Frontiers in the Treatment of Trauma

Transcription

1 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - TalkBack - pg. 1 Frontiers in the Treatment of Trauma The Power of EMDR to Treat Trauma: Identifying, Reprocessing, and Integrating Traumatic Memories a TalkBack Session with Joan Borysenko, PhD; Ron Siegel, PsyD; and Ruth Buczynski, PhD

2 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - TalkBack - pg. 2 A TalkBack Session: The Power of EMDR to Treat Trauma: Identifying, Reprocessing, and Integrating Traumatic Memories with Ruth Buczynski, PhD; Joan Borysenko, PhD; and Ron Siegel, PsyD Table of Contents (click to go to a page) What Stood Out Most... 3 How to Work with Clients with Shame Issues... 5 The Safe Place Technique... 7 The Role of Sleep in Trauma... 9 How Minor Events Can Lead to Traumatic Symptoms About the Speakers... 13

3 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - TalkBack - pg. 3 A TalkBack Session: The Power of EMDR to Treat Trauma: Identifying, Reprocessing, and Integrating Traumatic Memories with Ruth Buczynski, PhD; Joan Borysenko, PhD; and Ron Siegel, PsyD Dr. Buczynski: I m going to now turn to my two Friends, both licensed psychologists. Dr. Ron Siegel is assistant clinical professor of psychology at Harvard Medical School, in private practice, and the author of several books as well as co-editor of Wisdom and Compassion in Psychotherapy. Dr. Joan Borysenko is, in addition to being a psychologist, a cell biologist and the author of Fire in the Soul, among many other books. Welcome back to both of you. What Stood Out Most Dr. Buczynski: Let me start, again, by asking what struck you most in this session? Let's go with you first, Joan. Dr. Borysenko: First, Ruth, I was really struck with the humanity of this story: how Francine stumbled literally stumbled upon EMDR. She tells the story so simply how it was that she was an English literature professor, got cancer, and then had disturbing thoughts. She made the discovery one day that if a disturbing thought came up and her eyes were moving, when the thought came up again, the charge was gone. Most people would have simply let that go. But there was something about her very bright mind, the If a disturbing thought came up and her eyes were moving, when the thought came up again, the charge was gone. experience she had of cancer, and then the miracle of a disturbing thought going away with eye movement, that she became her own laboratory. She really looked at this. There is a woman who has tremendous self-awareness first, to be able to do that. Then, she went ahead and got the training that she needed to apply this clinically.

4 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - TalkBack - pg. 4 If you talk about wisdom and compassion that is what I really felt from her. She wanted other people not to suffer so much, and because this whole eye movement seemed weird and bizarre to people, she put up with a lot of, What do you mean? How could this work? There can t be any science behind it. And Ruth, I think you did a really superb job, having her discuss the really amazing statistics and studies that have been done on the success of EMDR and in how many places EMDR is used. The other thing that really struck me is she said, Look, it s not the beliefs that are causing the problem; they re a symptom of a deeper problem, and the deeper problem is that you have experiences that are unprocessed. Certainly, you have talked many times to Dan Siegel. You have had a couple of fantastic brain science series, and they all point to the need to It s not the beliefs that are causing the problem; they re a symptom of a deeper problem. integrate the various areas of the brain where these unprocessed emotions are. Siegel would say, You have to integrate the upstairs brain and the downstairs brain, and the right and the left. Ruth Lanius is really making a case for the fact that EMDR can do that. It s fascinating also to realize that, always in science, there has to be a hypothesis first, which is based on somebody being a really good observer, and she was a fantastic observer. This is a technique (EMDR) which has been shown to work and now we re kind of scrambling to understand the science of it. But I say, Bravo, Francine! This is a technique which has been shown to work and now we re scrambling to understand the science. Dr. Buczynski: What struck you, Ron? Dr. Siegel: I also enjoyed hearing the story and the humanity of it very much for the same reasons that Joan mentioned. I was also struck by how EMDR can so easily be oversimplified or dismissed as a technique. What was very moving to me in hearing the overall interview that you did with Francine was that the technique part is only one small piece of the overall picture. Her EMDR approach is really a comprehensive way of looking at what trauma is and how traumatic memories go on to affect us in many different ways in our lives.

