. Personal work with these skills is important so that you know what it means to modify and adapt skills for your optimal benefit, which puts you in a better position to do this with clients. While scripts can help us build our skills, a practice that most adult learners need and that I endorse, scripts can rarely help you apply them in the absence of practice and context. To intone the wisdom of Jennifer Emch, one of my program graduates and director of Ubuntu Wellness in Chardon, OH, “Life isn’t scripted and neither are people.”
In addition to understanding the imperative of trauma-focused and enhanced preparation in EMDR therapy, we must also consider as EMDR therapists that taking a chronological history is not the best way to go. Although I agree with Shapiro’s essential position that targeting the earliest memories first is ideal for getting to the root of any given problem, due to the nature of how complex traumatic memories are stored in the limbic brain, taking a chronological client history may be impossible. Or at very least, impractical. Most clients I’ve worked with over the years cannot track a chronology, have blanked out significant pieces of time, or get very tangential when we try to take a conventional history due to the disorganization in the limbic system. When I was trained many years ago I learned the 10 best memories and 10 worst memories method for taking client history, and I’ve also found this ineffective. The most effective approach to holistic client history taking I’ve found over the years, and the approach I teach in my program, is to discover potential targets thematically. Let’s use an addiction-specific example.
For many clients new to a recovery process, there is a willingness to do EMDR therapy reprocessing and yet there may be insufficient affect tolerance to go to the earliest instances of abuse or trauma. For optimizing engagement, you may be better suited to work with their goals for recovery first, while respecting the trauma history that led to the problem in the first place. Many individuals struggling to get better, regardless of their specific goals, carry a negative belief like, “I cannot deal with my feelings without alcohol (or other drugs/behaviors). That is a negative belief that can be “floated back” using questions like, “Thinking back over the course of your whole life, when is the first time you got the message that I cannot deal with my feelings without alcohol.” You can also ask the question for the worst or most recent. What you get from the client all represent potential areas that you can target. Might these targeting sequences link in to earlier, more impacting traumatic experiences? Of course. Yet targeting them this manner is, in my experience, a kinder, gentler way to go and helps them to see the relevant connection of the EMDR work to what may be their biggest issue of concern in therapy. To see some examples of how I conduct client history in a thematic way, please visit the video demonstrations section of the Institute for Creative Mindfulness website by clicking HERE.
One of the wisest pieces of direction I received in my rather traditional basic training many years ago is that the greater the degree of complexity in the case, the more level of interweave you will need. I feel that learning the principles of cognitive interweaves (as described by Shapiro in her texts and further elucidated by other great minds in the EMDR community) is essential to doing EMDR with addiction, dissociation, and other special situations that may throw you for a loop. Yes, the classic directive in EMDR therapy is to stay out of the way as much as possible. Yet I was delighted to see Shapiro (2018) use the phrase proactive measures so much in the third edition of her text. To me, solid interweaves work as a plunger of sorts. When the flow of reprocessing is clogged, we can apply good open-ended questions, gentle pieces of encouragement or psychoeducation, and mindful or somatic techniques to get the flow going again. Although I teach a list of common interweaves in my program and Shapiro offers some solid examples of them in her text, the best interweaves are the ones that you develop through constant practice of EMDR and working with consultation to hone your craft.
Sometimes we can get nervous talking to consultants or other EMDR therapists about modifications, fearing that we’ll get “called out” on deviating from protocol. Yet consider how all of these specialty protocols that we can get so excited about in the scripted books or special trainings are really just twists and turns on the standard protocol anyway. They are proactive measures. One final modification tip that I can offer from my clinical experience on working with complex issues like addiction and dissociation related to the part of the standard protocol where we are asked to get an image (or worst part) from the client. I’ve always liked the language of worst part because it recognizes that some memories, especially pre-verbal ones, may not be stored with an image. With folks who may not have sufficient affect tolerance to handle going to the “worst part,” yet who have done all they can with preparation skills, you may be better suited to ask, “What part of this target memory are you willing to work on today?” Then proceed with the standard protocol from there. This may make reprocessing more digestible for the client in the spirit of EMDR therapy Phase 2.5. Yes, you will likely have to go back later and check to see if there is an image or worst part in a separate targeting sequence in order to achieve completion of the target in a technical sense. Yet consider how this modification may be more tolerable for individuals.
