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 the 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
Even though I do my best to take off the clinical cap outside of session, friends often ask for my opinion about all things mental health. When a friend recently talked about their long-term struggles with anxiety, I mounted my usual soapbox about the importance of feeling your feelings fully and not stuffing them away. As a trauma-focused therapist and a yogi, I believe that most of the symptoms that trouble us are the result of unhealed emotional wounds that never got a chance to heal at earlier points in our lives. Until we permit ourselves to feel what we weren’t able, willing, or allowed to feel at these earlier points, we’ll remain in a loop of distress that manifests in a variety of symptoms.
“But I thought the point was not to engage my feelings? To not let them get the best of me?,” my friend replied.
My eyes rolled and my fury rose, knowing that they heard this from either a cognitively driven therapist or a psychiatrist. And in the spirit of feeling my feelings through, I am not afraid to disclose that I get incredibly angry when I hear that feelings phobia is alive and well among mental health providers. Once, a student reported to me that his psychiatric medical director was so nervous about clients not being able to handle feelings, she forbade any treatments at their clinic that might make patients cry. Even as I type this, I feel the Hulk rising up in my chest about to bust out, so infuriated that providers—either due to their own fear or restrictions that systemic forces placed upon them—are deliberately keeping people stuck in a rut when they offer such direction.
The major lesson that I have learned from people I’ve served in the last fifteen years as a trauma specialist is that our feelings are not the problem. Everything we do to keep from feeling our feelings and experiencing our emotions—even the dark and heavy ones—is the real problem. We engage in addictive behaviors, we isolate and cut off connection, and we begin to accept phenomenon like panic attacks, nervousness, persistent body distress, and dissociative numbing as the norm. As my friend Esther describes it, “I’ve parked diagonally in the depressive position as the lesser of evils for most of my life.” While I am not opposed to psychiatric medication that is responsibly prescribed within a larger context of care, I get concerned when people become so fixated on getting their medication type(s) and dosage just right. We believe that finding this medical solution will help us to survive the rigors of daily living, and for a time, it might. There are even some conditions and organic brain structures where psychiatric medication may even be necessary for survival.
But are we only meant to survive?
Or by refusing to listen to what our feelings, experiences, and sensations have to share with us about what needs healed, are we cutting ourselves off from the deepest well of healing that is available to us?
My answer to this question is obviously yes, and it may seem like that resounding affirmation comes from a place of tremendous privilege. True, I have extensive training in both EMDR therapy and classical yoga. I’ve invested a great deal of my own money in my therapeutic process and have gotten to a place where if I feel an emotional wave coming over me as I drive down I-80, I’m not afraid to cry until it passes. I take Rumi’s teaching in The Guesthouse to heart by welcoming and entertaining them all—the joys, the sorrows, and the meanness.
I also know how to put such waves of feeling into what therapists sometimes call a container, a visual or sensory strategy we can work on to hold the full expression of the feeling until the time and place is more appropriate. If I am still crying when I arrive at my worksite, I know how to use my container to keep it together in order to get through the day. Yet because I ride the waves as they come, I usually don’t need to use the container. The feeling will pass and I can get on with my day. If the same feeling keeps coming up as a pattern, I know to take it to my therapist, sponsor, spiritual teachers or friends, and they help me identify where I need to do the work. And as a woman in long-term recovery, I’ve had over seventeen years of practice in cultivating this art.
