Making the Complex Simple:

Transcription

1 Making the Complex Simple: A Simple and Efficient way to Organize EMDR Files Sue Genest, MSc. CCC EMDRIA Conference in Denver, Colorado September 2014 Outline Overview mind mapping Benefits of mind mapping & EMDR EMDR and mind mapping Mind map categories 8 phases & 3 pronged protocol & AIP model Template Case illustrations Mapping EMDR Protocols Mind Map Program Hands on creation of EMDR mind map 1

2 What is a mind map? is a diagram used to represent words, ideas, tasks, or other items linked to a central key word or idea. are tools which help you think and learn is a strategy for bringing order and structure to thinking through mentally mapping words or/and concepts Wikipedia Mind Map General Design Examples 2

3 () Excerpt from Sue Genest s thesis research Excerpt from Sue Genest s thesis research 3

4 Basic Addictions EMDR Protocols Recent Events Pre Verbal Benefits of Mind Mapping & EMDR Simplifies complex case files and targets Large files onto 1 or 2 sheets Procedure/structure for developing treatment plan keeping track of new targets re-arranging treatment plan Review of 8 phases, 3 pronged protocol, and AIP model Provides insight into past memory networks, adaptive information arising, themes, progress, etc. Benefits of Mind Mapping & EMDR Quick review of client file for re-evaluation returning client reviewing treatment plan report writing Clarifies stuck points in the process: missing parts of the standard protocol, for example: didn t floatback; missed future template incomplete targets, e.g. SUDs not 0; no PC installation 4

5 Benefits of Mind Mapping & EMDR Clarifies stuck points in the process: Dissociation; Ego States See over time the inconsistency of SUDs e.g. 0 then 8 then 0 then 9 then Easy review of what is or is not changing For example: client is no longer eating fast food, but still over eating still change in behavior Identifies areas in which to seek consultation Benefits of Mind Mapping & EMDR Sharing maps with clients builds rapport (footnote 1) helps them understand the EMDR process encouraging to see what has been accomplished Own self care where you need consultation; reminds therapist of progress; i.e. targets are clearing which is especially helpful with complex cases; addictions; etc. Points out patterns e.g. similar stuck points with several clients Helps grasp protocols e.g. DeTUR protocol Footnote 1: With DID & complex trauma some clients find looking at an extensive mind map of their history and targets overwhelming EMDR & Mind Mapping Mind Map Categories 8 phases & 3 pronged protocol AIP Model Template Case Illustrations Mind Mapping EMDR Protocols Mind Map Program Hands on creation of EMDR mind map 5

6 8 Phases of EMDR History Preparation Assessment Desensitization Installation Body Scan Closure Re-Evaluation 3 Phase Protocol Past, Present, Future or First Worst Most Recent Future AIP Model and Mind Mapping Map memory networks Map adaptive networks As you map you can see connections, themes, Keep track of adaptive responses in processing e.g. anger or PC s arising, etc. Map relevant past experiences that create and perpetuate maladaptive patterns of response / unmetabolized components of memory F. Shapiro & D. Laliotis, Clinical Social Work Journal (2011) 39: Published online October 12, 2010, p.193 Age 3yrs Dad hits mom Intimacy with partner Sexual Assault 20yrs old Body: pain, shaking Guilt I m damaged Anger Family holidays Partner Intimacy Aggressive men News stories 6

7 Car Accident Drunk driver's Death face files: I'm Gonna Noise of It's my Die Crash fault Body Pain & shaking Floatback Dog dies Insurance Grandma memories age 10 trauma dies age 3 Best friends suicide Map various components of an incident from the history taking or as you begin to process Husband Dies Doing CPR; still dies Sound of ambulance Hospital Children's reactions Judgement of in-laws Death files Parents Deaths I'm not good enough Its my fault Map chronology of recent event and associative links Mind Map Categories Goals (SMART) Resources e.g. calm place, container, Stabilization and Self Soothing; Life skills; Coping skills Strengths, Positive experiences, support systems, Targets / Unprocessed memories Top ten worst, History, PIC, NC, PC, VOC, SUDs, Floatback, Re-Evaluation; 1 st, worst, most recent, future Triggers Themes, repetitive cognitions Developmental milestones Symptoms & positive outcomes Connections b/w memories Progress indicators Tx Targets Pic NC / PC SUDs / VOC Emotions Body 3 pronged protocol NC's Themes Top 10 Worst Triggers History: Possible Targets Developmental Milestones Symptoms / Outcomes Goals Mind Mapping Progress Indicators Resources PC's Top 10 Best Calm Place; Container Support systems Self Soothing Life Skills; Coping Skills Strengths 7

