I grew up tortured by the tenets of fundamentalist Evangelical Christianity, and in my young adulthood, navigated to conservative communities within Catholicism. While some use my background against me, saying that I’m unnecessarily guarded, I believe that proactively healing from the wounds of spiritual abuse these last two decades gives me an uncanny ability to call out rigidity when I see it. Even as a kid being volleyed back and forth between two devout parents in their own right (one Evangelical, one Catholic), I learned to see the merits of both. AND I couldn’t understand why we all seemed to resist seeing the common ground. That included Jews, and Muslims, and Hindus, and Jains, and Buddhists, and all the great wisdom traditions of the planet! To me, our beliefs have a common thread, yet I grew up in contexts where I was told differently. The first time I ever saw the now legendary CoExist symbol was on a billboard when I first visited Sarajevo in 2000. I turned 21 that summer and Bosnia-Hercegovnia, where I would remain to live and teach for the next three years, was still in the throes of recovering from a brutal civil war. Personally, I was struggling to identify my own spiritual path as I sought recovery from addiction. When I saw that billboard, I knew with every fiber in my being that the CoExist symbol was my path. I came to learn it had a name--sanatan dharma—the threads that unite us are the essence of truth and worthy of embracing. The rest is just details.
Resting into this spiritual path serves me well in my personal life, and it’s largely shaped my professional outlook. Which brings this all to eye movement desensitization and reprocessing (EMDR) therapy… An experience with a phenomenally integrative EMDR therapist in 2004 saved my emotional life (when I was two years sober and still struggling with maladaptive dissociation). I received my training in 2005-2006, and jumped in with both feet, regularly offering the therapy to my clients. While working on my doctoral studies, I first attended the EMDR International Association (EMDRIA) annual meeting in 2007. Brazenly, I introduced myself to EMDR founder Dr. Francine Shapiro to thank her for what she created, yet it was at the conference where I would also meet other wonderful people in the EMDR community who would made even more of a difference for me. One of those people was Dr. Sara Gilman from Encinitas, CA, who became my primary consultant throughout the certification process. She also helped me wade through my frustrations around the politics and personalities in the EMDR community that bothered me immensely. Sara was (and still is) a radiant, real human being who truly understood how my mind worked, and she never once tried to change it. She worked with it and helped me fall in love with EMDR even more! A line that she consistently used in our work together, when I struggled with some of the rigidity in the protocols was, “Jamie, this is what the textbook tells you to do. This is what I actually do.”
That guidance from Sara represents a balance that I hope I have also been able to impart as an EMDR clinician, consultant, educator, and training provider. This guidance was the inspiration for my first book that Premiere Education and Media published in 2011, EMDR Made Simple: 4 Approaches to Using EMDR with Every Client. I knew that the book would likely make me a pariah in the EMDR establishment, and at that time I didn’t care. I believe I had something useful to say from my lived experience about how fundamentalism and rigidity benefits no one, especially people like me with complex trauma and dissociation. Even at that point, I would sit in conference presentations and feel like the powers that be who got the microphone on these topics were talking in such intellectual terms about people who need to be treated in a very human way—the way that Sara treated me. As I learned that EMDR therapy can play well with other therapies and approaches in a spirit of integration and modification, I started bristling when people said things like, “Well, that’s not really EMDR,” generally in putting down a savvy modification or adaptation. It reminded me of hearing people at church say things like, “Well, then you’re not really a Christian if you believe, say, or do that (insert any violation of the "rules" here).”
Ouch—why were people connected to a therapeutic modality that I loved, a therapy that helped me to heal from much of that trauma, spouting the same kind of aggression?
I dug in to investigate my reactions that were being elicited, and in 2010 I ended up writing an explanatory model that would become the basis for EMDR Made Simple—something I dubbed “the Four Faces of EMDR.” The idea is based on a teaching of St. Augustine called The Four Voices of God, presented for a modern audience by Fr. Benedict Groschel in the book Spiritual Passages: The Psychology of Spiritual Development. We studied this Augustine teaching in my Catholic graduate program and it was honestly the most important take away for me. People relate to God in one of four primary ways—as truth, as fire/oneness, as beauty, and a goodness. Of course we can have secondary paths of relating (I am fire/oneness first, and beauty second), and we tend to get along the least with the people whose style of relating to God most differs from our own (e.g., for me that’s the “truth” people… the theologians, dogmatic types, and to offer a clinical parallel, the strictly quantitative researchers). Augustine taught that all are different, and all have their place, for God shows up in a variety of ways and forms.