That is my privilege—yet remember, there was lots of stuff I needed to heal from in the first place! So many of my early childhood memories center around being made to feel weird because I felt things so intensely. I am the girl who cried for days when the bad people painted Big Bird blue in the 1985 Sesame Street film, Follow That Bird. I am the girl who was constantly told that she was too sensitive, whose caretakers didn’t really know how to handle her. I am also the girl who knew that if I expressed what I felt about many of the happenings of my childhood, my safety would be threatened. I still experienced emotions like fear, anger, disgust, and shame about the things going on around me over which I had no control. They just had nowhere to go or no healthy outlet through which to be expressed. So, I turned inward, first with eating. The arts eventually gave me an outlet that served as a bit of a release valve, yet when my perfectionistic tendencies shut those down in my life, drugs and alcohol became the natural way to temper my tendencies to feel things so damn hard. Fortunately, my recovery path led me back to the expressive arts as a healthy outlet for expression. And I can now embrace my sensitivity as a character asset. Yet getting to this place required time spent in healing practices and learning to remove the scripts of judgment around my feelings.
My clients, friends, and my own lived experience have also taught me a great deal about what makes it so commonplace to block the feeling and expression of even the most natural of emotions. The greatest hits of reasons include fear that I won’t be able to handle what comes up, fear of being judged, fear that I’m a bad person for feeling what I do, fear of being rejected, fear that they will never go away and so they’ll end up destroying me, fear of hurting others, fear of people taking advantage of my vulnerability, fear of doing the hard work, fear that no one will understand or get me, fear that my sense of safety or connection to people I love will be taken away, fear of being seen, fear of making real changes in my life…. With all of these fears, of course medicating alone seems appealing!
Consider, however, that these fears do not develop in a vacuum. We generally learn them from somewhere—from our families of origin, from society, from the systems in which we are educated and eventually go to work. For many of us, it’s literally the “systems,” like foster care, incarceration, and yes, the medical and mental health fields, that can teach us these horrid lessons. No wonder that so many of us are afraid to feel when people in positions of power, even people who we are told are there to help us, can literally be the source of our feelings phobia.
I’m not here to analyze whether your parents, guardians, teachers, or care providers had malicious intent when they first told you, “Don’t cry.” I do ask you to consider how this and other messages around feelings and emotions shaped your early experiences. A common thread for many of us is that some of our earliest wounding was also paired with damaging messages about what it means to express feelings, let alone have them. So whether, as a young man, you were taught that boys don’t cry, or whether you learned that crying only got you into more trouble, regardless of your gender expression, these source messages must be explored if it is your intention to overcome feelings phobia.
When I worked in addiction treatment, I offered this rather crude metaphor. Consider that trying to stop yourself from feeling your feelings is as futile as trying to stop the flow of a river, the waves of the ocean, or yes—as futile as trying to stop yourself from doing your business when your body signals that it’s time to find a toilet. Or at least somewhere to let it out, even if it’s a roadside bush or a makeshift litter box (which I once had to create on an overnight bus through India where no toilet was to be found on board). All whimsy aside, think about the last time you had to “go to the bathroom.” What if you were told, or even told yourself, I have to hold it in—indefinitely! Consider the level of pain and distress that would ensue, and how eventually what needs to come out will come out in an even messier, uncontained way.
As gross as it sounds, this is what we do when we do not allow ourselves the proper outlet to feel through our feelings, an experience of human living that is as natural as needing to do this physical business. Bringing this metaphor full circle, consider how most of us were toilet trained to be able to take care of this physical business in a safe and sanitary way. And yet most of us never received the same level of patient training and instruction about the naturalness of feelings and how to express them healthfully. So, show yourselves some compassion as you identify what’s kept you stuck and learn a new way of being in the world. Be kind to yourself. It may feel like you’re in toilet training all over again. Seek professional help with a provider who seems willing to do the deep digging with you in a supportive context. It’s not ridiculous to do a phone screen with a potential provider and ask them what their stance is on feelings and how they work with them in clinical practice. You can also turn to your friends and people in your life who relate to the struggle. In my experience, the daunting prospect of letting ourselves go there can feel less scary when someone can validate and affirm, yet also have the willingness to challenge us appropriately.
Every time you let yourself feel a feeling is a victory in this healing process or experiencing the world, not just surviving it.
It’s all training ground.