If you are the type of adult learner who needs more of a scripted protocol to learn new information, that is more than okay. I know that as a trainer I could not survive without using scripts with my students. And yet there comes a point in your development as an EMDR clinician when you must realize that the scripts are just modifications. These specialty protocols we can all get excited about are just very necessary modifications. No, modification is not a dirty word as long as you are able to clinically justify why you are making the modification or, in the case of Phase 2 preparation, enhancements. Doing this well and in the most trauma-focused manner will eventually involve you moving away from scripts and other peoples’ protocols and working to hone your own clinical common sense.
Shapiro, F., & Forrest, M. (1997). EMDR: The breakthrough “eye movement” therapy for overcoming stress, anxiety, and trauma. New York: Basic Books.
Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing therapy: Basic principles, protocols, and procedures, 3rd ed. New York: The Guilford Press.
In her recent work, Process Not Perfection, Dr. Jamie Marich described the “call and response” technique in several different modalities. So, this article is in response to the call of her article “The Popular Kid Complex.”
“I am not enough” has been an ongoing target for me in EMDR. You name it, I never felt like enough. Whether it was sports, music, friendships, I was good, but I was always 2nd. I can’t think of a time I was “the best.” And yes, everything has been a competition to me. I did not know how to play as a child, only compete. As a child I felt like I had friends as long as others were not around, but if others were around, I quickly felt invisible. I thought these feelings would go away as an adult. But, the popular kid complex lives on in all its glory, constantly wondering when someone is going to realize I am “not enough” to be in my field or doing anything else and shame me for even trying.
While completing step 9 in my 12 step program, I received a glimpse of a new idea. Maybe, just maybe, we all have quirks, fears, and our own damage and we are all doing the best we can. Being equals was a new concept. For example, I always thought I had to have the gift of speech or I was not smart enough because I compared myself to my brothers. I then realized I don’t want to be a speaker like my brother and that speaking is not my forte. I prefer the one-on-one contact with others and maybe this is my gift and my Higher Power’s will.
Jamie writes, “My meat suit and all its programming can get the best of me. In the language of recovery, I can still get in my own way.” I once heard a stat in recovery that every alcoholic (or addict) directly affects 54 people as a result of their addiction. As I read Jamie’s article I thought of this stat and my math brain took off. Yes, maybe Brene Brown quoting “The Man in the Arena” encouraged me to further my training, but Jamie have you thought of your stats? In my EMDR training there were 25 clinicians that work in community mental health. We average 150 clients on our caseloads. If we all average that number, 3,750 clients have been introduced to EMDR from that 1 training. You hold how many trainings a year? Then you have a large team doing their own trainings in either EMDR or Dancing Mindfulness. At this rate I estimate Institute of Creative Mindfulness will affect 500,000 clients just this year. This does not count book sales and advanced trainings. Who is the popular kid?
This breakdown can be done by all of us with our own stats when we are feeling like we are “not enough.” For me these numbers did not save my sanity or alter my clinical practice, but the examples my Higher Power has put in my path. We never know who is watching our example. Jamie speaking her truth, Rachel extending the invitation to come to retreat, Jennifer helping me to not take myself so seriously, and Mary always offering a positive word of encouragement. Watching Rhonda and her husband dance like the world disappeared also influenced my desire to let go. Peyton, Lexi, and Michelle dancing, painting, and confidence in their convictions and Adam continuing my training in EMDR. Yes, we are all the “popular kid” to someone and yes we are healers. Anyone that is “in the arena” inspires a “unique expression of Divine flow.”