8 Strengths Self Aware Motivated Intelligent Perseverance Attachment / bonding Kind; compassionate SESSION 2 Resources: Calm place Container Protective / Nurturing Figures Client Initials Best Grandmother Graduation Marriage Children Outcomes Calmer Assertive Triggers resolved No impulsive eating Depression resolved SESSION 1-2 Intro. to EMDR; History / Possible Targets Worst Parents Uncle Boss Symptoms Anxious Over eating Can't say No Depressed Themes SESSION 3 Original Target Name PIC; NC; Emotions; SUDs 9 Floatback: Utero PIC Alone in darkness NC I'm unlovable PC I'm lovable SUDs 5-0 VOC 2-7 Body: Clear SESSION 4 Re Evaluation Floatback SUDs 2-0 VOC 7 Worst: PIC; NC; PC SUDs 5-0 VOC 2-7 Body: Clear SESSION 5 ReEvaluation Floatback SUDs 0 Worst SUDs 0 Original Target PIC, NC, PC Emotions SUDs 5-0 VOC 7 Body: Clear Future Template Case Illustrations Blue for initially named targets Purple for targets that arose duringtx Best Friends Death SUDs 9 Floatback to grandmothers death Age 3 NC I did something wrong SUDs 5-0 PC I was just a kid Voc 7 Original & Worst NC I can't handle this SUDs 6-0 & PC I can handle this; VOC 7 Normal grief Calm Place: Ocean Cue: peaceful Strengths/Resources: Container: blue jar Son Humor Perseverance Resourceful Best friend Resilient Intelligent 1) Drunk drivers face SUDs 10 Car accident NC It's my fault Diagram by Symptoms Relieved: SueGenest PTSD Flashbacks Floatback to age 5yrs Nightmares 3yr old Sister lost Jumpiness NC Its my fault SUDs 10 Unable to drive SUDs 0 2) Noise of crash Anxiety driving PC It's not my fault SUDs 10 Sleeplessness VOC 7 Floatback to 1st Age 3 Outcome Dad yelling at mom Original & Worst Calm NC: I'm unsafe Sleeping well SUDs 7-0 PC I'm safe now Driving without anxiety PC It's not my fault SUDs 8-0 VOC 7 Healthy Grief process VOC 7 Future driving... with BLS in car Ex Husband Abuse (Worst) NC I'm powerless SUDs 8-0 PC I'm powerful VOC 7 Insurance Call Trauma SUDs 10 Original NC I'm in danger NC I'm going to die SUDs 0 PC I'm safe Session I SUDs 10 now and can work Session II SUDs 2 through this VOC 7 Session III SUDs 0 Body clear PC I'm safe now Future... all insurance VOC 7 dealings Body Clear Future loud noises; car screetches;... 8