5 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - TalkBack - pg. 5 Even though EMDR uses certain techniques, it is part of a much broader psychotherapy package. It includes a great deal of psychodynamic work and involves going back and looking at early experiences. It includes the narratives associated with those experiences, and how they re currently shaping our lives. EMDR has a behavioral aspect, in which it really looks at learning patterns and particularly patterns of avoidance and helping people to expose themselves to what they had been avoiding in the past. EMDR has a somatic part that resonates with Peter Levine s work the body holding the memory and the body being the source of information about the memory. EMDR has an interpersonal aspect or a systemic aspect, in which the nature of the therapy relationship is critical and the nature of one s relationship to the world is critical. Even though we re taught and we re using this technique, it s a therapy based on the technique that has been so effective. I frankly think it remains to be seen a little bit just how much is coming just from the technique and how much is coming from the fact that Francine has developed a package, which is a very comprehensive approach to psychotherapy more broadly. How to Work with Clients with Shame Issues Dr. Buczynski: Moving on, Joan, back to you Francine talked about working with clients who had shame issues clients who have done something in the past that they feel ashamed about. How do you work with clients who have shame issues? Dr. Borysenko: Actually, this was one of my greatest interests. When I ran a mind-body clinic in the eighties at one of the Harvard teaching hospitals, I tried to be a good observer of who could take the mind-body People who had a deep-seated sense of shame, and who really blamed themselves were the people who did not heal. techniques, really run with them, and have some kind of ease of symptoms and transformation. I was observing, too, who had a lot of trouble with mind-body techniques they didn t seem to work for them they didn t want to do the meditations.

6 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - TalkBack - pg. 6 If you looked at their medical and psychological symptoms, they didn t change very much. I found, and this was not a study it was an observation that people who had a deep-seated sense of shame, who really did not like themselves and who really blamed themselves and beat themselves up, were the people who did not heal. So, I have had a long questioning in my mind: How, as a therapist, can I be most helpful to that pattern? It really comes down to self-forgiveness. This is very important. There is now a very robust literature on forgiveness forgiveness of others and forgiveness of self. There are steps to self-forgiveness. There are lots of different kinds of steps to forgiveness, but in general, what I help people do first of all is come to the recognition of how the shame is affecting their life so positively. It s not so much that something is coming from the outside world, but it s something that is coming from inside themselves that has become a roadblock for them. I want a person to really look at what ways that creates suffering, and then to begin the process of forgiveness. It really comes down to self-forgiveness. Turns out that what is critical in this process is changing the meaning of an event. Maybe we ll talk more about this in another question, but there are lots of studies that have shown that if you do something wrong or somebody else does something wrong and you can find a benefit in it, then that completely changes the memory. For example, I learned something about myself I became more compassionate I really discovered what empathy was This got me on the road to doing volunteer work or practicing meditation or I wouldn t be me Self-forgiveness is the transformation of what you have done into a celebration of who you have become. if I hadn t any of these can change the memory. Francine talked a lot about this: how you actually don't just put in some new memory, but you transform the original memory. That is what self-forgiveness is all about it s the transformation of what you have done into a celebration of who you have become.

7 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - TalkBack - pg. 7 The Safe Place Technique Dr. Buczynski: Ron, one of the other parts that Francine talked about and it was a technique was the safe place technique. Do you have any ways of making sure that clients feel safe when they are working with distressing experiences? Dr. Siegel: One of the first ways involves taking off from what Joan was just talking about seeing to what extent they re busy beating themselves up for their participation in that past experience and developing some sense of self-compassion out of it. It s noticing that, My experience makes perfect sense, given all the factors that were around, given my circumstance, and given my own background it s not because of some basic badness in me. So that is one level of it. All of these techniques involve bringing the attention back to some neutral stimulus in the present moment. In EMDR, many of the techniques are these explicit safe place techniques, which are about imagining places that we have felt safe in during our life. But there is also a kind of safety which is brought about simply by doing these rituals of bilateral stimulation whether it s the eyes moving back and forth or you re tapping alternately one side or another, or they ll use flashing lights to one side or another. All of these techniques involve bringing the attention back to some neutral stimulus in the present moment. They all are training the mind to Come here and attend to this. It turns out that this the actual moment-to-moment sensations that we re experiencing (and we talked about this in the last call) is usually safe. We re trying to let a person take refuge in the simple sensory experience of the present moment. Unless we re actually being attacked by the lion or actually being attacked in Central Park, this moment is safe to be embodied in physically. So many of the techniques in EMDR are similar to the techniques that we use in mindfulness-oriented treatment where we re trying to let a person take refuge in the simple sensory experience of the present moment. Then there are forms of safety that are more spiritual in nature; they re about helping us to identify with