Feelings are not facts. When those times arise that we feel what we do is not making a difference or we are “not enough”, maybe we would benefit by stepping back and looking at the big picture and thank those that have touched our own journeys. Maybe I should take my own advice.
Parental Leave and Parenthood in Private Practice: 20 Ways to be Trauma-Informed by Suzanne Rutti, LISW-S
I have had a lot of people reaching out to me lately for some advice and insight on balancing private practice work with parenthood, and more specifically, how to handle parental leave. In the spirit of developing an open dialogue, I have decided to share my experience in the hope that it may be helpful to others. For some background, I am an EMDRIA Approved Consultant and Certified Therapist, focused primarily on trauma therapy. I have been in the field of social work for almost twenty years and started my EMDR therapy journey in 2008. I am a faculty member with The Institute for Creative Mindfulness, and own a small private practice in Columbus, Ohio where I work with clients of all ages who have experienced some form of trauma or adverse life experiences. I live with my husband, dog, and beautiful one-year-old daughter.
There are days I feel like I am really succeeding as both a business owner and a mother. There are other days it seems I am frantically trying to juggle all the pieces of my life, without feeling confident that I am successfully managing any of them. This has just become part of my personal journey. Self-care and balance are hard enough concepts when we are solely dealing with being mental health providers in the field. Add to that a relationship with a partner, and the responsibility of caring for a child, and it’s easy to see how self-care can be pushed to the back burner. As we preach to our clients though: if we are not taking care of ourselves, we will not be able to care for others. So here I am, putting on my oxygen mask first and finding ways to balance my sanity, in order to have time and energy to devote to my family and my work.
I’ll start off with some of the things to think about as you prepare for taking some leave from work. Whether you are giving birth, adopting, or your partner is having a baby, there will be a period that you will need to be home with your family.
Things to consider before your leave:
1. Think about how and when to tell clients about your baby: The timing of this is completely your choice. Some people start telling everyone they know as soon as they get a positive pregnancy test. Others wait until they are as far along as possible to minimize the risk of having to disclose a lost pregnancy. Just be sure to think through all of the options before going to one extreme or the other. If you are pregnant, you cannot assume that your clients won’t notice a growing bump or other symptoms. This is particularly important when working with trauma survivors; many trauma clients pick up on any small changes. Their brains have been programmed to attune to others as a form of protection and defense. So, if you are experiencing extreme fatigue, nausea or other symptoms, you may want to let clients know what is going on so that they don’t form any of their own conclusions.
2. Consider that your situation may be triggering for clients: While you may be bursting at the seams with your exciting news, please keep in mind the impact this could have on your clients. Some of your clients will be overjoyed for you. Some clients will immediately start to panic in anticipation of your absence, or even the possibility that you won’t be returning to work at all. For others, they may have dealt with infertility, had an unplanned pregnancy, had a miscarriage, lost a child, or have a history of terminated pregnancy. Think about each of your clients carefully and consider how you will deliver your news.
3. Decide when to stop taking new clients: You will need to decide on a reasonable date to ethically stop taking new clients on your caseload knowing that you have an upcoming period of leave. This time frame should depend on the nature of your populations and scope of practice. If you have started telling existing clients on your caseload, then you also need to inform potential new clients before they start investing time into coming to see you. You will also need to consider the type of work that you are doing with clients as you approach your baby’s arrival date. Be sure to allow ample time to work with your clients on planning their transition. With some clients, it is not responsible to continue to do trauma processing up until your last day, because of the possibility of destabilization and your inability to be available to support that client. You also need to consider the possibility that your leave will begin sooner than anticipated.