Call me crazy (I truly don’t care, it’s a compliment these days), this idea seemed to fit as it relates to all psychotherapies and the controversies that ensue about model fidelity versus tendencies to innovate and to modify. And from there I proposed “the Four Faces of EMDR:”
I’ve long embraced that all of these faces of EMDR are valuable, and we need all of them in the clinical arena. Since I attempt to be as non-dogmatic as possible, I also agree it’s possible to identify with more than one face. For instance, although primarily Face 2, I have a great deal of Face 4 in me. I consider the Dancing Mindfulness approach to expressive arts therapy that I developed in 2012 to be an extension of my EMDR work and thus Face 4 in many ways. Additionally, a person may see themselves as somewhere between Face 1-2 or between Face 2-3. Although I am Face 2, I can pull out my "Face 1" language and savvy when I need it, especially in offering foundational (basic) trainings or in communicating my ideas to other Face 1 people.
I published this model in an attempt to promote some semblance of unity and cohesion among people who love and are intrigued by the wonders of EMDR therapy. Of course many resented me for it, and many considered me a genius for it… I’ll let you be your own judge of that. I’ve been thinking a great deal about “The Four Faces of EMDR” since the COVID-19 pandemic thrust an entire community of therapists, not just EMDR therapists, into working in telehealth…an area where so few of us are trained and where few research studies exist on best practices. As battles ensued around me over propriety and appropriateness in shifting EMDR therapy to telehealth (e.g., do you let people self-tap or not?, is it ethical to do trauma work online with people who dissociate?, is it prudent to venture into an area where there is so little research?, should we be taking advice on online therapy from people who are in different ideological camps?), the Jamie who wrote EMDR Made Simple ten years ago re-emerged.
I admit, especially since I am now an EMDRIA-approved trainer who has more Face 1 qualities than she used to, I’ve sometime wondered if EMDR Made Simple did more harm than good in helping therapists hone their EMDR craft. I am much less rebellious and a lot more party line as it relates to proper EMDR technique than I was back then. I’ve learned that the technique isn’t the enemy; it’s the attitude and approach that people take to the technique that causes problems. You can use it rigidly, or you can use it artfully. I even wrote two pieces lauding proper technique and explaining how I reconciled with the standard protocol here on this blog. I’ve come to appreciate that much of what I initially interpreted as rigidity in Dr. Shapiro was truly her push to get EMDR therapy validated as evidence-based by the metrics of empirical research. Even though thinking in those terms does not serve me either personally or clinically, I see how it serves our larger community. And in 2018, Springer Publishing—one of the largest publishers of mainstream EMDR material and the publisher of The Journal of EMDR Practice and Research—put out my second EMDR book (EMDR Therapy and Mindfulness for Trauma Focused Care, co-authored with Dr. Stephen Dansiger). Rebel Jamie from 2010-2011 was a bit shocked by that one!
Yet in the week when we switched over to telehealth and I struggled to find resources for my trainees and community—I listened to the different voices and the old Jamie who wrote EMDR Made Simple paid me a visit. I realized that rebel Jamie is who I need to be for myself right now, and how I need to show up for my students and my community. As I declared on a public webinar I did with my friend Mark Brayne on March 22, however you do EMDR in your office and in whatever face you work—transfer that to telehealth. Your confidence in your approach will inevitably translate and we can continue to ease or even end some suffering during this difficult time. There’s plenty of time to debate and even to research when all of this is over. For now, show up for your clients with whatever EMDR face you wear and do your best to honor other EMDR and EMDR-related clinicians who are doing the same.
Adapt - to make suitable for new use or purpose; become adjusted to new conditions (merriam-webster.com)
COVID-19 has brought disruption to everyone’s lives in so many different ways. I never imagined my life and daily routines would be so drastically altered in a week. My kids are at home all day now instead of going to school and will probably finish up the school year interacting with their teacher and classmates through Zoom and being semi-homeschooled by myself and my husband. We can’t go to restaurants or workout at the gym, and a trip to the grocery store feels like a wild goose chase trying to figure out what store stocks when and who will have everything on my list.
