9/3/2014. Which impairs the ability to integrate these experiences in an adaptive manner.

Transcription

1 Presented by DaLene Forester Thacker, PhD Licensed Marriage and Family Therapist Licensed Professional Clinical Counselor Director and Trainer with AEI I was not able to use EMDR at my work site because... I took some time off and now I m not sure I remember all the steps. I left the Basic Training feeling confident but when I thought about using EMDR, my confidence went out the window. I was afraid I would do EMDR wrong 1

2 o Evidence-based psychotherapy for o PTSD o A variety of researched mental health issues o Somatic symptoms o The AIP model posits that much of psychopathology is the result of o maladaptive encoding o incomplete processing Which impairs the ability to integrate these experiences in an adaptive manner. The 8-phase, 3-pronged process of EMDR facilitates the resumption of normal information processing and integration. By targeting past experience, current triggers, and future potential challenges, EMDR alleviates presenting symptoms, decreasing or eliminating distress from the disturbing memory. Resulting in an improved view of the self, relief from bodily disturbance, and resolution of present and future anticipated triggers (EMDRIA, 2011). Shapiro s (2001) AIP model guides clinical practice explains EMDR s effects provides a common platform for theoretical discussion. The AIP model provides the framework through which the 8-phases and 3-prongs (past, present, and future) of EMDR are understood and implemented. The evolution and elucidation of both mechanisms and models are ongoing through research and theory development. 2

3 In the broadest sense, EMDR is an integrative psychotherapy approach. Intended to treat psychological disorders alleviate human suffering assist individuals to fulfill their potential for development while minimizing risks of harm in its application For the client, EMDR treatment aims to achieve comprehensive treatment safely, effectively and efficiently, while maintaining client stability. Through EMDR, resolution of traumatic and disturbing adverse life experiences occurs Utilizing a unique standardized set of procedures and clinical protocols Incorporating dual focus of attention and alternating bilateral visual, auditory and/or tactile stimulation. Activating the components of the memory and facilitating the resumption of adaptive information processing and integration. Adverse life experiences trigger or exacerbate a wide range of mental, emotional, somatic, and behavioral disorders. Under optimal conditions, new experiences are assimilated by an information processing system that facilitates the linkage with already existing memory networks. The linkage of these memory networks tends to create a knowledge base regarding such phenomena as perceptions, attitudes, emotions, sensations and action tendencies. 3

4 Traumatic events &/or disturbing adverse life experiences can be encoded maladaptively in memory resulting in inadequate or impaired linkage with memory networks containing more adaptive information. Pathology is thought to result when adaptive information processing is impaired by these experiences which are inadequately processed. Information is maladaptively encoded and linked dysfunctionally within emotional, cognitive, somatosensory, and temporal systems. Memories thereby become susceptible to dysfunctional recall with respect to time, place, and context and may be experienced in fragmented form. Accordingly, new information, positive experiences and affects are unable to functionally connect with the disturbing memory. This impairment in linkage and the resultant inadequate integration contribute to a continuation of symptoms. EMDR procedures facilitate the effective reprocessing of traumatic events or adverse life experiences and associated beliefs, to an adaptive resolution. Specific procedural steps are used to access and reprocess information which incorporates alternating bilateral visual, auditory, or tactile stimulation. 4

5 These well-defined treatment procedures and protocols facilitate information reprocessing. EMDR utilizes an 8-phase, 3-pronged, approach to treatment that optimizes sufficient client stabilization before, during, and after the reprocessing of distressing and traumatic memories and associated stimuli. The intent of the EMDR approach to psychotherapy is to facilitate the client s innate ability to heal. Therefore, during memory reprocessing, therapist intervention is kept to the minimum necessary for the continuity of information reprocessing. Phase 1 History Phase 2 Preparation Phase 3 Assessment Phase 4 Desensitization Phase 5 Installation Phase 6 Body Scan Phase 7 Closure Phase 8 Reevaluation 5

6 Picture (Sensory level: images, sounds, smells, touch, taste) Cognitions (Neg & Pos Cogs) Emotions Body Sensations Measurement Scales (SUDs & VoC) Bilateral Stimulation Client Readiness Level of rapport with Therapist Affect tolerance and regulation Life stability Suicidal/Homicidal assessment Support System General Physical Health Medications, Drugs, Alcohol Client Readiness Systems Issues, Secondary Gains Timing Considerations Legal Requirements Dissociation (Dissociative Experiences Scale) 6

7 Standard intake process Focus on trauma history Genograms and trauma timelines Presenting Problem and Symptoms Listen for images, NCs, EMs, body sensations Duration Initial Cause (First) and additional past occurrences (what s pushing symptoms) Other complaints Present Constraints/Triggers Desired State Clinical judgment in choosing a comprehensive treatment plan Psycho-education Problem-solving Stress Management tools EMDR (some cls need strengthening of internal and external resources first) etc 7

8 Past Traumatic Issues: Touchstone Event Single Incidents Repetitive Similar Incidents (clusters) Identify-first, worst, most recent Top Ten Hit List (10 worst incidents) Relational Trauma w/ Significant People Target the dysfunction Negative Cognitions/beliefs Emotions Body Sensations Grief/Loss Difficult Decisions Four Basic Options (Shapiro, 2006) Symptom Focused Single Incident PTSD Single Issue, Brief Treatment Comprehensive Multiple Issues Complex PTSD 8

