an overview emdr. outline of today’s presentation g what is emdr g what is the goal g how does it...

An OverviewAn Overview

EMDR

Outline of Today’s

Presentation

Outline of Today’s

Presentation What is EMDR What is the goal How does it work The phases of EMDR The client’s experience of EMDR The Populations EMDR works with Special populations Considerations Group exercise

What is EMDR What is the goal How does it work The phases of EMDR The client’s experience of EMDR The Populations EMDR works with Special populations Considerations Group exercise

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What is EMDR?

What is it?What is it?

A psychological method for treating experientially based disorders

It includes various orientations to treatment

An eight phase approach that views pathology as based upon perceptual information that was maladaptively stored

A psychological method for treating experientially based disorders

It includes various orientations to treatment

An eight phase approach that views pathology as based upon perceptual information that was maladaptively stored

What’s the Goal?What’s the Goal?

To facilitate resolution of traumatic early life experiences

Desensitize stimuli that causes present day distress

Incorporate adaptive attitudes, skills, and desired behaviors for enhanced future functioning

To facilitate resolution of traumatic early life experiences

Desensitize stimuli that causes present day distress

Incorporate adaptive attitudes, skills, and desired behaviors for enhanced future functioning

How does it work?

How does it work?

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How does it work? When the brain is upset it does not process

the same way as when it is in a stable state The average daily information is stored in

the midbrain (amygdala) and then shifted into the neocortex during REM sleep

When trauma occurs, it is “too big” to be processed and stays in the Amygdala where it can be felt

Similar memories form in clusters so others will attach to like memories in both the neocortex and the amygdala

When the brain is upset it does not process the same way as when it is in a stable state

The average daily information is stored in the midbrain (amygdala) and then shifted into the neocortex during REM sleep

When trauma occurs, it is “too big” to be processed and stays in the Amygdala where it can be felt

Similar memories form in clusters so others will attach to like memories in both the neocortex and the amygdala

How does it work? (continued)

How does it work? (continued)

EMDR works to break up this information and process it into the long term memory… So you can REMEMBER but not RE-EXPERIENCE.

The Neurobiological effect created during EMDR is not fully understood, however, it is currently theorized that EMDR recreates the processing similar to what happens during REM sleep.

EMDR works to break up this information and process it into the long term memory… So you can REMEMBER but not RE-EXPERIENCE.

The Neurobiological effect created during EMDR is not fully understood, however, it is currently theorized that EMDR recreates the processing similar to what happens during REM sleep.

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The Eight PhasesThe Eight Phases

1. Taking History1. Taking History

GenogramsThorough AssessmentsFollowing your instinctsOther methods???Balancing Trauma with Strengths

GenogramsThorough AssessmentsFollowing your instinctsOther methods???Balancing Trauma with Strengths

2. PreparationA Strong skill for the EMDR therapist, as well as,

therapists not working with EMDR. It will be emphasized both in presentation and group

exercise

2. PreparationA Strong skill for the EMDR therapist, as well as,

therapists not working with EMDR. It will be emphasized both in presentation and group

exercise

ContainmentGroundingSafe/Calm PlaceAllies/ProtectorsInner advisorIFS

ContainmentGroundingSafe/Calm PlaceAllies/ProtectorsInner advisorIFS

3. Assessment3. Assessment

This goes hand in hand with Desensitization

Setting up the target image Assessing emotions Assessing Somatic/Sensations Assessing the Negative Cognition Uncovering the desired positive

cognition SUDS VOC

This goes hand in hand with Desensitization

Setting up the target image Assessing emotions Assessing Somatic/Sensations Assessing the Negative Cognition Uncovering the desired positive

cognition SUDS VOC

4. Desensitization4. Desensitization

Introducing Bilateral StimulationChecking in on awareness of

experienceAuditoryTactileVisual (research based)

Introducing Bilateral StimulationChecking in on awareness of

experienceAuditoryTactileVisual (research based)

5. Installing5. Installing

The desired positive cognitionInstallationChecking the client’s belief in the

positive cognitionPast PresentFutureContain

The desired positive cognitionInstallationChecking the client’s belief in the

positive cognitionPast PresentFutureContain

6. Body Scan6. Body Scan

Checking for full clearingSometimes finding new

information/feelingsEmphasizing the experiental

nature

Checking for full clearingSometimes finding new

information/feelingsEmphasizing the experiental

nature

7. Closure7. Closure

Safe/Calm PlaceContainment

Safe/Calm PlaceContainment

8. Re-evaluation8. Re-evaluation

The next sessionChecking the SUDS and the VOCMay find more information/feelingsSometimes find feeder memories

The next sessionChecking the SUDS and the VOCMay find more information/feelingsSometimes find feeder memories

QUESTIONS?QUESTIONS?