My therapy practice has drastically changed as well. Hardly anyone, clinician or client, is in the office, which is normally bustling. We had to shut down our yoga studio, and I haven’t been able to practice in the space that has been my yoga home for years. In just a few days, I had to figure out how to meet with clients remotely in case either one of us is quarantined. Teletherapy never was a platform I wanted to use because of the nature of the trauma work I do, but at this point, it isn’t a choice; it’s a necessity.
In short, everything is turned upside down and what was the norm a week ago, feels like ancient history and who knows if it will go back to that way of life ever again. I spent the last few days grieving and feeling like I was living in crisis mode, trying to make sense of everything and finding a stable footing. I know my family is fortunate; my husband and I both still have our jobs and the ability to work from home, we have our health and endless resources. Our theme for life today is adaptation, and we must find new ways to adjust to these new conditions.
Take time to grieve and have a breakdown. There is so much turmoil and uncertainty now; acknowledging this can help you cope with these feelings. And it’s okay to be sad about the more superficial changes like not being able to stop by Target randomly or having a mid-afternoon cappuccino at Starbucks. Take the time you need to experience and process these feelings.
Be mindful and stay in the present moment. Even with all the stress and chaos happening around us, there are so many positive moments that we could miss. It could be your kids laughing and talking as they are playing Minecraft together or hearing the spring peepers at night. By being mindful and paying attention, we can strengthen the importance of these positive moments.
Limit social media and the news. It’s so easy to get caught up in minute by minute updates in the news and all of the commentary on social media. It’s beneficial to stay informed but do so in small doses to avoid vicarious trauma.
Find control in the things you can. There are so many restrictions being placed on us right now in regard to where we can go and who we can be around. Businesses and restaurants are being told to close, people are losing their jobs, and normal resources are scarce. This can trigger a feeling of not having control, and it is important to find control in the things you can. It may be as simple as setting a time to get up in the morning or when to eat meals. Take the initiative to turn off the news and limit social media and go outside for a walk.
You are not alone. No one on this planet is immune to what is happening right now. In different ways, everyone is affected by this pandemic. My hope is that we, as a global community, find solidarity in this. It is a time to come together and find strength in this shared experience. If you feel that you are the only one overwhelmed, anxious, angry, remember, you are not alone. We are all learning how to adapt, and we are all in this together.
They’re doing it for the attention.
It’s a refrain uttered everywhere, as people attempt to explain why troubled adults, adolescents, and children behave the way they do. Overused and indiscriminately applied, doing it for the attention has bothered me since I was a trainee in child psychology. Surely, humans do what they do for a wide range of reasons. And if someone is crying out for attention, don’t they deserve—need—us to notice? To attend?
Instead, seeking attention from others is all too often reviled. It’s dismissed as indulgent, considered a reward for undesirable behavior, a reinforcement of disavowed emotion. So, we stop being curious about others’ internal experiences — disconnecting from what they know, feel, need, want, fear — and, necessarily, we disconnect from our own. Rather than noticing, bringing attention to what’s happening inside no matter how confusing or intense or messy, we learn to turn our attention away. We numb, avoid, put aside. It feels safer to stop noticing. If we don’t give it attention, we can make it disappear or pretend it’s not real.
Not so in the process of EMDR therapy. There, the words, “Just notice,” are the foundational guideposts.
“Just notice,” we therapists say. “Let whatever happens, happen.” We may repeat this mantra countless times a day-- a reflex woven into procedural memory as we support clients dealing with trauma.
Just notice? The mother wonders, just notice what?, as she stands over the warming bed of her two-pound baby in the NICU. She tries desperately, silently, to notice what the nurse is showing her about her newborn baby’s skin tone. What if I never get it? she thinks. What if my ability to notice what’s important is broken?
“…and let whatever happens, happen,” we say, as the newly bereaved parent of a baby who died at birth looks at us with wide eyes.
“Let whatever happens, happen? I can’t just notice. I can’t trust my judgment. Just look at this baby, who my body failed, who I have failed…”
We say these words because we know that the key to healing begins with simply noticing. Pay attention. Be curious, see what happens next.