4. Have a plan for coverage while you are on leave: What you do with your cases while you are off is something that you will need to decide with some input from your clients. Some of your clients will be able to manage a period without attending counseling. There are some clients that you may think would be able to manage without counseling but will elect to see someone anyway, and vice versa. Finally, some clients may be required to see a counselor during your leave due to safety reasons. If you work in a group practice or with colleagues, reach out and see who would be willing to cover your cases while you are on leave. If you work alone and don’t have many colleagues, reach out in some networking groups to see if anyone is available, or do some of your own research and find some referral sources for your clients. You can link clients with specific clinicians, or you may provide a list of a few therapists that are available and willing to see them while you are off and leave it up to them to make the contact.
5. Clean up your caseload: I do not recommend leaving any cases open on your caseload while you are on leave. Complete a discharge summary for each client that outlines your recommendations while you are on leave. You can always re-open cases when you return to work. However, this will relieve you of any liability while you are off as well as compensate for any potential delays returning to work or issues that could prevent you from returning to work. I also recommend creating a form letter that lets clients know that you will be going on leave with general recommendations. Provide a copy to your clients and keep one in their file. This can prevent any claims later that you did not provide ample notice or planning.
6. Plan how long you intent to be off: Think about how long you plan to be off and begin financial planning as soon as possible. If you are in private practice, you may be an independent contractor and not have access to paid time off. If you plan far enough in advance, there are some short-term disability insurance plans that may fit your needs. You will need to start paying into the plans before you or your partner are pregnant. Remember that babies are not always on the same timeline as we are, so consider a window of time that allows for the baby to come earlier or a little later than expected, and consider how you will handle any situations that may require extra time off. Consider alternative strategies for income to make up for your time off. If professional development or consultation are within your scope of practice, consider scheduling some trainings before and/or after your leave to bring in some additional income. Think about hiring someone part-time to supplement your time off (and as an added bonus they can start off by covering some of your cases while they build their own caseload). In my experience, trainings allowed me to supplement my maternity leave and enabled me to come back to work seeing clients part-time. I invest about one weekend a month to training, but it allows me to spend more days at home with my daughter overall. Consultation groups for EMDR therapists have also allowed me to make income in a shorter block of time than seeing a full day of clients. Balancing a schedule of trauma therapy with consultation and training also facilitates self-care and secondary trauma prevention.
7. Identify how you will communicate the start of your leave: Figure out a plan for how you will communicate that your leave has started. You may want to pick a date a few days before your baby’s due date as your last day to see clients. You do not want to be thinking about calling to cancel clients while you or your partner are in labor or arranging plans for the immediate arrival of your child. If you need to work until your baby comes, create a new voicemail each day that states whether or not you are in the office. Let your clients know to call the voicemail before heading in for their appointments. When you start your leave, be sure to change your voicemail and email responses to communicate that your leave has begun, as well as the steps clients should take if they have a clinical need.
8. Have a backup plan: As mentioned earlier, babies do not always follow the plans we have set in our heads. Some people also fully intend to come back to work but things change while they are home snuggling their new squishy babies. Be sure you have a strategy for communication of any changes to your schedule to clients that are hoping and planning on coming back to see you when your leave is over.
9. Identify how you will communicate your return: Just like the form letter that you sent to clients to notify them of your upcoming leave, you will want a plan for how to announce that you have returned to the office. If you have a social media account for your business, you could direct clients to check there and make a post when you have a return date. You could also send a general announcement to your former client load.
10. Establish a plan for working during your leave: If you plan to do work while you are on leave, I would encourage you to think about how crucial that is. In my case, I was running a small practice without an office manager, so I didn’t have a choice but to continue to do billing and payroll. Decide whether any of your tasks can be delegated, and if not, identify specific times in your week to allot to doing work. You only get parental leave one time with your baby and you want to make the most of it.