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 woke up this morning to the news that a mass shooting occurred in Dayton, Ohio, about 90 miles west of my home. This was the second mass shooting in 24 hours from which I am still reeling. Though these events did not affect me directly, it is still impactful because of the way it alters my thoughts, feelings, beliefs, and actions. I feel heavier, weighed down with worry, and just an overall sadness. Today, I was planning on taking my kids back-to-school shopping and can’t help but think “What if this happens there and should we even go?”
I hate this thought process and don’t want to live in fear of a tragedy happening to my family, but it’s something I can’t shake. These feelings reveal themselves in the conversations I have with my kids about what to do if a shooting occurs in a public setting. Not to terrify them, but to prepare them in a time of crisis. Unfortunately, this is a common dialogue I have with them to teach them how to keep themselves safe, and they have already gone through this narrative in their schools where they practice lockdown drills and have even been exposed to shootings within our own community. Again, though we weren’t personally affected by these tragedies by being there or having a friend or family member involved, these traumas do affect me personally as I move through the world and teach my kids how to move through the world. I have a heightened sense of worry and anxiety for my family and friends because you never know when it is going to happen.
As an EMDR therapist, I am acutely aware of how trauma can impact individuals in a variety of ways. It is important to understand how mass shootings and community traumas impact not just the direct victims but also impact the community as a whole. The obvious application of EMDR therapy is with any person who was directly involved in a shooting as a victim. There may be images, sounds, smells, somatic sensations, and other stimuli that are triggering and bring the experience flooding back into the present creating a fight, flight, or freeze response. All of these can be processed with EMDR therapy, releasing the emotional charge associated with these triggers and distancing the past from the present.
Survivor guilt is often talked about in conjunction with shootings. My friend was killed, and I survived. A stranger died saving me; if I was at that event that day, it would have been me that was killed. Our brain tricks us into believing that if I was there I could have stopped it, it’s my fault she died, it should have been me, or any number of negative beliefs that our brain uses to try to make sense of what happened. The problem is that these beliefs are just not true and most of the time our rational brain knows this (the neocortex). Our trauma brain (limbic and reptilian) just hasn’t caught up and is in fight, flight, or freeze mode. When you process the traumatic memories, the trauma brain links up with the rational brain, bringing an adaptability to these negative beliefs.
Hearing about these events on the news or through stories told by survivors can be traumatizing in and of themselves. This can instill the same trauma response as directly experiencing a traumatic event. These vicarious traumas can be reprocessed in the same manner using EMDR therapy by targeting the corresponding images you have about these events. Reprocessing these events with EMDR therapy can help desensitize the horrific pictures that go along with a mass tragedy. It allows you to bring these images and memories to an adaptable place letting go of the associated negative beliefs, putting the past in the past and building resiliency. By doing so, you can engage in everyday life and feel empowered.
As I take my kids shopping this afternoon for their first day of school outfits, I will still talk to them about what to do if some crisis occurs to prepare them to keep themselves safe. However, I will do this from a place of preparedness and not fear. I will also talk to them about the different tragedies in our community and how they can affect change just by treating others with kindness and respect and putting more positivity out into the world. I hope to instill in them a sense of safety, empowerment, hope, and love. I hope and pray nothing like this directly affects us, but with the frequency of these occurrences, I fear it is inevitable. My hope is that as we help people to heal and show loving kindness to others, the occurrences of these tragedies will diminish.
When I first met the person who would become one of my spiritual teachers, he told me that I wasn’t ready. I asked him a series of challenging questions from the crossroads at which I found myself in life. I struggled to make sense of deeper yoga teachings that would help me move from a place of doing to being. Ever the good student programmed to challenge what I was told at face value, I persisted with my questioning.
“You’re not ready,” he said.