8 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - TalkBack - pg. 8 something larger than ourselves. One of my favorite cartoons shows a couple of middle-aged women and middle-aged guys sitting on the couch, and one woman is saying to the other, Donald is such a fatalist; he s convinced he s going to grow old and die. Our existential predicament is difficult. Our prognosis is quite poor. There is a lot of reason to not feel safe. Once we go through, Well, bad things only happen to cigarette smokers and people who don't wear their seatbelts, at a certain point we realize, No bad things happen to everybody. At one point or another, and if we re going to have any sense of safety If we re going to have any sense of safety it has to be through identification with something larger. in this, it has to be through identification with something larger than our personal drama, and particularly our own aggrandizement of achievements. The whole realm of spiritual practices whether those are theistic, in terms of God or divinity, or whether they re about feeling part of nature or even part of the creative processes is another form or another way that people can get a sense of safety. Then there are the techniques that Francine was talking about imagining the beach, or the mountainside or something like that. It s useful for us to think flexibly about all of the different ways that we can find refuge. This also raises the very interesting question and I don't know the research on this of how much of the It s useful for us to think flexibly about all of the different ways that we can find refuge. wonderful effects of EMDR are really based on bringing the person back to a sensation in the present moment, developing safety there, and from that point of safety, dipping into the traumatic memory and going back and forth titrating the intensity of this which is what we would want to do in good trauma work generally. Is it the bilaterality that is crucial, or is it this movement back and forth that is crucial? I frankly don't know, but I would be very interested in seeing what the research is as they compare those two trying to see which component has to do with the bilaterality and which component has to do with this larger mechanism?

9 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - TalkBack - pg. 9 The Role of Sleep in Trauma Dr. Buczynski: Joan, let s talk about sleep the role of sleep in trauma. You must have worked with a lot of people who have sleep issues as perhaps their primary PTS symptom, or people who have had night terrors. Can you tell us some of your thoughts on how you incorporate those ideas how do you think about sleep and trauma? How do you work with it? Dr. Borysenko: We spend a third of our life sleeping and then every night we have four to five sessions of REM sleep and dreaming, which start with really short sessions and by morning, most of us are aware that our dreams have taken on an epic quality and they re long. In fact, that last REM phase is about ninety minutes, and in it we re actually integrating the themes from dreams earlier in the night. There has been quite a lot of dream research, and it s interesting to note that some people will tell you, Well, I don't dream. But, we do we all dream. We all have these periods of REM sleep. The question is whether we recall our dreams. The thing about having nightmares, which frequently come after We all dream. We all have these periods of REM sleep. The question is whether we recall our dreams. trauma, is that we can t help recalling those dreams they break through in such a vivid way and we have a choice to make with those dreams. We can either try to ignore them not go to sleep, so that we won t have them in other words, avoid them. Or we can look into them here we re back to a good psychoeducational framework when the therapist says, Your dreams hold within them the seed of your healing and so let s look for the gift in these dreams. Now, Francine was talking about a theory of dreams. There are many theories of dreams and what they do Your dreams hold within them the seed of your healing and so let s look for the gift in these dreams. physiologically and psychologically. She was talking about the theory that dreams actually do something like some of the psychotherapeutic aspects of EMDR they help you integrate emotional experience and put it in a different framework. Normally, though, you don't see that in a nightmare. But there may be a seed and it is interesting to say,