Things to consider with your transition back to work:
11. Don’t plan on continuing to work as effectively at home as you do in the office: I thought I would be able to get a lot more work done from home. As I look back, the time period I probably could have gotten the most work done was the first several weeks of leave when my daughter was mostly sleeping. However, that was the time I soaked up the most and really bonded with my new baby. Once they start becoming interactive and eventually mobile, you will need to be more deliberate in delegating a time and space for working in the home. Fortunately, I have an amazing partner and a lot of family and friends that jump at the chance for some baby time.
12. Ease back into your schedule: Some of you will be itching to get back to work by the time your leave is done, and some of you will be dreading it. Either way, make sure you plan for a transition back to work. Not only will you be making the adjustment back to seeing clients and using your brain in a new way again, you will also be adjusting to a new schedule and being away from your baby. This doesn’t have to mean a very gradual transition, but I don’t recommend planning to see a full day of clients your first day back.
13. Expect to be sleep-deprived: Sleep deprivation is a real thing. I know people joked to me about it all the time, but it is the real deal. I have not slept through the night in almost two years, counting the sleepless nights that started while I was expecting. I don’t have any good advice here, but I wanted to normalize and validate this for all of you. You are going to be tired. There are going to be days you have a full day of intense clients and your child is also teething, has a fever, or just didn’t sleep the night before. Take care of yourself. And coffee. Sweet, sweet coffee.
14. Prepare for a range of emotions: As I mentioned earlier, you are going to experience a lot of emotions as you return to work. Whatever those emotions are, notice and pay attention to them. Take care of yourself and your needs. If you feel you need extra support and you don’t already have a good therapist, find one! EMDR therapy can work wonders for postpartum depression and anxiety. There are also some great groups on social media if you are looking for some camaraderie with other working parents, such as “Moms in Private Practice (Mental Health).”
15. Think about countertransference: As trauma therapists, you may find that you experience some new countertransference now that you are a parent. As a clinician, I validate to my clients that as their own children reach certain developmental stages, they may find themselves newly triggered by their past experiences at those ages. The same can happen as clinicians. Hearing about trauma and adverse life experiences your clients experienced as children may feel different to you now that you have your own child. Just be aware of what you are experiencing, and find someone that you trust and that you can process these feelings with: a coworker, supervisor, consultant or even your own therapist.
16. Establish a self-care plan: Establish a self-care plan, and don’t minimize it. As a new parent, I have to schedule time that is set aside for myself. I make an extra effort to go to bed at a certain time, drink water, and eat healthy meals. I also schedule purposeful social interaction with other adults. Identify self-care strategies that are small and some that take more time, and figure out how these can fit into your routine. If we just assume that it will get done, it won’t. You need to be purposeful about this. I have found bullet journaling to be especially effective for tracking my daily, weekly, and monthly goals.
17. Prepare for pumping needs: If you will be breastfeeding, you will need to think about your pumping needs. Be sure to schedule time for pumping. Because of the nature of our work, most of us already have a private office, but if not, find out how to establish a private space for pumping. Kellymom has some great articles for support with pumping at work.
18. Re-examine your boundaries: The biggest change for me since going back to work as a mother has been my boundaries with my schedule. If you ask any of my colleagues, they will be the first to tell you I used to work a ridiculous schedule. I was known to see nine or ten clients in a day and work sixty hours a week. As a new mom and recovering workaholic, I am now forced to say “no” to appointments that are outside of my scheduled week. Primarily because I would need to arrange additional childcare, but also because it intrudes on my time with my family. I learned the hard way that coming home right at my daughter’s bedtime to put her to bed didn’t go as smoothly as I planned. I also know that I cannot allot exactly enough time to drive to pick up my daughter from my last scheduled session. Sometimes sessions run over, or I need to make a client phone call at the end of the day.
19. Let the guilt go: The first day I went back to work, I definitely cried more than my daughter did. Looking back now, I’m actually not sure how much she noticed me walking out the door. At the time, my guilt was at an all-time high, and I had an unrealistic impression of how much my work would affect her. In reality, she has been able to spend much more time bonding with family members and caregivers and finding ways to develop. I had to let go of the grief around not getting to see every single thing she did, said, and discovered. Instead, I make an effort to be fully present when I am with her. There are going to be things that I don’t get to see, but I try to make up for it by mindfully experiencing the events I am there for.