On one hand, he had a point. I hadn’t been ready for quite some time—but I was there. Present. Doing the work. Asking the questions. Preparing myself in a manner that would allow me to become ready. Yet on the other hand, I felt incredibly insulted to be told I wasn’t ready when I was clearly willing and making preparations. It made me think of every time I’d told a client, “You’re not ready yet,” and I suddenly chided myself, realizing how demeaning and degrading that could have felt for them. Since that incident in the Fall of 2015, I stopped using the word ready in clinical settings with my clients or in teaching with my students.
A visceral reaction overcomes me every time that I hear the word ready. Maybe because I realized how ugly it sounded when pelted at me. I also became attuned to how often people say, “I’m not ready.” And I recognized how frequently my clinical consultees, primarily learning EMDR and other trauma therapies, worry that their clients weren’t ready to go further with their work. When they express this worry, the subtext is usually that they do not feel ready to take a client further. Folks that I mentor can doubt their ability to teach a class or accept a professional opportunity I present, claiming they are not ready. Why did I suddenly hate the word so much? In addition to it feeling like an insult towards me, it felt like others were using I’m not ready as an excuse or an easy word to express distrust in their own abilities within the natural flow of process.
For years I taught the importance of client readiness in moving forward with deeper phases of 12-step work or trauma therapy. Yet my experience caused me to reevaluate the word and everything I believed about it. Like I do at any crossroads in inquiry, I turned to word origin for some answers. The word ready traces to the 13th-14th century Middle English where it is largely conflated with the word prepared or preparedness. Although there is an element of the original word usage that also implies promptness; i.e., not dragging out the process. Ready and prepared may seem like synonyms, yet there are subtle differences that may offer some solutions.
I’ve been posing the question quite a bit lately—to my friends and to the hivemind that is my social media following—about the difference between ready and prepared. Most seem to association readiness as a state of mind or a mental quality whereas preparedness or being prepared is more logistical. There are plenty examples out there of people believing they are ready for something (e.g., marriage, a hike on the Appalachian Trial), only to find out that they are ill-prepared. For me, embracing the full meaning of prepare and all of its forms (preparedness, preparation) is where we find our freedom to grow and to realize our intentions. The Latin root from which we draw the English word prepare draws from the same root as to parent. To bring something to life! Taking the action to get ourselves prepared inevitably impacts our attitude of readiness. If we declare that we’re not ready and do nothing to get ready (i.e., prepare), we can find ourselves in an excuse-making loop for years. Moreover, consider that such a thing as perfect readiness may not even exist.
Amber Coulter, an artist I follow on Instagram, recently published one of her visual journaling pages that declared, “If we wait until we’re ready, we’ll be waiting for the rest of our lives.” My body rejoiced with an enthusiastic YES when I read those words. The answer to the question of why I held so much disdain for the word “ready” began to take shape. A few weeks later I taught a workshop on my Trauma and the Twelve Steps book. A participant posed a question about readiness to do the steps, especially the fourth and fifth step (the inventory and sharing the inventory with another human being steps).
“Who is ever really ready to do a fourth step?” I replied.
I offered that letting people off the hook from doing a fourth and eventually a fifth step is not the answer. Rather, how can we better prepare them for the challenges of these steps and guide them through the difficulty? I’ve heard too many sponsors tell people to “just do Step 4 and don’t come back until you’re ready to do the fifth.” With that lack of guidance, no wonder that people don’t feel ready and keep putting it off! To be clear, forcing people to do the steps is not the answer. I still believe there is value to not rushing any process. Yet playing the “I’m not ready” card, even if it is out of legitimate fear, can keep us stuck in the rut of life behaviors and emotional states that cause us problems. I have found that doing these steps are a lot less scary with proper preparation and guidance. Preparation and guidance can assuage the fear.
What if we could learn to replace the declaration of “I’m not ready” with the question “What can I do to get myself prepared?” There are other helpful questions too: “What kind of support will I need to grow into readiness?” or “How will taking action and making necessary preparations help me to get ready?”
