Incorporating working with voices into EMDR Therapy. Colin Ross & Dolores Mosquera, EMDRIA 2017

Transcription

1 Incorporating working with voices into EMDR Therapy Colin Ross & Dolores Mosquera, EMDRIA 2017

2 DDIS PROFILE OF DIFFERENT GROUPS DID DDNOS Schizophr Adolesc CD-1 CD-2 GI Gen Pop 10 0 Somatic Schneider 20 DID BPD ESP Total

3 DID TREATMENT OUTCOME REFERENCES } Ellason, J.W., Ross, C.A. (1996). Millon Clinical Multiaxial Inventory II follow-up of patients with dissociative identity disorder. Psychological Reports, 78, } Ellason, J.W., Ross, C.A. (1997). Two-year follow-up of inpatients with dissociative identity disorder. American Journal of Psychiatry, 154, } Ellason, J.W., Ross, C.A. (2004). SCL-90-R norms for dissociative identity disorder. Journal of Trauma and Dissociation, 3,

4 DID TREATMENT OUTCOME REFERENCES } Ross, C.A., Ellason, J.W. (2001). Acute stabilization in an Trauma Program. Journal of Trauma and Dissociation, 2, } Ross, C.A., Haley, C. (2004). Acute stabilization and three month follow-up in a Trauma Program. Journal of Trauma and Dissociation, 5, } Ross, C.A., Burns, S. (2007). Acute stabilization in a Trauma Program: A pilot study. Journal of Psychological Trauma, 6, } Ross, C.A., Goode, C., & Schroeder, E. (under review). A ten-month follow-up of inpatients in a trauma program.

5 TALKING TO THE VOICES Principles of Individual Therapy The Central Paradox of DID The Problem of Host Resistance Talking Through to Alters Orientation to the Body & The Present

6 TALKING TO THE VOICES Principles of Individual Therapy Therapeutic Neutrality Practicing Co-Consciousness Practicing Co-Presence Writing Letters to Alters

7 The internal conflict and the work with voices

8 The internal conflict and the work with voices } When we approach the internal system of parts, some degree of conflict between these parts is often present. } The main goal in the beginning is to reduce the conflict within the system.

9 The internal conflict and the work with voices } Most approaches to helping people with voices have something to do with: } Trying to get rid of the voices, such as by taking drugs till they fade away } Ignoring the voices or distracting attention away from them.

10 The internal conflict and the work with voices } One problem with these strategies is that they all involve avoiding issues or emotions the voices may be bringing up. } A key aspect of the work with voices is to listen and understand their function and the meaning behind their disruptive behaviors.

11 The internal conflict and the work with voices } And the less they are heard and the more they are ignored, the more they need to scream

12 } Video

13 Basic aspects of the work with voices

14 The work with voices and parts Basic aspects } Use the client s language (parts, aspects, things in me, voices, ) } Our messages should keep in mind the whole system } Important to respect the feelings and thoughts of all parts

15 How to improve the relationship with the voices Moskowitz, Mosquera & Longden, 2017

16 How to improve the relationship with the voices } Patients typically need help in understanding and relating differently to their voices. } It is known that patients who develop a meaningful understanding of their voices usually do better than those who are avoidant or critical of, or reject their voices (Romme et al., 2009).

17 Some ways to begin the work } Have patients listen to what the voices have to say, but not act on any suggestions or commands. } Explain that we recognize this is often difficult, but the less we listen and the more the voices are ignored, the more likely they are to get louder or escalate their behaviors in a desperate attempt to be acknowledged. } Promote empathy between patient and voices. } The more empathy, the more compassion and cooperation.

18 Some ways to begin the work } Once the patient is able to listen: } Promote curiosity toward the message that the voice is attempting to get across. } What is the voice trying to achieve by its comments? } What is the voice concerned about? } Is the voice trying to help in some way? } What does the voice think would happen if you did x, and how would the voice feel after that?

19 Some ways to begin the work } Try to recognize the function the voice has and its capacity to help } For example, by calling attention to situations similar to previous conflicts the person has faced. } After understanding what the voice is concerned about or how it is trying to help, validate the effort but suggest more useful or adaptive ways for the voice to help the person.

20 Some ways to begin the work } Exploring resources and ways of moving forward that are shared by the different voices and the patient. } For example, one voice might have the capacity to help defend the system, another to identify possible dangers, and a third to be playful and enjoy life. } This can lead to a more integrated self where each voice represents something that is useful for better functioning. } Reach agreements or compromises that all voices can accept, for the benefit of the entire system/person.

21 Goals in the first sessions

22 Goals for the first sessions I } Establish a good alliance with the whole system. } Avoid insults and negative comments. } Increase curiosity (healthy curiosity). } Promote dialogue and collaboration instead of arguments or fights.

23 Goals for the first sessions II } Identify the function of each part. } Identify the needs of each part. } Promote empathy, cooperation and negotiation } (Compassion and understanding as key ingredients) } Respect the rhythm of each part of the system } Identify and develop resources } Increase reflective thinking } By doing this we are promoting integration from the first session.

24 Exploring the internal system

25 Exploring the internal system. Useful questions (Mosquera, 2013) } Can you describe the voice/s? } How does it sound? What is the tone? Does it remind you of anyone? } When does the voice show up? } Does it show up when you feel upset or when you feel ok? } How do you notice the voice/s? } Is the voice angry, upset, afraid.

26 Exploring the internal system. Useful questions (Mosquera, 2013) } What does this voice need? } What do you think about that? } What do you need from this voice? } What does the voice think about that? } How does this voice feel about? } How do you think the voice feels about? } What is this voice s function? } What is it trying to achieve by doing? } How can this voice help? } How can we help this voice?

27 } Case examples and videos