20. Find a new balance: I have to be more purposeful about when I check work email and when I do work from home. I want to be fully present at work and fully present with my family. I am definitely not always perfect, but I don’t feel good about my role as a mother when I am trying to do work while simultaneously feeding my daughter lunch, nor do I feel like a great clinician when I am responding to an email while trying to sing Old MacDonald.
I hope that this article has been a useful resource for considering your parental leave, and I hope to hear from many of you with more helpful additions to this conversation. I have to make a conscious effort every day to try to practice the kind of self-care and balance that I encourage for my clients. It is my hope that by sharing my experience some of you may be inspired to begin planning for balance in your new journey.
Suzi Rutti, LISW-S
Rutti Counseling & Consultation, LLC
When I first started to use EMDR with my clients, particularly with more complex cases, there seemed to be more that needed to get done before trauma processing. There needed to be more resourcing but also something that is able to touch a deeper trauma that is inside of our clients. Shame is usually the culprit.
Mason (2013) stated that, “shame safeguards the spirit.” When shame is our reality, we don’t feel good about ourselves. Shame is generally learned from experiences in our most vulnerable developmental years. However, since memories can be moved/restored through the process of memory reconsolidation (Ecker, Ticic, & Hulley, 2012), our reality is subjective to the meaning we give it. This teaching may question our foundation of what composes our reality. Even more to the point, it calls into question the very essence of who we are.
In the Institute for Creative Mindfulness EMDR therapy training, we explore the client’s trauma targets using a thematic approach. Addressing traumas in a thematic way allows the client to address what they believe and how they feel about themselves in order to rewrite, renew, or own their story. Because of this, anything can be targeted with EMDR, if it holds adaptive or maladaptive value and the client can emotionally access it. However, what about the experiences that are there but not recognized consciously or that started before narrative or declarative memory developed in the brain?
Let me first acknowledge the difference between what I am presenting and Paulsen and O’Shea’s (2017) “When There Are No Words” protocol. Paulsen and O’Shea’s stance is that their protocol “reset the hardwired neuro-affect circuits” and this is done in Phase 2 Preparation. What I am presenting here is an option for clinicians who are not trained to do “When There Are No Words” (or are having difficulty following the nuances of protocol they downloaded off the web). Paulsen and O’Shea’s protocol can be helpful for clients; however, I also believe that accessing implicit memories through what I am suggesting holds additional value on two levels. One, it is a good and safer place to get “buy-in” from a client, and two, if it does not go as we would hope, it can be “diagnostic.” I want to gain access to my client’s earliest wounds. What I am proposing is more of a “Phase 2.5” intervention that links Phase 2 and the reprocessing Phases 3-6 (Marich, 2019). This intervention allows clinicians to address our client's preverbal schemas with any and all thematically shame-based core belief clusters because this is actually where the cluster begins.
Shape and Color Set-up: While taking clients trauma history (Phase 1) and assessing core beliefs (Phase 3), I am looking to put their core beliefs in two categories: shame-based (i.e., I am bad, I am worthless) and fear-based (i.e., I am in danger, I am powerless) core beliefs. Before floating back on a core belief I will ask, “Do any of these shame-based beliefs just feel like they have always been there?” (I will either ask this during Phase 1, Client History or Phase 3 Assessment.) Nine times out of ten, clients will identify a shame-based negative cognition. If the clients pick a fear-based cognition like “I am in danger,” I stay away from it because it is most likely linked directly to an event that can be directly recalled and I am not trying to have them start reprocessing a direct memory. If this happens, I will guide them towards a shame-based core belief.