10 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - TalkBack - pg. 10 Let s look at the seed of this nightmare. You then bring it into therapy and just see how it applies how it reintegrates. I will give you a personal example. Last night I had a bizarre dream there What piece of wisdom does this dream hold for my healing? was a house with many rooms; it was all chaotic. I had a group and I was trying to get them to a room where meditation was practiced, and I couldn t get there the elevator didn t work. Then I got there and a group of angry monkeys were disrupting the whole thing sort of like monkey mind, a typical metaphor in the framework of awareness and meditation. But as I woke up, I realized there was such an important message in there. It was my nervous system trying to reintegrate: at this moment, I feel like my life is distracted and chaotic; I m doing too many things and the center cannot hold. So in looking at a dream every dream is to say, What piece of wisdom does this dream hold for my Once you have put an experience into a framework that has positive meaning, it is held in an entirely different way. healing? That is so important. If a piece of wisdom is not immediately evident, then you can ask the client, If there were a seed of healing or a healing image in this dream, what might it be? Jung did a lot of work like this, on waking dream, and you would figure out, Okay you can take it to another conclusion. Then Francine was very good at looking at some of the brain science of this: where memories are held. The idea is that once you have put an experience into a framework that has positive meaning, it is held in an entirely different way. Dreams are just an elegant way of getting information and integrating it. How Minor Events Can Lead to Traumatic Symptoms Dr. Buczynski: Ron, when Francine was talking about trauma, she talked about big T and small T or ideas that sometimes relatively minor events can lead up to traumatic symptoms. Did you have any thoughts on how we might work with that?

11 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - TalkBack - pg. 11 Dr. Siegel: Yes, I was very appreciative that she had laid this out because I often feel, sheepishly, that I do have some personal appreciation for what the effects of trauma are, even though my life has been pretty good. I really haven't suffered major out-of-the-ordinary kinds of traumas, and yet I seem to notice that relatively small things will cause me to dissociate mildly not in a big way, but I really haven't suffered major traumas, and yet I seem to notice that relatively small things will cause me to dissociate mildly. dissociate in the sense of pushing affects out of awareness or not connecting the narrative with the somatic experience of a memory. There are triggers that I will encounter in the course of my life. I sometimes joke when I m teaching that I am polymorphously psychopathological; that means I have never read about any kind of disorder that I haven't experienced to some degree in my own consciousness. But I feel guilty about it, thinking, Well, people have real trauma and yet I m trying to extrapolate from my own experience. I really appreciated that Francine was able to put this on a continuum and was even able to invite us to Traumatic memories tend to distort how we take in our current experience. remember a time I think she said in grade school in which we might have been embarrassed or had some untoward emotional experience, and to begin to notice that even those kinds of events become encoded as traumatic memories. We are triggered when we get near to them; they tend to distort how we take in our current experience we tend to see whatever is happening currently as a replay of what had happened in the past. It s enormously useful to see it this way and very useful to not see severe trauma as discontinuous with everyday trauma. It also means when we re with our patients, if we haven t suffered really bad traumas ourselves, we don't have to think of them as living on another planet. We can understand that, Okay, they have had this trauma only big time, and multiplied it as living in a larger way. Perhaps, it has had even more profound effects on their consciousness. We all experience trauma in the small ways and in the big ways. But we can talk about it with them in the sense that, We all experience trauma in the small ways and in

12 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - TalkBack - pg. 12 the big ways. That is enormously normalizing. It is very helpful to think of all of psychotherapy as basically reintegrating past traumatic events whether it s that moment in junior high that felt awkward, or the horrible thing that happened in war, in sexual assault, or in some other kind of circumstance. Dr. Buczynski: Thanks. I m afraid we re going to have to stop there. This has been a fascinating session.

13 The Power of EMDR to Treat Trauma Francine Shapiro, PhD - TalkBack - pg. 13 About the speakers... Joan Borysenko, PhD has been described as a respected scientist, gifted therapist, and unabashed mystic. Trained at Harvard Medical School, she was an instructor in medicine until Currently the President of Mind/Body Health Sciences, Inc., she is an internationally known speaker and consultant in women s health and spirituality, integrative medicine and the mind/body connection. Joan also has a regular 2 to 3 page column she writes in Prevention every month. She is the author of nine books, including New York Times bestsellers. Ron Siegel, PsyD is an Assistant Clinical Professor of Psychology at Harvard Medical School, where he has taught for over 20 years. He is a long time student of mindfulness mediation and serves on the Board of Directors and faculty for the Institute for Medication and Therapy. Dr. Siegel teachers nationally about mindfulness and psychotherapy and mind/body treatment, while maintaining a private practice in Lincoln, MA. He is co-editor of Mindfulness and Psychotherapy and co-author of Back Sense: A Revolutionary Approach to Halting the Cycle of Chronic Back Pain.