??????

What is the experience like for the client???

What is the experience like for the client???

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History TakingCan feel unearthingCan be moderately disruptiveTherapist is to emphasize the data

collection and not encourage the client to re-experience

Experienced clinician decreases disruptions and increases hope

History TakingCan feel unearthingCan be moderately disruptiveTherapist is to emphasize the data

collection and not encourage the client to re-experience

Experienced clinician decreases disruptions and increases hope

PreparationA period where the client learns better skills for

copingUsually a period marked with self soothing (for

some the first time)Empowered and/or recognizing strengthsSometimes frustrating

PreparationA period where the client learns better skills for

copingUsually a period marked with self soothing (for

some the first time)Empowered and/or recognizing strengthsSometimes frustrating

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AssessmentAgitatingIntense emotionsAwareness of physical sensations

AssessmentAgitatingIntense emotionsAwareness of physical sensations

DesensitizationA myriad of sensations and emotionsThe goal is to keep the sensations moving and

changingTherefore creating multiple shifts for the clientEventually ending in a lack of emotion and

sensation around the target memory

DesensitizationA myriad of sensations and emotionsThe goal is to keep the sensations moving and

changingTherefore creating multiple shifts for the clientEventually ending in a lack of emotion and

sensation around the target memory

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Installation (and closure) The Fun Part! Usually marked by smiles and sometimes laughter The client often experiences empowerment, relief, and

joy

Installation (and closure) The Fun Part! Usually marked by smiles and sometimes laughter The client often experiences empowerment, relief, and

joy

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Body ScanUsually very little to no discomfortSometimes additional issues and “feeder

memories” found here

Body ScanUsually very little to no discomfortSometimes additional issues and “feeder

memories” found here

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Re-evaluationUsually very little to no discomfortSometimes additional issues and “feeder

memories” found here

Re-evaluationUsually very little to no discomfortSometimes additional issues and “feeder

memories” found here

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QUESTIONS?QUESTIONS?

??????

Video of EMDR SessionVideo of EMDR Session

NLP Eye Movement Integration with a Vietnam Veteran

http://www.youtube.com/watch?v=GnoqWqijYvQ

Target PopulationsWhat different kinds of clients does EMDR work for

Target PopulationsWhat different kinds of clients does EMDR work for

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The EMDR PopulationThe EMDR Population

Personality Disorders

Panic Attacks

Complicated Grief

Dissociative Disorders

Phobias

Pain Disorders

Eating Disorders

Performance Anxiety

Stress reduction

Addictions

Disturbing Memories

Body Dysmorphic

Disorders

Post Traumatic Stress Disorder

Sexual/Physical/Verbal

Abuse

Special PopulationsSpecial Populations

Chronic Pain

Conjoint Couples Therapy

Children and Adolescents

Sports and performance

Ascertaining DurationAscertaining Duration

Single incident traumaMultiple incident traumaBig T and Small t TraumaFeeder MemoriesThe importance of taking a

thorough history

Single incident traumaMultiple incident traumaBig T and Small t TraumaFeeder MemoriesThe importance of taking a

thorough history

Considerations and when to bewarePower of the techniqueDisruptive to Pregnant womenLegal Involvement

Considerations and when to bewarePower of the techniqueDisruptive to Pregnant womenLegal Involvement

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Group ExerciseGroup Exercise

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Practicing Resource Building

Practicing Resource Building

Research indicates we learn to execute actions through doing more than we do through listening or seeing

Some clinicians become tentative around using a technique due to a lack of experience

Today’s exercise is an effort to become more comfortable enacting some of the resource building discussed thus far today

Research indicates we learn to execute actions through doing more than we do through listening or seeing

Some clinicians become tentative around using a technique due to a lack of experience

