emdr treatment initial packet - christopher carter,...

EMDR TreatmentInitial Packet

Includes:

1. EMDR Brochure

2. Informed Consent – please review, initial/sign and return to your

first session with any questions you may have

3. Dissociative Experiences Scale – please review, fill out and

return to your therapist

4. After session debriefing – information for after your EMDR

session

Designated as

an effective

treatment

by the

American Psychiatric Association, the W

orld Health O

rganization (W

HO),

the U

.S. Departm

ent of

Veterans Affairs and Department of Defense, the

U.S. Departm

ent of Health and Human Services

(HHS) and more.

WHAT IS

EMDR?

Eye Movem

ent Desensitization and Reprocessing (EM

DR) is a powerful psychotherapy approach that

has helped over an estimated tw

o million people of

all ages relieve many types of psychological distress.

No one know

s how any form

of psychotherapy w

orks neurobiologically or in the brain. However,

we do know

that when a person is very upset,

their brain cannot process information as it

does ordinarily. One m

oment becom

es “frozen in tim

e,” and remem

bering a trauma m

ay feel as bad as going through it the first tim

e because the im

ages, sounds, smells and feelings haven’t

changed. Such mem

ories have a lasting negative effect that interferes w

ith the way a person

sees the world and the w

ay they relate to other people.

HOW

DOES EM

DR WO

RK?

EMDR

CAN BE

THOU

GHT

OF AS A

PHYSIOLO

GICALLY

BASED THERAPY THAT HELPS A PERSO

N SEE

DISTURBIN

G

MATERIAL IN

A N

EW AN

D LESS

DISTRESSIN

G

WAY

EMDR seem

s to have a direct effect on the way that

the brain processes information. N

ormal inform

ation processing is resum

ed, so following a successful EM

DR session, a person no longer relives the im

ages, sounds and feelings w

hen the event is brought to mind. You

still remem

ber what happened, but it is less upsetti

ng. M

any types of therapy have similar goals. How

ever, EM

DR appears to be similar to w

hat occurs naturally during dream

ing or REM (rapid eye m

ovement) sleep.

Therefore, EMDR can be thought of as a physiologically

based therapy that helps a person see disturbing m

aterial in a new and less distressing w

ay.

HOW

WAS EM

DR DEVELOPED?

In 1987, psychologist Dr. Francine Shapiro made

the chance observation that eye movem

ents can reduce the intensity of disturbing thoughts, under certain conditions. Dr. Shapiro studied this effect scientifically, and in a 1989 issue of the Journal of Traum

atic Stress, she reported success using EMDR

to treat victims of traum

a. Since then, EMDR has

developed and evolved through the contributions of therapists and researchers all over the w

orld. Today, EM

DR is a set of standardized protocols that incorporate elem

ents from m

any different treatm

ent approaches.

For more inform

ation:

EMDR International Association

@

EMDRIA

w

ww

.emdria.org

© 2014 EM

DR International Association

WHAT IS THE ACTUAL

EMDR SESSIO

N LIKE?

The client calls to mind the disturbing issue or event,

what w

as seen, felt, heard, thought, etc., and what

thoughts and beliefs are currently held about that event. The therapist facilitates the directional m

ovement of the

eyes or other dual attention stimulation of the brain,

while the client focuses on the disturbing m

aterial, and the client just notices w

hatever comes to m

ind without

making any effort to control direction or content. Each

person will process inform

ation uniquely, based on personal experiences and values. Sets of eye m

ovements

are continued until the mem

ory becomes less disturbing

and is associated with positive thoughts and beliefs about

one’s self; for example, “I did the best I could.” During

EMDR, the client m

ay experience intense emotions, but

by the end of the session, most people report a great

reduction in the level of disturbance.

During EMDR, the therapist w

orks with the

client to identify a specific problem as the

focus of the treatment session.

HOW

LON

G DO

ES EMDR TAKE?

One or m

ore sessions are required for the therapist to understand the nature of the problem

and to decide w

hether EM

DR is

an appropriate

treatment.

The therapist w

ill also discuss EMDR m

ore fully and provide an opportunity to answ

er questions about the method.

Once the therapist and client have agreed that EM

DR is appropriate for a specific problem

, the actual EMDR

therapy may begin.

A typical EMDR session lasts from

60 - 90 minutes. The

type of problem, life circum

stances and the amount of

previous trauma w

ill determine how

many treatm

ent sessions are necessary. EM

DR may be used w

ithin a standard “talking” therapy, as an adjunctive therapy w

ith a separate therapist, or as a treatment all by itself.

