OVERVIEW of EMDR

6 March 2020
One of our members, a retired trauma therapist, was invited to give an overview of Eye Movement Desensitisation Reprocessing (EMDR). He was an accredited practitioner for over ten years.
The group was asked to respond to and ask questions about the following proposed and recent definition of EMDR:
The group was asked to respond to and ask questions about the following proposed and recent definition of EMDR:

Definition – EMDR is an evidence-based, clinician led, psychotherapy for Posttraumatic Stress Disorder (PTSD). In addition, successful outcomes are well-documented in the literature for EMDR treatment of other psychiatric disorders, mental health problems, and somatic symptoms. The model on which EMDR is based, Adaptive Information Processing (AIP), posits that much of psychopathology is due to the maladaptive encoding of and/or incomplete processing of traumatic or disturbing adverse life experiences. This impairs the client’s ability to integrate these experiences in an adaptive manner. The eight-phase, three-pronged process of EMDR facilitates the resumption of normal information processing and integration. This treatment approach, which targets past experience, current triggers, and future potential challenges, results in the alleviation of presenting symptoms, a decrease or elimination of distress from the disturbing memory, improved view of the self, relief from bodily disturbance, and resolution of present and future anticipated triggers. EMDR therapy is a therapeutic intervention that must be administered by an EMDR trained clinician or those who are currently participating in an EMDRIA Approved training.

Wisely the group noted the absence of ‘bi-lateral stimulation’ in this definition.

Reference was made to the insistence within theEMDR profession that the 8 stage protocol was adhered to rigorously. The fundamental reason was assumed to be to ensure that there was a consistent base upon which to base efficacy research. Evidently many many different adaptations of the basic protocol were available. The EMDR UK and Ireland has a jiscmail interaction and frequent requests are made for information about how to use the protocol for numerous different presentations.

A copy of the 8 stage protocol was shared with the members. As seasoned professional therapists this mapping of normal good therapeutic process was noted. The need to be thorough about history taking becomes clear when it is acknowledged that trauma builds on trauma. Often a current trauma effect does not get ‘cleared’ until earlier traumas have been dealt with. Just as likely is the scenario in which the client is unaware of earlier and unprocessed memories until processing begins. Processing refers to the use of bi-lateral stimulation when focused on the physical bodily awareness of a memory.

It is is of paramount importance to spend as much time as is necessary in the early phases of the protocol to ensure that a client is able to say where in the body the feeling that tells them there is an unprocessed memory upon which they may then focus using bi-lateral stimulation. And it is essential that as much time as is necessary is taken to ensure the client has learnt how to self-soothe. It would of course, be irresponsible to encourage the client to engage with a trauma memory without the practised confidence of being able to self-soothe.

A member of the group volunteered to experience bi-lateral stimulation being used whilst focused on a ‘safe place’ memory and the stored memories of each of the sensed about that memory. A client would be invited to practice accessing this now reinforced ‘safe place’ until they were confident that they could manage more anxiety than previously realised perhaps. This was acknowledged to be a real experience which made the safe place memory more vivid. The value of this for a client was noted.

Reference via a UTube video drew out the specific nature of PTSD as a particular form of trauma memory defined by DSM 5. The life long history of potential unhealthy experiences leading to trauma, beginning in the womb ‘where there are no words’ (with reference to the workshops led by Sandra Paulson), and moving on to the whole of the attachment process and the manner in which those experiences are recorded in the limbic system, was noted.

The group also had a transcript of an interview with Peter Levine whose book Waking the Tiger and In an Unspoken Voice were highly recommended reading. The interview can be accessed at: https://www.psychotherapynetworker.org/magazine/article/2347/an-interview-with-peter-levine

Reference was made in conclusion to the training available. in particular training  from EMDR Workshops and David Blore and that offered by Sandi Richman (the presenter’s trainers) was recommended.

Definition – EMDR is an evidence-based, clinician led, psychotherapy for Posttraumatic Stress Disorder (PTSD). In addition, successful outcomes are well-documented in the literature for EMDR treatment of other psychiatric disorders, mental health problems, and somatic symptoms. The model on which EMDR is based, Adaptive Information Processing (AIP), posits that much of psychopathology is due to the maladaptive encoding of and/or incomplete processing of traumatic or disturbing adverse life experiences. This impairs the client’s ability to integrate these experiences in an adaptive manner. The eight-phase, three-pronged process of EMDR facilitates the resumption of normal information processing and integration. This treatment approach, which targets past experience, current triggers, and future potential challenges, results in the alleviation of presenting symptoms, a decrease or elimination of distress from the disturbing memory, improved view of the self, relief from bodily disturbance, and resolution of present and future anticipated triggers. EMDR therapy is a therapeutic intervention that must be administered by an EMDR trained clinician or those who are currently participating in an EMDRIA Approved training.