Today’s exercise is an effort to become more comfortable enacting some of the resource building discussed thus far today

Practicing Resource Building

Practicing Resource Building

Please take one of the handouts being passed around

Then break up into groups of three Once settled choose one of the three

exercises (one person acting as therapist, the other as client, and the final as observer)

“Therapist” will walk the client through the exercise with the “client”, once finished move onto the next Therapist, client, observer

Please take about five minutes per exercise and then at the end take another five minutes to discuss your experience (total 20 minutes)

Please take one of the handouts being passed around

Then break up into groups of three Once settled choose one of the three

exercises (one person acting as therapist, the other as client, and the final as observer)

“Therapist” will walk the client through the exercise with the “client”, once finished move onto the next Therapist, client, observer

Please take about five minutes per exercise and then at the end take another five minutes to discuss your experience (total 20 minutes)

Practicing Resource Building

Practicing Resource Building

Take your time as there is no need to rush through

Feel free to add to the exercise with processes you feel comfortable with

Choose a the one you feel would be most challenging for you to approach with a client

Take your time as there is no need to rush through

Feel free to add to the exercise with processes you feel comfortable with

Choose a the one you feel would be most challenging for you to approach with a client

The Anatomy of our “Selves”

The Anatomy of our “Selves”

The child or exileThe critic or managerThe firefighter (this is when we get to

see most people)The Self

The child or exileThe critic or managerThe firefighter (this is when we get to

see most people)The Self

The Internal FamilyThe Internal Family

DynamicsThe effects “Parts” have on one

anotherCommon Dynamics

Child/Critic cycleFirefighter InterventionFirefighter engaging the critic, hence

the child

DynamicsThe effects “Parts” have on one

anotherCommon Dynamics

Child/Critic cycleFirefighter InterventionFirefighter engaging the critic, hence

the child

Common Early Communication Dynamics

Common Early Communication DynamicsSelf to child

AngerAbandonmentLack of trust in the Self to maintain

contactRelief and assuranceCalmingThe importance of consistency

Self to childAngerAbandonmentLack of trust in the Self to maintain

contactRelief and assuranceCalmingThe importance of consistency

Common Early Communication Dynamics

Common Early Communication DynamicsSelf to Critic

Resistance to stopping communication with the child

Struggle for powerRelief from the critic roleCalm around a true leader

Self to CriticResistance to stopping

communication with the childStruggle for powerRelief from the critic roleCalm around a true leader

Fire FightersFire Fighters

AddictionsAngerBehavioral IssuesEating DisordersOthers???

AddictionsAngerBehavioral IssuesEating DisordersOthers???

Methods to Work with Clients

Methods to Work with Clients

JournalingMeditatingIn Session discussionsEmpty chair with internal partsInternal discussionsTalking out loud

JournalingMeditatingIn Session discussionsEmpty chair with internal partsInternal discussionsTalking out loud

Intervention in Cases of Extreme Emotional

Distress

Intervention in Cases of Extreme Emotional

DistressPanic attacks (child)Waves of depression (critic)Extreme Confusion (various)Rage (child)

Panic attacks (child)Waves of depression (critic)Extreme Confusion (various)Rage (child)

Story of Debra and IFSStory of Debra and IFS

Trauma HistoryOne year of therapyDaily JournalingImprisonment

Trauma HistoryOne year of therapyDaily JournalingImprisonment

Story of Sherri and EMDRStory of Sherri and EMDR

Home InvasionPanic with AgoraphobiaPre and post treatment

Home InvasionPanic with AgoraphobiaPre and post treatment

IFS ExerciseIFS Exercise

Journal: If you were a child, how old would you be?Ask the child “what is your favorite thing to

eat?” and let the child answerAsk the child “How do you feel right now?”

let the child answer candidlyReassure the child if experiencing difficulty Ask the child “Would you like me to write

with or talk with you more often?”Go from there!! What would you ask if you

wanted to get to know any child

Journal: If you were a child, how old would you be?Ask the child “what is your favorite thing to

eat?” and let the child answerAsk the child “How do you feel right now?”

let the child answer candidlyReassure the child if experiencing difficulty Ask the child “Would you like me to write

with or talk with you more often?”Go from there!! What would you ask if you

wanted to get to know any child