After resourcing in Preparation (Phase 2), assessing targets (Phase 3), and establishing some kind of stop signal, I then have the client create a target of the core belief felt-sense by asking, “What shape and color would represent this ‘has always been there’ belief?” Once the client has the image (and negative cognition) then it is standard protocol time (i.e., Phases 4-7 and Phase 8 in the next session). Future template can be done but I feel that because I am priming the pump and that there are declarative memories still to go, I wait until I see how the client responses to the process and do future templates with memories that are able to be recalled.
Rationale: I am trying to see what is going on under the hood and also preparing their memory system for reprocessing shifts. My reference to the shape and color or image comes from Mark Grant’s work on pain management (1995). Paulsen and O’Shea also use this strategy; they do not, however, want you to activate the client. My position is that if we are addressing the client’s schema, that they are feeling all the time, they are already activated. Again, I suggest doing this on shame-based themes and not fear-based ones because I believe it is safer and the client is less likely to activate actual memories. However, activating shame-based memories does happen. In this case, I will guide them back to target or go back to resourcing. If the client has too much shame then the standard practices of creating some distance between the client and image, having the client pendulate, or taking only doing a fragment is advised. To further support my position, if the theme carries a high SUDs, which it normally does, Shapiro (2018) suggests doing a more intense early memory first because if they can do this, then they can handle whatever else is to come. Lastly, and for obvious reasons, this is actually the start of the cluster.
Buy In: Starting with a shape and a color allows the client to test-drive reprocessing. When clients open up to reprocessing they are opening themselves to their own healing. When that positive shift happens, they have experienced something that is effective and they will have more buy-in into their treatment. When, as the clinician, we express that it is a more indirect way of reprocessing EMDR, it implies that we are starting someplace safer. Clients appreciate this. Also, since their core beliefs are something that they already feel and live with on a daily basis they are familiar with it and okay talking about this more than their traumas. Once they have seen a shift in this, then now know and have direct experience that EMDR therapy works for them.
Diagnostic: Doing this is also a good test run to see if the person is able to do the deeper work and can be diagnostic in the sense that you get a feel for the clients protective/dissociative system and their level of preparedness on an unconscious level. Ideally, this is assessed in Phases 1-3 of EMDR but it is not always apparent on an unconscious level. Obviously, we need to have rapport, do assessments like the DES (at a bare minimum), and use our clinical judgment but it is not always obvious how someone’s unconscious will respond. If the client picks a shape and a color that goes from dark to something light and has freed something in them or they feel lighter, then chances are they are ready to do the deeper work that they are coming to us for. Additionally, they now have direct experience with feeling a shift in their emotional body, particularly with something that feels like it has always been there, again, we get a lot of buy-in.
As clinicians, we also get a lot of information regarding diagnostics if the client cannot remember their early childhood and/or by seeing if the client can do calm/safe place or container. If they cannot do this effectively then there is more going on in their dissociative process that is worth discussing with them (Paulsen, 2009). I started doing the Color and Shape Set-up before having the Dissociative Table (Paulsen, 2009) as a tool in my EMDR toolbox. I now will start with the dissociative table, O’Shea and Paulsen’s “When There Are No Words,” and then this Color and Shape Set-up, when appropriate.
Observations: The shame color/shape/image is usually dark. When reprocessing goes well, people get to a bright and lively color and/or translucent image. Sometimes, it just disappears. When it does not go “right” the image usually stays the same and clients will say, “it does not feel like it is going to move.” This is clinically telling and potentially diagnostic so more psycho-education and resourcing may be needed. Yes, some clients will have the wherewithal to identify that “it has always been there” or “I just feel it.” This insight may indicate where they are at in their readiness to do deeper reprocessing. This suggests to me that they are highly attuned to their body and are already primed to do EMDR or trauma reprocessing.