9 Appropriate Therapeutic Relationship Client-centered approach; client empowerment Therapist attunement to facilitate bonding Sufficient trust for client honesty about his/her experience Introducing EMDR to Clients EMDR Background Research Supporting EMDR Cautions for Clients DAS setup Metaphor for EMDR Processing Expectations or fears about EMDR Containment Image of Container Gather disturbing images, thoughts, emotions, body sensations Put in the Container Close Container and put it away Reverse Spiral Technique Light Stream Technique Safe Place Exercise Dual Attention 9

10 Issue What issue would you like to work on today? When is the first time you remember feeling that way? Image What picture represents the worst part of the incident? When you think of the incident what comes to mind? Negative Cognition What words go best with that picture that express your negative belief about yourself now? What does that make you believe about yourself now? An I statement Stated in the Present: I m worthless 10

11 Positive Cognition When you bring up that picture, what would you like to believe about yourself now? Self-referenced, generalizable belief Positive language avoid the word not Appropriate and relevant, same issue as Neg Cog, avoid always and never Identified by what feels right to the client Validity of Cognition (VoC) When you think of the picture, how true do those words (repeat PC) feel to you now on a scale of 1 to 7, where 1 feels completely false and 7 feels completely true? Emotions When you bring up the picture, and the words (repeat NC), what emotions do you feel now? 11

12 SUDS (Subjective Units of Disturbance) On a scale of 0 to 10, where 0 is no disturbance or neutral, and 10 is the highest disturbance you can imagine, how disturbing does it feel now? SUDS (Subjective Units of Disturbance) On a scale of 0 to 10, where 0 is no disturbance or neutral, and 10 is the highest disturbance you can imagine, how disturbing does it feel now? Reprocessing the disturbing material. Goal is to reduce the disturbance to a SUDs of Zero. Remember Cognitive restructuring is also occurring during this phase of EMDR 12

13 Remember, it is your mind and body doing the healing. It s like you re on a train riding through the landscape of disturbing material. Just let whatever happens, happen. It may be unexpected or odd; any information is connected in some way. Let yourself experience the images, thoughts, emotions, and body sensations without judging them or trying to understand them. You stay silent during the processing, and then we ll stop and check-in briefly about what s coming up. Now, bring up the picture and the words (NC) and notice where you feel it in your body, and follow my fingers. Observe and stay connected Supportive statements Begin with 24 sets during processing and adjust as necessary Check-in Point Educate the Client Does not need to report everything, only what s happening now Important to report changes in images, emotions, body sensations Be honest 13

14 Negative Material: Go with that. Mixed Neg/Neutral/Pos Material: Go with that disturbance. Neutral Material: Go back to the original image, and go with any disturbance. Positive Material: Go back to the original image, and go with any disturbance. Once all associated channels have been processed, returning to the original image will result in no disturbing emotions, thoughts, or body sensations arising for the client and a SUDs = 0, the target is considered desensitized. Check the PC Do the words (PC) still fit or is there another positive statement that fits better? Check the VoC When you bring up the original picture, how true do the words (PC) feel now on a scale from 1 to 7, where 1 is completely false and 7 is completely true? 14

15 Install the PC Now think of the original image/memory and hold it with the positive belief (PC). Keep repeating the positive belief and notice your experience. Keep doing sets until the VoC=7 or higher Close your eyes and keep in mind the original memory and the positive cognition. Then bring your attention to the different parts of your body, starting with your head and working downward. Any place you find any tension, tightness, or unusual sensation, tell me. If any tension or disturbance, target with DAS sets. The body scan phase is complete when the client, holding the target image and PC, can mentally scan the body and report no residual tension. Positive sensations can be targeted with short DAS sets. 15

16 Complete Session Remember that following an EMDR session you may experience continued processing in the next few days, including dreams, insights, new memories, emotional vulnerability, and body sensations. This is normal. You can keep a log of things that arise, especially potential future targets. If something disturbing arises, write it down and do the Containment, Safe Place &/or Spiral technique. If you feel it necessary, you can call me. Incomplete Session Inform the Client We are almost out of time and it is clear that there is more processing to be done on this issue. Is this a good place to stop for today? Acknowledge the Client s Work You have done some very good work today, moving through this issue. Incomplete Session Skip the Installation of PC and Body Scan Containment, Safe Place, or any other relaxation exercise that you are comfortable with Same closing comments as for a complete session 16

17 Reevaluation occurs at every session following EMDR processing. Focus on Has the target been resolved? Has associated material been activated that should be addressed Have all necessary targets been reprocessed. Peace with the past, empowered in the present, able to make choices for the future Phase One: Client History Phase Two: Preparation Phase Three: Assessment Phase Four: Desensitization Phase Five: Installation Phase Six: Body Scan Phase Seven: Closure Phase Eight: Reevaluation Past Future Present 17

18 The goal of treatment is: Process dysfunctionally held negative cognitions and incorporate new adaptive ways of viewing the past, i.e., positive cognitions. Let go of the past. Past: What memories set the foundation? Present: What situations trigger the disturbance? Future Templates: What skills, behaviors, information are necessary for optimal functioning in the future? Practice Session Phases 3 through 7 Assessment to Closure 18

19 Phase Three: Assessment Image NC PC VoC Emotions SUDS Body Sensations Phase Four: Desensitization Phase Five: Installation Phase Six: Body Scan Phase Seven: Closure (Complete or Incomplete) What did you learn? 19

20 20