Art of EMDR. Art of EMDR. Art of EMDR 7/16/16. Therapeutic presence, attunement and resonance

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Horace Blake
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1 Roger M. Solomon, Ph.D. Most of this workshop is observing videos of sessions and understanding what is happening from an interactional, nonverbal, process perspective Therapeutic presence, attunement and resonance Tracking client s response Timing and pacing of BLS Controlling the pace Type of BLS When to interweave, when to stay out of the way EMDR therapy - Its still therapy EMDR therapy involves clinical presence, attunement, resonating with the client, and using DAS to move and integrate material according to client s readiness, tolerance, and capacity. Therapist presence during processing such events is crucial and DAS is an extension of therapeutic attunement and resonance. 1

2 Therapeutic presence, attunement, and resonance In physics resonance is a sympathetic vibration between two elements (prolongation of a sound)that allows them to energetically entrain, synchronize and act in a sudden new harmony. (Entrainment, within the study of chronobiology, occurs when rhythmic physiological or behavior events match their period and phase to that of an environmental oscillation. Resonance Resonance between people is the direct experience of temporarily entering into the perceptual / feeling / thinking / relational world of another in which the other is experienced as one s own self the you in me Results in a synchronicity of movement, expression, breathing, pacing and leading.. Begins at the start of therapy and is particularly important during EMDR processing. Attachment and attunement (Siegel, 2010) Attachment has everything to do with felt safety, and attunement by the caregiver is crucial to a secure attachment and affect regulation Psychobiological core of attunement ( beginning with mother and child) is the continual, subtle, body-based, interactive exchange of looks, vocalizations, body language, eye contact, and speech. Therapist needs to tune into the "critical micromoments of interaction" with the client includi ng tone of voice, facial expression, posture, motion, eye gaze that "reveal otherwise hidden states of mind 2

3 Attunement (Siegel, 2010) A hands-on, body-on, mind-on therapy, in which the therapist's whole self vibrates like a tuning fork to every quiver in the client's being without losing the basic emotional stability that the client needs to help regulate his or her own runaway emotions (Wylie and Turner, 2016) The right brain/limbic (unconscious, emotional, intuitive) interaction of the psychotherapist and client is more important than cognitive or behavioral suggestions from the therapist; the psychotherapist's emotionally charged verbal and nonverbal, psychobiological attunement to the client and to his/her own internal triggers is critical to effective therapy. Energy flow.secure attachments in both childhood and adulthood are established by two individual's sharing a nonverbal focus on the energy flow (emotional states) and a verbal focus on the information-processing aspects (representational processes of memory and narrative) of mental life. (Siegel, 2001) The matter of the mind matters for secure attachments. (Siegel, 2001) Resonance (energy flow)/attunement Occurs between therapist s fingers (or other forms of BLS) and the client as the therapist adapts to client and client adapts to therapist - a dance The dance is adapting Dual Attention Stimulation DAS) to maximize processing as observed through facial expression, breathing, and changes noted after a set ( What do you notice.?). There seems to be a cross cultural facial expression that occurs when material is processing in adaptive manner. 3

4 Tracking client response Each set of DAS is an assessment Safe/calm place and RDI are an assessment of client response to EMDR therapy Client s response determines what to do next Timing and pacing Two trajectories: 1) As fast as the client can comfortably go 2) Timing/pacing determined by client s facial expression of engagement, breathing, and client s post DAS response. Entrainment - rhythmic physiological or behavior events match their period and phase to that of an environmental oscillation - flow that occurs Controlling the pace Eye movement vs tapping vs auditory Longer versus slower sets Talking in between sets Back to target 4

5 Type of DAS EM vs tapping Determine DAS modality by client response, not only client preference Keep it simple Remember, client is still aware of you, regardless of type DAS and takes cue from your non verbal resonance When to interweave Hallmark of EMDR is staying out of the way and facilitating client s response through DAS, augmented by resonance and fine tuned to client s response You can t do it better than the client When to interweave Looping Lack of generalization Running out of time Outside of Window of tolerance 5

6 To interweave or stay out of the way Is the client within the window of tolerance and able to stay present, report what is happening, and reflect? If there is a block, remember the hierarchy of intrusiveness - change direction or type of DAS - back to target - float back - interweave Understand cause of blocked processing Lack of information Dissociated part of the personality is triggered Too much is coming up resulting in hyperarousal - client is overwhelmed Too much is coming up resulting in phobic avoidance and shut down or hypoarousal (signs include headache/body aches, numbness, vague body sensations, dizziness, sleepiness..) Feeder memories Blocking beliefs Know the clinical phenomena being experienced Dissociation Whether the client is talking then or now A part is hijacking or interfering with processing 6

7 EMDR therapy is therapy and the therapeutic relationship is paramount 7

PTSD, Chronic PTSD, C-PTSD

Treating Complex PTSD and Dissociation with Integrative EMDR Therapy: A Resilience Informed Approach to Trauma Treatment Arielle Schwartz, PhD PTSD, Chronic PTSD, C-PTSD Acute Traumatic Stress: Normal