Generalization: Generalization is when the client starts to reprocess all of the thematic memories in a cluster (Ecker, Ticic, & Hulley, 2012). This happens because once a core belief is resolved in an earlier memory the lesson learned is applied to other similar situations. Since the brain works through making associations, any association can connect to the neuro-network that rides this theme is going to be impacted, hence has the opportunity to be reprocessed. If the client is consciously and unconsciously open to healing then they are going to do a great deal of work starting in this way.
Populations: I particularly love doing this with people are addressing their addictions because they are usually living in their right-brain processes. This also goes for people who are creative and children between the ages of 2-12 respectfully. Highly motivated adolescents respond well but other adolescents find it weird. Similarly, I like doing this with personality disorders as well because it gives them the opportunity to allow shifts to happen, and/or challenges them if it does not. It provides experiential material to work on. For more left-brained people, it can be a challenge but it gives them the opportunity to connect to their more emotional side.
Healing Light: Also, consider that this can be done in combination with healing light. I will have clients get their SUDS down to a like 2-3 and then I will perform the healing light or Light Stream on the remainder. I have witnessed some very spiritual and religious experiences by doing this.
Target Order: When I do a floatback and get the earliest memory if it is not between the ages of 2-5, I have my client’s try and float further back. Because of what I am purposing, with regard to schemas and shame-based beliefs, it is implied that the earliest recall memories are going to be represented around the chronological ages of 2 to 5. Our expertise that tells us that the schemas started before the age of 2.
Clients are coming to us for our expertise on the therapeutic process and trauma etiology, which can conflict with letting the client lead or decide what memory to do first. If I have a client who wants to address something more recent or only one specific memory then I will have them try the Color and Shape Set-up first as a test run. Similarly, if there is no discrete memory (Greenwald, 2007) or test run memory to do, I also do this. There are times when having the client lead or pick a memory that they want to work on can be effective. Allowing the client to lead the selection of targets without any guidance, however, can be what creates more work later. So, we have to have a good case conceptualization in order to maximize the outcomes of healing and our conceptualization has to be based on trauma-informed care, which means to me, safety first. What this writing ultimately comes down to is that traumas are compounded in the memory network because our neuro-networks are associative and by previous traumas so starting off at the earliest is the safest and will be more likely going to produce better outcomes (Greenwald, 2007).
Feel free to contact me for individual consultation or attend my weekly group on Friday’s 12-2pm EST.
Ecker, B., Ticic, R., & Hulley, L. (2012). Unlocking the emotional brain: Eliminating symptoms at their roots using memory reconsolidation. New York, NY: Routledge.
Grant, M. (1995). From https://emdrtherapyvolusia.com/wp-content/uploads/2016/12/Mark_Grants_Pain_Protocol.pdf Retrieved on 2/8/19
Greenwald, R. (2007). EMDR: Within a phase model of trauma-informed treatment. Binghamton, NY: Haworth Press, Inc.
Marich, J. (2019). EMDR Therapy Phase 2.5: Honoring a Wider Context for Cnhanced Preparation. [Blog Post] Retrieved from https://www.instituteforcreativemindfulness.com/icm-blog-redefine-therapy/emdr-therapy-phase-25-honoring-a-wider-context-for-enhanced-preparation-by-jamie-marich-phd-lpcc-s-licdc-cs-reat-ryt-200
Mason, M. (2013). Women and shame: Kin and Culture. In. Claudia Bepko (Ed.), Feminism and addiction (pp. 175-194). New York, NY: Routledge
Paulsen, S. (2009). Looking through the eyes of trauma and dissociation: An illustrated guide for EMDR therapists and clients. Bainbridge Island, WA: A Bainbridge Institute for Integrative Psychology Publication.
Paulsen, S., & O’Shea, K. (2017). When there are no words: Repairing early trauma and neglect from the attachment period with EMDR Therapy. Bainbridge Island, WA: A Bainbridge Institute for Integrative Psychology Publication.
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures (3rd ed). New York, NY: Guilford Press.
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