Eye Movement Desensitization and Reprocessing (EMDR)

Transcription

1 Eye Movement Desensitization and Reprocessing (EMDR) EMDR with families A case study Karl Speirs (LMFT) David Eliscu (LCSW) March 1, 2012 Clifford W. Beers Guidance Clinic, Inc.

2 Outline History of this presentation New Paradigm Allan Schore Theory impact of trauma on the brain Trauma Attachment Intervention Why MFT & EMDR? Systems Theory/Family Therapy Adaptive Information Processing/EMDR Integration of MFT & EMDR Working with the family

3 Learning Objectives Participants will be able to: Describe Schore s new paradigm in psychotherapy Describe the impact of trauma and attachment trauma on the brain Describe how the Adaptive Information Processing model can be used to help children and families overcome trauma List the benefits of using EMDR with Family Therapy

4 History of this presentation Who we are Clifford Beers Guidance Clinic, New Haven Population Medicaid clients Children and families, most with significant trauma histories Private Practice Family therapy and EMDR A complex family presentation at CBC

5 New Paradigm Allan Schore

6 New Paradigm Allan Schore New research shows that the cognitive Left-Brain models of the past are inadequate Shift from left to right brain focus Right brain has strong link to limbic system Limbic system central to self regulation

7 Vertical axis of right brain cortical-subcortical limbicautonomic circuits and subsequent connections into the left brain - Allan N. Schore, PhD

8 Trauma impact on the brain

9 Trauma Theory ( Acute Trauma Single traumatic event Chronic Trauma Multiple or ongoing trauma Complex Trauma Chronic trauma that involves/is caused by adults entrusted with the child s care (primary care giving system) The impact of such exposure on the child pervasive impact

10 Trauma Theory ( Trauma has serious implications for brain development Trauma may affect cross-talk between the brain s hemispheres, including parts of the brain governing emotions. Trauma may be stored in the body in the form of physical tension or health complaints.

11 Brain s response to trauma Single Photon Emission Computed Tomography (SPECT) Scans with Vietnam vets Right hemisphere extremely active Left hemisphere is completely shut down Psychological trauma causes disruption of bilateral hemispheric processing Trauma memories isolated in right hemisphere unable to be interpreted and processed by cognitive awareness of left hemisphere

12 Attachment Early developmental stages in attachment determine the quality of later relationships and how an individual relates to him/herself and the world at large As the caregiver understands and responds to the newborn infant s signals of moment-tomoment changes in his state, a dyadic regulatory system gradually evolves. If not the child may not learn how to regulate his/her own emotions

13 The Attachment System The Attachment System is A training ground for later relationships Trust, safety, self worth A training ground for emotional regulation

14 Attachment and family systems Poor quality attachments interfere with a healthy family hierarchy no respect for/ comfort with caregiver Parents not adequately regulate emotional experience Cannot fully trust caregiver/parent No sense of I am the little one, you are the big one, and I can depend on you. EMDR & Family Therapy Processes (Kaslow Maxfield Shapiro)

15 Brain s response to Attachment trauma Early abuse and neglect impact the growth of the limbic system (emotional regulation) Attachment relationship literally shapes baby s ability to cope with emotions Determines whether development of stable, trusting relationships and ability to regulate and self-soothe. Early trauma, neglect or abuse creates predisposition to the development of PTSD

16 Integration Why MFT & EMDR?

17 Systems Theory/Family Therapy Systems theory looks at systems: Community - School, legal, service providers Family - the dynamics of the individual parts, and how they interact as a whole Individuals - what is happening within the individual (e.g. reactions to trauma, barriers to relationships)

18 Systems Theory/Family Therapy Private Practice Individuals Family Agency Legal system School Care Coordination

19 How it fits together TRAUMA SYSTEMS THEORY Individuals EMDR EMDR Attachment Family Community

20 Integration Family Therapy Family therapy (provides safe foundation) Genograms Structural Family Therapy Parent education (Circle of Security) Emotional Literacy Communication patterns and skills Conflict resolution