But it’s a catch-22. Trauma fractures our natural ability to notice. It disrupts our capacity to access that calm curiosity that allows us to stay connected to what’s happening inside. Bringing our attention to pain, even though it’s uncomfortable, seems to be essential to recovery. It’s as if we need people to be healed in order to access the healing.
Fortunately, as in all relational psychotherapy, EMDR therapists offer our attuned presence as scaffolding and support as people begin to turn their attention to their internal world. With EMDR therapy, we provide precisely the sort of nuanced appreciation for the ebb and flow of thought and feeling, somatic sensation, and memory that parents must bring to their babies and that, especially in the face of disruptions on the road to parenthood, can seem both frightening and out of reach.
It goes something like this:
As you bring your attention to yourself, just noticing, I will help you. I will notice with you. I will notice the subtle changes in your skin tone, as your cheeks redden and clear, as the tears rise and fall. I will note your breathing and breathe with you. I will not turn away from your fear or your pain or your anger. My nervous system will listen to the rhythms coming from yours. I will notice and then you can notice, too.
That subtle sensation, that flickering emotion, it all matters. “Notice that,” we say, inviting gentle curiosity, remaining just as engaged and attentive as when tears are flowing. “What are you noticing now?” we ask. So often, language is elusive but the emotion, the emergent shift, is palpable and so we lean in. “Just notice it,” we say, affirming that it exists even when it can’t yet be articulated. “That blossoming warmth? That stab in your chest? Just notice it. And when you do, when you let whatever happens happen, we will notice together. We will know its truth and meaning together.”
This is how we walk with our clients into the process of EMDR therapy where everything they notice, no matter how subtle, counts, not just the sobs or the searing flash of memory. It’s also how we accompany bereaved and traumatized parents into the new world born in the face of perinatal trauma. We notice the shrapnel causing pain and blocking healing. Just as important, we nourish and support the gradual creation of connective tissue that forms the foundation of a new sense of self: as a parent to this baby within the matrix of relationships, within this family.
All of it, every single nuance, counts.
“My baby only spent a few days in the NICU,” said one father to me in response to a call for interviewees for our book. “Are you sure you want our story?” “Our baby died,” whispered another. “Do you really want to interview us?”
It’s a common concern that parents express to therapists. Does it count? Does our experience really matter? Even if my baby is fine now, or if there are no marks on my body to prove that we’ve walked through the fire or no living baby to parent after all we endured? Do I have permission to notice what this means to me, how it actually feels? And if I do notice where it hurts, can I show you? Will you pay attention?
So we sit across from the families who land in our offices-- parents unmoored from what they used to know about themselves, about babies, pregnancies, and the way the world is supposed to work when you’ve followed all the rules, and we pay attention. We notice and most importantly, we trust what they notice. We show them with our engaged, calm presence, staying out of the way but staying.
If we’ve been fortunate to become a parent to a full-term, healthy baby, conceived, gestated, and born without incident, it can be challenging to learn to decipher these signs of dislocation and the consequences. When the road to parenthood has been pitted with earthquakes and storms, parents cannot trust in what once seemed natural and easy. Without that steady sense of “I can figure this out,” or “everything will be okay,” parents feel unmoored and may desperately turn to others to steady themselves.
They often turn to professionals, like us.
And yes, they are doing it for the attention.
And in fact, they benefit when we pay attention-- when we see them as they are, validate their experience of their journey, acknowledge their pain, and accompany them as nonjudgmental witnesses. Our attention is what helps them learn to notice both the obvious and the nuanced and let what happens happen. Our attention is what helps them regain feelings of confidence and competence. Gradually, they begin to believe in themselves as parents, including, “I can learn to read this baby’s cues,” or, “I can trust my sense that something is wrong (or right) with myself or my baby,” or, “My pain counts even though other parents are experiencing a grief and fear I can’t even fathom.” Or even, “I feel love and hope and joy even though strangers glance at my baby and turn away,” or, “I am a loving parent even though my baby died.”
Our attention validates these truths. Noticing them guides our clients to turn their own attention back to their lived experience in all its mess and meaning. Only then can they weave together the strands of their experience, appreciating them all as part of a larger whole.
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.
Institute for creative mindfulness
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