The founder of EMDR therapy, the late Dr. Francine Shapiro, made a brilliant move when she named Phase 2 of the therapy Preparation instead of Stabilization. While many other trauma modalities use terms like stabilization, I find that this word can frustrate clinicians and clients alike. Clinicians can believe that a client has to be totally stable before they can handle deeper phases of trauma healing. Yet it may be impossible to achieve stability in a total sense until the person whose life is ruled by unhealed trauma engages in some deeper healing that allows them to process the impact of their trauma. When new trainees pose the very common question, “Are they stable enough?” or “Are they ready?” to handle deeper level EMDR, I generally respond with, “What are you doing to help them prepare? Remember, the phase is called Preparation. The objective is for the client to acquire enough mental resources and skills so that they can reasonable handle or tolerate what may come up when the work gets harder.”
I assure my clients, and pass this along to my trainees, that if they begin the deeper journey and realize they are not adequately prepared, we can always take refuge back in the Preparation phase and work on more skills and strategies. To simply say “I’m not ready,” especially when you have a goal of getting better, is generally not helpful. True, some people just need some time. Yet I encourage people to productively use that time by taking proactive steps, no matter how small, towards their own healing.
Perhaps my overachieving, good student tendencies that I’ve carried throughout childhood have simply carried over to how I approach the healing process. I recognize that my tone in this piece may come with an air of “no excuses” and I am aware of my privilege. Since I decided to get sober and well 18 years ago, I’ve had the ability to access healing resources in the form of counseling, psychiatry, 12-step meetings and other holistic practices. I also had seasons of my life where unhealed trauma rendered me paralyzed and unable to fully take advantage of them. Yet realizing what I do have and mustering enough willingness to prepare myself has long been the key that’s opened the door to readiness. I’ve seen people without the resources I have access to make up for it the willingness to prepare themselves in whatever way is possible. Which leads to a final question: When we say, “I’m not ready,” are we really declaring that we’re not willing?
Maybe. Maybe not.
I’ve seen the answer to that question go both ways for people. And in both contexts, the lynchpin seems to be preparation. Taking action steps. Change will come as it is meant to when we put one foot in front of the other with a minimum of stalling. There’s a recovery saying that it’s easier to act your way into better thinking than to think your way into better acting. This approach is generally more trauma-informed than change the thinking, change the behavior mantra that can dominate cognitive-behavioral discourse. Acting your way into better thinking recognizes that our thoughts keep us stuck. Our thoughts tell us things like “I’m not ready.” Our actions move us towards a different reality and eventually a different attitude and outlook on life.
As a certified therapist in both Eye Movement Desensitization and Reprocessing (EMDR) therapy and Dialectical Behavior Therapy (DBT), many times therapists give me the “huh” look when I say that I use them both – together. You know that look, head cocked to one side and brow furrowed. “I don’t see how that could work”, “my clients don’t like DBT”, “I don’t like DBT” and/or “it’s too structured”. “HOMEWORK?!?!” However, over my thirteen years of working in the field I have found EMDR and DBT to be a beautiful fusion. Just like fusions with food, two things that might seem counterintuitive to put together can turn out being even better than their standalone ingredients. Think about it: chocolate and chili, sea salt and caramel, brown sugar and ketchup (BBQ sauce). Dialectics hard at work!
Like my colleague Dr. Mary Riley, the culinary arts and metaphors have been a large part of my life. Many times, the metaphor of baking has helped me to make sense of new ideas, learn new concepts, or put my thoughts together more seamlessly. Before we dive any further into the kitchen with EMDR and DBT, let’s explore some introductory information first. For those in need of an orientation, the proceeding paragraphs will give a short explanation of EMDR and DBT. Note, trauma in this context is considered to be a “wound” not necessarily just the big traumas many of us usually identify such as war, a lethal accident/occurrence, or sexual assault/rape.