21 Integration - Adaptive Information Processing We assimilate incoming stimuli into existing memory networks Disturbing memories can be maladaptively stored in their own networks causing symptoms These maladaptively stored memories are largely inaccessible to the prefrontal cortex without BLS EMDR s procedures have been developed to access maladaptively stored information by activating the natural healing process of the brain (Adaptive Information Processing System). Bilateral stimulation accesses this information and allows its emotional impact to be lowered (desensitisation). Shapiro, F., Kaslow, F.W, Maxfield, L (2007)

22 EMDR why it works Client centred/empowering SUDs & VoC Sensation-based, cognitive, emotional, and physiological processing Dual Attention Stimulation (DAS) = dual focus of attention on present stimuli and past trauma Bilateral Stimulation (BLS) = stimulating both hemispheres of the brain

23 Modes of Bi-lateral Stimulation

24 Subjective Units of Disturbance (SUD) for Negative Cognition

25 Validity of Cognition (VoC) for Positive Cognition

26 ress.com/emdr.html

27 EMDR EMDR allows access to traumatic memory in right hemisphere Right hemisphere links to limbic system EMDR works from bottom -up (limbic system to neo-cortex) Talk therapies try to work from top down

28 Benefits of EMDR for Attachment issues Helps prevent parent attachment problems with children Re-process memories from parent s childhood Facilitates attachment repair Re-process memories from parent s childhood Re-process neural network for attachment trauma in child Results New more adaptive neural networks for both child and parent Affect regulation through adaptive processing

29 MFT & EMDR EMDR - removes the obstacles to affectional bonds within an individual, creating a window of opportunity for closeness MFT - If the family is not ready to support those changes (ability to express feelings, listening, conflict resolution, having fun together) then the window may close

30 Case study material removed for posting on Clifford Beers Website

31 Affect Regulation: Treatment Window Hyperarousal TREATMENT WINDOW Hypoarousal

32 Specific interventions Family therapy Family maps Boundary interventions Communication interventions Attachment and attunement work AIP/EMDR Container Safe Place Resource Development and installation Mind Map Walking running using AIP/EMDR protocol EMD processing Free association processing Cognitive interweaves

33 Container

34 Safe Place

35 Mind map

36 Getting started & EMDR training Non profits = EMDR Humanitarian Assistance Programs (HAP) EMDR part I & part II ($375 per training) Each training (morning lecture, afternoon practical) Fri 8:15 AM - 6:00 PM Sat 8:15 AM - 6:00 PM Sun 8:15 AM - 5:00 PM EMDR Advanced Child & Adolescent Training STEP BY STEP: Making EMDR Treatment Effective and Developmentally Appropriate for Children and Adolescents, Ana Gomez, MC LPC

37 Internet resources EMDR Institute, Inc. EMDR International Association (EMDRIA) EMDR-Humanitarian Assistance Programs (HAP)

38 Bibliography Eye Movement Desensitization and Reprocessing (EMDR): Basic Principles, Protocols, and Procedures, 2nd Edition. Francine Shapiro (2001) Handbook of EMDR and Family Therapy Processes. Francine Shapiro, Florence W. Kaslow, and Louise Maxfield (2007) EMDR and the Art of Psychotherapy with Children (Text & Treatment Manual), Robbie Adler-Tapia PhD and Carolyn Settle MSW LCSW (2008) Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development. Allan N. Schore (1999) Paperback Press. The treatment of psychological trauma from the perspective of attachment research, Felicity De Zulueta, Journal of Family Therapy, Volume 28, Issue 4, pages , November 2006 Through the Eyes of a Child: EMDR with Children. Robert H. Tinker, Sandy A. Wilson, Robbie Dutton, Sandra D. Wilson. (1999) New York: W.W. Norton.

39 Bibliography internet

40 EMDR Substance Abuse and Mental Health Services Administration (SAMHSA) (2010) - EMDR was included in the registry of Evidence Based Practices. Department of Veterans Affairs and Department of Defense (2004, 2010) - EMDR was placed in the "A" category as strongly recommended for the treatment of trauma. American Psychiatric Association (2004) - EMDR was determined to be an effective treatment for trauma.

41 Dr D Amen: PTSD, EMDR & SPECT

42 Typical plan Family therapy, psychoeducation and support EMDR work to reduce emotional response to triggers Social skill development and support