Trouble shooting Common Difficulties when using the Standard EMDR protocol. Kay Toon
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1 Trouble shooting Common Difficulties when using the Standard EMDR protocol Kay Toon
2 Focus today Getting to grips with the protocols This session: Getting to grips with the standard protocol difficulties and errors when using the standard protocol with single or multiple simple traumas Focus on the reprocessing phase
3 Kay Toon EMDR (Europe) Accredited Consultant Chartered Clinical Psychologist, BPS Registered with Health Professions Council Worked in NHS for > 20 years Now works independently at The Orchard, Horsforth, Leeds EMDR Therapist, Supervisor, Performance Enhancement Co author of Breaking Free and The Breaking Free Workbook Facilitator of training workshops (not EMDR trainer) Kay Toon
4 Motivation Consultant training (standard protocol and supervision skills) Joany Spiering inspiration and materials Getting even better results! Share learning and learn more! Why me?
5 Aims of this session To increase the confidence and effectiveness of the participants in their use of the EMDR standard protocol (with single or multiple simple traumas, etc). To increase knowledge of the standard protocol by looking at common errors and problems that can occur and by using the theoretical basis to find solutions. To encourage participants to keep to the standard protocol where possible; and to understand the circumstances when it may be necessary to deviate from it. For us all to learn something and enjoy ourselves! Kay Toon
6 Programme Common difficulties when using the standard protocol Reprocessing phase speed of processing Window of Tolerance errors in the process of Desensitisation Summary Questions Overheads will be put on the website ( Back burner Kay Toon
7 Common problems and difficulties What problems/difficulties do you experience when using the standard EMDR protocol?
8 Common problems and difficulties Confidence in self or the protocol/model Finding clients Management support Client engagement Explaining the model to clients/other professionals Integrating with own theoretical orientation Selecting targets/ where to start Overwhelming emotions Processing stalling or being very slow Looping When to intervene Using interweaves Finishing/ closure (thanks to DBlore)
9 Trouble Shooting Focus today: 8 Phase Treatment Approach 1. Client History and Treatment Planning 2.Preparation 3.Assessment 4.Desensitisation 5.Installation 6.Body Scan 7.Closure 8.Re evaluation
10 Desensitisation What are the aims/purpose of the desensitisation phase? How is this achieved theoretically? practically?
11 Desensitisation aims Focus on negative affect related to the target as measured by the SUDS To reprocess and clear out the dysfunctional material in all the associated channels To reduce the SUDS to 0
12 Desensitisation and Reprocessing how is it achieved? Reprocessing dysfunctional material to an adaptive resolution by accelerated reprocessing of information This is achieved by maximally activating the neural networks involved in the representation of the target event; at the same time as using bilateral stimulation to enable information processing If the basic components are correctly identified in the assessment phase this will help to maximally activate the appropriate neural networks by making links to the dysfunctional material Re processing will be optimized by following the protocol
13 Speed of processing Many problems during the desensitisation phase are related to the speed of processing eg Too fast abreaction/ being overwhelmed Too slow little or no change occurring
14 Optimum Arousal Zone Spiegel (1999) Ogden and Minton (2000) High Arousal A R O U S A L Optimum Arousal Zone Low Arousal Arousal Capacity window of tolerance
15 Too fast abreaction/ being overwhelmed Why does processing result in my client being overwhelmed? How can we prevent this? How can we slow it down again?
16 Too fast Being overwhelmed Client or therapist overwhelmed? Processing is still happening during abreaction Level of arousal, (preparation of client) Relationship with therapist Not following the protocol Association chain to previous traumas
17 Too slow little or no change occurring Why is processing so slow with this client? Why has it stalled? How do we get it going or speed it up again?
18 Reprocessing What factors may slow or stop processing? Arousal too high or too low Not following the protocol! eg Returning to the target after each set Too much intervention Too much time between sets Not getting the optimal negative cognition Errors in identifying the positive cognition Client blocking process (fear/other issues/litigation/secondary gains/ reln with therapist) preparation phase Alcohol, medication or other substances Active listening!! Slows processing Blocking beliefs
19 Blocking beliefs examples It s not possible to get over this I ve had it so long its who I am/part of my life If I get over his/her death I will be betraying my son/mother/partner I won t get compensation if I don t have PTSD any more
20 Working with blocking beliefs Even though you believe you can never get over this would it be OK if you did? If answer is YES stay with that BLS (Jim Knipe) Install PC with BLS What would you prefer to think about yourself? Challenge thoughts, use BLS
21 Common errors in the process of desensitisation Therapist interventions doing too much! Measuring SUDs too often Stopping because negative affect has initially increased Abreactions stopping BLS, talking the client thro it Spending too long between sets (talking, notes) Going back to target before reached end of chain of associations, (stops processing) Selection and order of components during assessment phase vital to get these components right.
22 Getting even better results Stick to the standard protocol wherever possible, each step is there for a reason; including the order If you need to deviate from the protocol, using your clinical judgement, then discuss the reasons at supervision. Minimal intervention whilst the process is moving on. (Self healing, minimal intervention) Take a video to supervision and work thro with supervisor (or watch yourself!) Back to basics!
23 Final questions/ discussion Back burner any unanswered questions? Any remaining questions/ comments? Aims of session achieved? To increase the confidence and effectiveness of the participants in their use of the EMDR standard protocol. To increase knowledge of the standard protocol by looking at common errors and problems that can occur and by using the theoretical basis to find solutions. To encourage participants to keep to the standard protocol where possible; and to understand the circumstances when it may be necessary to deviate from it. For us all to learn something and enjoy ourselves!
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