EMDR therapy is defined by World Health Organization in this manner:
“[EMDR] therapy is based on the idea that negative thoughts, feelings, and behaviors are the result of unprocessed memories. The treatment involves standardized procedures that include focusing on (a) spontaneous associations of traumatic images, thoughts, emotions and bodily sensations and (b) bilateral stimulation that is most commonly in the form of repeated eye movements. Like CBT with a trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive beliefs related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework.” (Marich, 2019).
Regarding DBT, Marsha Linehan the developer of the therapy states:
“Dialectical Behavior Therapy is a broad-based cognitive-behavioral treatment originally developed for chronically suicidal individuals diagnosed with Borderline Personality Disorder (BPD). Consisting of a combination of individual psychotherapy, group skills training, telephone coaching, and a therapist consultation team, DBT was the first psychotherapy shown through controlled studies to be effective with BPD. Since then, multiple clinical trials have been conducted demonstrating the effectiveness of DBT not only for BPD, but also for a wide range of other disorders and problems, including both undercontrol and overcontrol of emotions and associated cognitive and behavioral patterns Furthermore, an increasing number of studies suggest that skills training alone is a promising intervention for a variety of populations…” (Linehan, 2015).
Merging these together, just like chocolate and chili, if we look at the theoretical frameworks alone (cue the eye rolls from us more expressive arts types), EMDR’s AIP model is closely related to DBT’s Biosocial Theory. They both assert:
Now that we have our foundational principles in place, let’s bake a cake, shall we? The use of metaphors is frequently implemented in DBT and can help clients understand weightier concepts; just as the baking metaphor has helped me in my life. Let’s put on our aprons and get to work! The 8 Phases of EMDR can be considered the recipe while the application of EMDR is putting the ingredients together to bake. DBT’s role is that of fusion, again, the chili to the chocolate. With this idea of baking, DBT’s modules and skills (ingredients) can easily align with EMDR’s phases (recipe with ingredients). The recipe is as follows:
Voila! A perfectly baked therapy cake with all its yummy fusion goodness! To finish off our baking masterpiece, let’s talk about icing. Icing is what usually draws us to the dessert. Seeing those lovely frothed peaks of icing begging to be eaten, how can we say no? Icing, in this case, can be identified as the “sell” to the client; the explanation of why EMDR and DBT work so great together. In Phase 3 of EMDR, when we are getting the client activated, we can compare this to a raging fire or the extreme temperatures of an oven. When making the “sell” Arbeitman, Goodwin-Brown, and Loomis (2016) give the example that “DBT manages the fires. EMDR Therapy extinguishes the fires.” By educating clients that the fires of life will always be there in one form or another, we give them a choice. They can choose to use those fires and temperatures to bake a cake or choose to have those same fires burn them alive. I’m guessing your clients might want cake instead of ongoing emotional 3rd degree burns. So why not invite them into the kitchen and have them sample how the combination of chocolate and chili might sound odd?
Odd, and yet oh so tasty!
Arbeitman, D., Goodwin-Brown, R., & Loomis, G. (2016, April). Integrating dialectical behavioral therapy (DBT) and EMDR with suicidal and self-injuring clients. Presentation at the 12th Western Mass Regional Network Spring Conference, Amherst, MA
Koerner, K. (2012). Doing Dialectical Behavior Therapy: A Practical Guide (Guides to Individualized Evidence-Based Treatment). The Guilford Press. New York, NY.
Linehan, M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder.
Linehan, M. (2015). Skills Training Manual for Treating Borderline Personality Disorder. Second Edition.
Marich, J. (2014). Trauma made simple: Competencies in assessment, treatment, and working with survivors. Eau Claire, WI: PESI Publications & Media.
Marich, J. (2019). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Training Course Part 1 and Training Course Part 2 Manuals. The Institute for Creative Mindfulness 2015. 8th Edition.
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.
“Jamie, when we first met, you brought up all of my popular girl issues and I didn’t know how to act around you.”
