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Blind to therapist (B2T) Blind to therapist (B2T) EMDR ProtocolEMDR Protocol

Blore & Holmshaw 2009a; b

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Some uses for the B2TSome uses for the B2T• Clients wishing to maintain or reassert control (e.g. Thompson 1981 Blore 1997, 2005;

Blore & Holmshaw 2009b)

• Clients experiencing acute embarrassment or shame (Blore & Holmshaw 2009b)

• Where there is a risk of vicarious traumatisation of the therapist

• In translator-situations where the client is reluctant to divulge material because of fear of real or imagined retaliation ‘back home’

• MoD clients wishing to preserve ‘confidentiality’ and thus not compromise adherence to the Official Secrets Act

• Clients with serious speech impediments that may result in stalling the flow of processing

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Underpinning of B2TUnderpinning of B2T

• B2T provides a client-centred solution to problems largely of behavioural avoidance

• B2T facilitates compliance by ‘meeting the client half way’

• B2T facilitates therapist’s adherence to client-centred work

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B2TB2T

• Phase 1

– Identify non-disclosure as an issue during suitability assessment/ history-taking

– Explanation that treatment will not suffer if material cannot be disclosed

• Phase 2

– Coach client to recognise change, using simple descriptions

– Simple descriptions may need further explanation:• ‘leading’ the client or setting expectations?

– Subtlety of change metaphor

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B2TB2T

• Phase 3

– Negotiate a cue word to refer to target image

– Check that image is static

– If not static then ‘freeze frame’ at most distressing point

– Make no attempt to obtain NC, PC or take VoC

• Phase 4

– Commence first set:• Notice (cue word)• Notice emotion• Notice where the emotion is located

– Process as normal but feedback only ‘change’ or ‘no change’

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B2TB2T

• Phase 4 (cont)

– If no change, distinguish between end of channel of association and blocking/looping:

• Ask “is (cue word) distressing neutral or positive” (as an experience)

• If distressing then assume blocked/ looping

• If neutral/positive then two consecutive instances assume end of channel of association > return to (cue word)

• If assumed blocked/ looping then:

– Use basic strategies (change speed direction modality of BLS). If these don’t work then go to visual interweaves:

– ‘morphing’/ stretching image, or two image strategy

– Keep repeating until ‘change’ indicated

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B2TB2T

• Phase 4 (cont)– Disclosure may never occur. Disclosure not needed for resolution– If disclosure occurs continue with the standard protocol– PCs tend to emerge spontaneously – don’t ‘make’ PCs happen!– Never attempt to identify a NC retrospectively particularly if obvious

from an emerging PC– Phase 4 complete when SUDs = 0

• Phase 5– Install PCs that have emerged– If still no PC go to body scan (phase 6)

• Phase 6– If no phase 5 then be prepared for further dysfunction material to

arise and then return to phase 4 (B2T version)

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B2TB2T

• Phase 7– Be aware that the incomplete protocol for the B2T protocol may

differ considerably from normal• If SUDS not 0 treat as a normal incomplete session and allow extra

time for phase 7• If no PC emerges and/or body scan can’t be completed then treat this

as an incomplete session to

– Two ‘yeses rule’:• Yes client safe to leave clinic• Yes, client has required resources AND will use them between now and

next session

• Phase 8– Reassess as usual, don’t forget cue words if disclosure hasn’t

occurred