9 Home Practice: Calm & Confident Watching sports Gardening 1st Session: Container: Black Bin Calm Place: Fishing; Cue: "blue" when relaxed Bullied at school Goals: Rarely Anxious Calm and Okay about son Assertive vs. Angry Feel good about self Billy Best things in Life: Partner Son Education Travelling Promotion at work Strengths: Affectionate, loving Committed father, husband Perseverance Intelligent Resourceful Responsible Compassionate HISTORY 2nd Session; Ongoing Childhood illness Mother overbearing Parenting Mothers Social guilt anger anxiety Car Death accident Grandmother Triggers: Sons problems Strong women Lg trucks behind me in traffic Themes: Take care of others 1st Can't say my truth Don't fit in Threat to my life Not good enough Damaged 3rd Session Parenting Pic: Son's scared face Emotion: profound sadness; shame; guilt SUDs 7 NC: I'm a failure Floatback: 4yrs old (also Worst) Pic Mother's angry face Emotions: fear, NC: "I'm a bad person" PC "I'm good person" SUDs 8; Voc 3 Body: chest; throat (PreVerbal - Imaginal nurturing) SUDs 3 4th Session Re-evaluation FloatbackSUDs 2 End Session: SUDs 0; Voc 7; Body Clear 5th Session Re-Evaluate FloatbackSUDs 0 Re-evaluate Original Parenting SUDs 4 NC "I'm a failure" PC "I'm a loving parent" Emotions: sadness; guilt; shame Body: Chest; throat Ends SUDs 0; Voc 7; body clear Future: Son has any life difficulty; Movie free of disturbance 6th Session: Social Anxiety Pic Hiding in a corner with head down SUDs 10 NC "I'm not good enough" Floatback Car accident age 18yrs; Bullied Grd.4; Grandmothers death age 5yrs Earliest: Childhood Illness Age 2yrs Pic: Alone in hospital room in dark Emotions: Intense fear; loneliness NC: "I'm gonna die" PC "I'm safe now" Voc 4 SUDs 8 7th Session ReEvaluation Age 2yrs SUDs 9-4 (bring in protective/nurturing figure) 8th Session ReEvaluation Age 2yrs SUDs 4-2 (grandmothers death arises & clears; PC arises "Its not my fault") 9th Session ReEvaluation Age 2yrs SUDs 3-2 (Bullying clears & PC arises "I am worthwhile") 10th Session ReEvaluation Age 2yrs SUDs 3-0 VOC 7 Body: Clear 11th Session: Worst: Car accident 18yrs NC "I'm gonna die" PC "I'm ok" SUDs 4; Ends SUDs 0; Voc th Session: ReEval. Worst SUDs 0 Voc 7 Original Social Anxiety: SUDs 5 PC "I'm good enough" Ends SUDs 0; VOC 7; Body Clear 14th Session: Future Template Trucks in traffic; Various Social situations 15th Session Check In with day to day social triggers and relationship with son No disturbance; calm 16th Session ReEval. all targets SUDs 0 PC's Voc 7 and strong CLOSURE OUTCOMES: Partner notices more calm Able to listen to son's problems without anxiety Approached boss with needs Joined staff in lunch room Mind Mapping EMDR Protocols Working through procedural steps 8 Phase Std Protocol Phase 1 History & Tx planning Phase 2 Preparation Phase 3 Assessment Phase 4 Desensitization Phase 5 Installation Phase 6 Body Scan Phase 7 Closure Phase 8 Re- Evaluation When Phase 1 & 2 are complete move to Phase 3 Partial set up Current target based on Tx plan in order to do floatback PIC NC Emotion SUDs Body First Memory PIC; NC; PC; VOC; Emotions; SUDs; Body Desensitize to SUDs 0 Install PC to VOC 7 Body: clear scan Worst Memory PIC; NC; PC; VOC; Emotions; SUDs; Body Desensitize to SUDs 0 Install PC to VOC 7 Body: clear scan Closure at the end of each session Incomplete session instructions in manual Re-Evaluate at beginning of each session Floatback to earliest memory Current Situation PIC; NC; PC; VOC; Emotions; SUDs; Body Desensitize to SUDs 0 Install PC to VOC 7 Body: clear scan Future Template Run movie eyes closed till no disturbance Run movie eyes open (People, places, things, time,...) Associative Network 9

10 Understanding a protocol e.g. DeTUR DeTUR Dr. AJ Popky (diagram by Sue Genest) History Preparation Resource State Positive Tx Goal Pos. Goal State Phys. Anchor Installation Triggers Triggers w/ Pos. Goal State Desensitization Past Trauma Standard Protocol Barriers to Current Recovery Distress Future Relapse Future Closure Re Evaluation Understanding a protocol e.g. DeTUR DeTUR Dr. AJ Popky (diagram by Sue Genest) I. History Diagnosis Trauma Hx A. Preparation Screen for dissociation Resources in Life Support system e.g. AA, Resource State I now have clients recall a time when they experienced feelings of being resourceful, powerful and in-control and direct them to those to notice the powerful feelings, and then use eye movements (EM) to strengthen these powerful feelings. This appears to empower clients and allows the process to move faster. The trick here is to have them freeze the experience and only focus on the positive element before doing eye movements. a. Positive Tx Goal (1) Client's attention is directed towards a positive, attractive, achievable, compelling goal of coping and functioning The positive treatment goal should be attractive and achievable, one that has a magnetic pull that they can easily maintain their focus on. I use their definition of how they would look coping and functioning successfully in a positive manner. (1) Pos. Goal State Phys. Anchor - The next step is to have them associate with their goal. Give them the experience of how it would feel to successfully achieve their goal, and then using associative representation, anchor the experience into their physiology. Anchoring or Conditioned Response: is a process of being able to replicate the physiological experience associated with an emotion or state by linking it to a physical representation (slight finger pressure). I exert slight pressure on a knuckle as the representation (after obtaining Inspiration Program 10

11 Tx Targets Pic NC / PC SUDs / VOC Emotions Body 3 pronged protocol NC's Themes Top 10 Worst Triggers History: Possible Targets Developmental Milestones Symptoms / Outcomes Specific Goals Mind Mapping Measurable Progress Indicators Achievable Realistic Trackable Resources PC's Top 10 Best Calm Place; Container Support systems Self Soothing Life Skills; Coping Skills Strengths 11

12 Goals Tx Targets Pic NC / PC SUDs / VOC Emotions Body 3 pronged protocol NC's Themes Top 10 Worst Triggers History: Possible Targets Developmental Milestones Symptoms / Outcomes Goals Mind Mapping Progress Indicators Specific Measurable Achievable Realistic Trackable Resources PC's Top 10 Best Calm Place; Container Support systems Self Soothing Life Skills; Coping Skills Strengths Hands on Creation of Your own Map info@suegenest.ca 12