My mouth was agape when Ramona, a member of the Dancing Mindfulness community and now a senior affiliate trainer in our program, revealed this to me several years ago. While I didn’t wish to negate her experience, there was a part of me that wanted to rage back, “But you don’t understand! I’m anything but a popular girl. After all, the popular girls in school gave me a complex that’s taken years of therapy to repair!”
The images of that chubby girl with a bad perm being teased and set up on the Catholic school playground in elementary school came flooding back. The panic I experienced in junior high that I would never be “liked” in that way by a boy or a girl rose up in my chest. The despair in which I found myself as a competitor in high school speech because I never felt pretty enough, talented enough, or likable enough to win the top prizes came into the clearest view. Then I realized—even as an accomplished professional with a public image, I still let the kids I perceive as more popular affect me. And it turns out that many of us still do, long into adulthood.
There’s a great deal of talk about impostor syndrome in pop psychology literature and on social media—the fear that one day people are going to expose us as the frauds that we are and realize that we’re full of shit and have no business to be working in our fields. What I am putting out there for consideration is related and yet essentially different—the popular kid complex. This is the fear that no matter how hard we try, how great we look or how talented we are, we’ll never be invited to sit with the popular kids at their lunch table. While we can argue that in an ideal, spiritually enlightened world there ought to be no such thing as lunch tables and that external metrics of this nature shouldn’t matter, we do live in that world. And no matter how hard we work on ourselves or how deeply we invest in our spiritual practices, things like this can still matter even to the steadiest among us.
This idea may feel like just another variation on the keeping up with the Joneses concept, always wanting more out of a sense of competition. To explain how I see the popular kid complex as fundamentally different and even bigger problem, I’m going to call myself out on my own shit. Many years ago, I set out on the path of my teaching career as an extension of service and continuing to live in the eleventh step as described in a 12-step program—to pray for knowledge of my Higher Power’s will and the power to carry it out. At first I was simply over the moon that people wanted to book me for trainings and read some of my articles. The more I kept putting myself out there, I gratefully received more teaching invitations and my first book contract in 2011, primarily to write for other therapists.
Then at some point, I found myself getting intimated and maybe even a little jealous by the likes of Brené Brown, Gabrielle Bernstein, and Anne Lamott. They are popular! They are on the New York Times best seller list! They have a reach beyond just their niche market. Oprah invites them onto Super Soul Sunday, the ultimate cool kids lunch table for modern times. Here’s the kicker—I like their stuff, I adore their teachings. They put themselves out there the way that I would like to, and what still stops me short is this fear that I will never be as pretty, whimsical, charming, likable, talented, relatable, or popular as they are. I am even prone to thinking thoughts like, “Why does the world need teachers like me when they have teachers like them?”
Fortunately those thoughts come and go, as I know at my core that what I do in my work is a direct fruit of me asking my Higher Power and the universe to make me a vessel, in whatever form that may take. But as much as that spiritual perspective keeps me grounded, I am still human. 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.
Sometime last year I looked at jealousy—is it that I’m just jealous of people who are better than me and can get things done where I can’t? The teachings of the Kripalu-Amrit lineage in which I study yoga helped me through that one. I accepted that jealousy is a fear that, at my core, I am not enough. Jealousy is about being cut off from the reality of my true Self and my true nature where none of us are separate. Spiritual me gets that. Human me still struggles.
I was recently doing some of my own EMDR therapy on this matter and the Brené Brown brings up my popular girl issues and I’ll never be likable enough to get a Netflix special was tripped-wired. The therapist working on me said “go with that” and I immediately blurted out, “Brené Brown is my Marla Carano.”