Wisely the group noted the absence of ‘bi-lateral stimulation’ in this definition.

Reference was made to the insistence within theEMDR profession that the 8 stage protocol was adhered to rigorously. The fundamental reason was assumed to be to ensure that there was a consistent base upon which to base efficacy research. Evidently many many different adaptations of the basic protocol were available. The EMDR UK and Ireland has a jiscmail interaction and frequent requests are made for information about how to use the protocol for numerous different presentations.

A copy of the 8 stage protocol was shared with the members. As seasoned professional therapists this mapping of normal good therapeutic process was noted. The need to be thorough about history taking becomes clear when it is acknowledged that trauma builds on trauma. Often a current trauma effect does not get ‘cleared’ until earlier traumas have been dealt with. Just as likely is the scenario in which the client is unaware of earlier and unprocessed memories until processing begins. Processing refers to the use of bi-lateral stimulation when focused on the physical bodily awareness of a memory.

It is is of paramount importance to spend as much time as is necessary in the early phases of the protocol to ensure that a client is able to say where in the body the feeling that tells them there is an unprocessed memory upon which they may then focus using bi-lateral stimulation. And it is essential that as much time as is necessary is taken to ensure the client has learnt how to self-soothe. It would of course, be irresponsible to encourage the client to engage with a trauma memory without the practised confidence of being able to self-soothe.

A member of the group volunteered to experience bi-lateral stimulation being used whilst focused on a ‘safe place’ memory and the stored memories of each of the sensed about that memory. A client would be invited to practice accessing this now reinforced ‘safe place’ until they were confident that they could manage more anxiety than previously realised perhaps. This was acknowledged to be a real experience which made the safe place memory more vivid. The value of this for a client was noted.

Reference via a UTube video drew out the specific nature of PTSD as a particular form of trauma memory defined by DSM 5. The life long history of potential unhealthy experiences leading to trauma, beginning in the womb ‘where there are no words’ (with reference to the workshops led by Sandra Paulson), and moving on to the whole of the attachment process and the manner in which those experiences are recorded in the limbic system, was noted.

The group also had a transcript of an interview with Peter Levine whose book Waking the Tiger and In an Unspoken Voice were highly recommended reading. The interview can be accessed at: https://www.psychotherapynetworker.org/magazine/article/2347/an-interview-with-peter-levine

Reference was made in conclusion to the training available. in particular training  from EMDR Workshops and David Blore and that offered by Sandi Richman (the presenter’s trainers) was recommended.

OVERVIEW of EMDR

EMPATHY

 

On 24 Jan 2020 we looked at the subject of empathy and ethics with a review of Christian Keysers Book “The Empathic Brain” focussing on the chapter on empathic ethics and Psychopathy. The questions we looked with this chapter included :

What is the basis of empathy, Can empathy be learnt, Is empathy derived from the unconscious due of our mirror neurones or is it simply operant conditioning.

We started with a reminder of how the discovery of mirror neurones and has impacted on our understanding of neurobiology and sense of self by watching three short videos  from Dr Dan Siegal.

Dr Dan Siegal Mirror Neurones   :

https://www.youtube.com/watch?v=24fITRNWh1k

 

https://www.youtube.com/watch?v=Tq1-ZxV9Dc4

 

DR Dan Siegal The basis of empathy https://www.youtube.com/watch?v=CnvSRvmRlgA&list=PLqwFctTE_-O2t8er6kBsmjqYNMP4QsCD5

Dr Siegal describes how a sense of empathy comes from the unconscious interaction of our mirror neurones downwardly connecting with our Insula which is involved in perception and sense of self down through the brain to the body and back to give a sense of interoception.

We explored how our mirror neurones inform our  ethical decision making and the question of do emotions fog our ethical decision making.

We continued to look at Keysers observation that to change someone’s mind you have to make them see the problem from a perspective that is linked with other emotions to make them feel differently.

This led to a discussion on how to use grounding techniques to help those who feel suicidal and the importance was recognised of not just doing a cognitive process of remembering how things were in better times to really engage with an emotional element of when they felt well. We also looked at the risk of using grounding photos that may feel distressing and to use a bespoke assessment of client needs.

We agreed that an empathic approach to relating can be learnt but that our mirror neurones enable this also.

We looked at Keysers assessment that genuine empathic feelings and moral sentiments can co exist in a person along with brutal aggression and the “golden rule” of “do to others as you would have them do to you reframed from thinking about a  mirror neurone perspective of “I shall do to you what I wish would be done to me”.

We looked examples of clients who are challenging in their communicating and presentation and how our mirror neurones may give away a sense of how we are reacting.  Also the importance of relational depth in the moment and being careful not to be intoxicated by momentary deeply felt empathy but recognise it has to be strived for from moment to moment.

EMPATHY