Marla Carano was the best speaker in the Ohio region where I competed my senior year of high school. Tall, articulate and charming, she looked about ten years older than the rest of us, wearing a stylish olive green suit for major competitions. She went to one of the powerhouse suburban high schools where her father was the legendary head coach. As a kid from a city school with a small team, I believed I could never be as cool as her. To be clear, she won on her talent. Also to be clear, Marla was always a gracious competitor and genuinely nice to me. I never felt anything like a “mean girl” vibe coming from her. Yet I could never shake the fact that I would perpetually be second or third next to the likes of her because I wasn’t as pretty, whimsical, charming, likable, talented, relatable, or popular as she.
And the reality is, in what has since become the classic Dr. Jamie Marich move that has defined my adult career, I wrote a pretty avant-garde original oratory for high school speech tournaments. My speech created conversations with other students and even other judges even if I didn’t necessarily win top prizes. The move I made that year to put my voice out there is the gutsiness that I celebrate and applaud in my own students. That move, I believe, made me the speaker I am today whose primarily livelihood is literally forged on my ability to go up there and speak truth without fear.
So why isn’t that enough? At seventeen, one could say I was still in high school and having a place in the spotlight matters. But I’m nearly forty. Why can I feel, especially within myself, that life is still a damn speech and debate competition? Maybe it is. After all, I’m still vying with others to win teaching contracts, spots as a keynote, deals with publishers. The cynical and yes, human, side of me knows that there will always be an element of competitiveness to life. As I continued to “go with it” in my own EMDR session that day the larger, spiritual truth filled my heart—teaching and being public in my field must never be a competition.
Our purpose as healers is to alleviate human suffering, bringing one of Buddha’s noble truths into beautiful fruition in this world. This task takes all kinds of people—those who have mass appeal and those who have niche appeal—and all types of talent. Working the front lines of community care in places like correctional facilities, treatment centers, and poorly funded public mental health facilities requires talent and commitment. People who will never give a training or write a book have a different yet wholly essential talents that I do not. This is where the heart of our work is happening and when I get into crazy places with my own ego, I must remember this truth.
In preparing to write this piece, I reached out to Marla Carano Honen, as we’ve been in touch on Facebook through the years. I wanted to make sure she was okay with me putting an article out there in which she is my nemesis of sorts. Marla is anything but a villain; she has helped me to see a higher truth. And in speaking with her about the premise of the popular kid complex—guess what? It affects her too! I firmly believe we are all that “popular kid” to someone who brings up their issues, and all of us have popular kids who bring up stuff that as adults we must learn to heal and to manage.
I also had the chance to spend some time on a retreat (Ram Das: Spring on Maui) with one of my legendary popular kids, Anne Lamott. And guess what? Anne has struggled with the perils of comparison and can still face her own share of dark thoughts. What I learned from her so robustly on retreat is that she continues to put one foot in front of another by working a 12-step program and reaching out to safe people with whom she can be honest. And in a story I ended up sharing with her, Anne helped me to sink into much of the solution.
After sitting through another beautifully folksy talk by Anne in her awkward loveliness, I walked to the back of the pavilion to get some tea. I thought to myself, “Jamie, even though you are getting more public with your work you will never be as likable as that.” And literally in the next breath a lovely young yogi comes up to me and says, “I like watching you dance at the kirtan. It’s so inspiring!”
Okay, I’m human enough to admit that part of my thinking went to, “Wow, a perfect looking young yogini likes the way I dance, I matter... I am valid! Roll credits.” Fortunately the spiritual truths of what I’ve been learning and studying kicked in and gave me the real lesson: When I dance, I am my most authentic self. I dance absent any kind of technical prowess. Dancing and responding mindfully to the music is the purest experience of being a vessel for Divine energy to flow. That doesn’t make me popular, and yet it does something much more magical. It attracts the people who need to feel it too so that hopefully they will be inspired to open up and be their unique expression of Divine flow.
And hmmm... doesn't this sound like something Brené Brown would teach in her groundbreaking work around vulnerability? Turns outI just had to work on my edge around her to fully open myself up to the teaching. From the bottom of my heart, I thank you Brené and all of my other popular kids for allowing me to "go there" and receive your wisdom.
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