Personality Disorders

Panic Attacks

Complicated Grief

Dissociative Disorders

Body Dysmorphic Disorders

Disturbing Mem

ories

Phobias

Eating Disorders

Performance Anxiety

Stress Reduction

Addictions

Sexual and/or Physical Abuse

Pain Disorders

WHAT KIN

D OF PRO

BLEMS

CAN EM

DR TREAT?Scientific research has established EM

DR as effective for post traum

atic stress. However, clinicians also have

reported success using EMDR in the treatm

ent of the follow

ing conditions:

EMDR CLIEN

T TESTIMO

NIALS

“This is to let you know how

EMDR has changed m

y little girl. W

e started therapy and have had 8 sessions so far. She is 6 years old and has had severe sym

ptoms of PTSD from

being abused. Although regular therapy had been a little help, her progress w

as slow and arduous. Now

, through EMDR m

y daughter seem

s happier, and her “fits” (aggressive rages) have been significantly reduced. I could not w

ait to tell you how

much w

e think this therapy has helped our daughter.” -R.A.

DOES EM

DR REALLY WO

RK?Approxim

ately 20 controlled studies have investigated the effects of EM

DR. These studies have consistently found that EM

DR effectively decreases/eliminates the

symptom

s of post traumatic stress for the m

ajority of clients. Clients often report im

provement in other

associated symptom

s such as anxiety. The current treatm

ent guidelines

of the

American

Psychiatric Association and the International Society for Traum

atic Stress Studies designate EM

DR as an effective treatment

for post traumatic stress. EM

DR was also found effective

by the World Health O

rganization (WHO

), the U.S. Departm

ent of Veterans Affairs and Department of

Defense, the United Kingdom

Department of Health,

the Israeli National Council for M

ental Health and m

any other international health agencies. The national registry (N

REPP) of the Substance Abuse and Mental

Health Services Administration (SAM

HSA), an agency of the U.S. Departm

ent of Health and Human Services

(HHS), cites EMDR as evidence based practice for the

treatment of PTSD, anxiety and depression sym

ptoms.

Research has also shown that EM

DR can be an efficient

and rapid treatment.

“A few years ago I underw

ent EMDR therapy. I w

as skeptical, like m

any, of course. At this point in time, how

ever, I see that it saved m

y marriage, m

y sanity and my relationship w

ith m

y children. I was suffering from

PTSD after experiencing m

uch loss and never even realized that’s what stood in the

way of a positive and healthy life. It’s a w

onderful treatment

and more people should be inform

ed about it. I was lucky to

come across EM

DR by accident.” -J.M.

EMDR Informed Consent form – Christopher Carter LICSW – revised 10/14

EMDR Informed ConsentPlease initial each box after you have read the material.EMDR is a simple but efficient therapy using bilateral stimulation (BLS) ─tapping, auditorytones or eye movements ─to accelerate the brain's capacity to process and heal a troublingmemory. BLS, which occurs naturally during dream sleep, causes the two brainhemispheres to work together to reintegrate the memory. Some clients experienceemotional relief or positive effects in just a few sessions. EMDR is effective in alleviatingtrauma-related symptoms, whether the traumatic event occurred many years ago oryesterday. It gives desired results –with little talking and without using medications._________(INITIAL)As of 2014, 24 randomized controlled (and 12 nonrandomized) studies have beenconducted on EMDR in the treatment of trauma. These studies have established EMDR aseffective for the treatment of post traumatic stress, phobias, panic attacks, anxietydisorders, stress, sexual and physical abuse, disturbing memories, complicated grief andaddictions. EMDR is endorsed by the World Health Organization, the American PsychiatricAssociation, the Department of Veterans Affairs and Department of Defense._________(INITIAL)The possible benefits of EMDR successful treatment include, but are not limited to, thefollowing:

Difficult memories are still remembered but the painful emotions and physicalsensations and the disturbing images and thoughts are no longer present. EMDR helps the brain reintegrate the memory and store it in a more appropriateplace in the brain. The client’s own brain reintegrates the memory and does thehealing. _________(INITIAL)The possible risks of EMDR treatment include the following: Reprocessing a memory may bring up associated memories that may be unpleasant.This is normal and those memories will also be reprocessed in EMDR treatment. During the EMDR, the client may experience physical sensations and retrieveimages, emotions and sounds associated with the memory. Reprocessing of the memory normally continues after the end of the formal therapysession. Other memories, flashbacks, feelings and sensations may occur. The clientmay have dreams associated with the memory. Frequently the brain is able toprocess these additional memories without help, but arrangements for assistancewill be made in a timely manner if the client is unable to cope. _________(INITIAL)As with any other therapeutic approach, reprocessing traumatic memories can beuncomfortable. This often means some people won’t like or be able to tolerate EMDR

EMDR Informed Consent form – Christopher Carter LICSW – revised 10/14

treatment well. Others need more preparation, offered by the therapist, before processingtraumatic events. There are no known adverse effects of interrupting EMDR therapy. A client maydiscontinue treatment at any time. Alternative therapeutic approaches may include individual or group therapy,medication, or a different psychotherapy modality. EMDR treatment is facilitated by a licensed psychotherapist having EMDRIA-approved training. _________(INITIAL)

HISTORY AND SAFETY FACTORSThe client must …

disclose to therapist and consult with his/her physician before EMDR therapy ifhe/she has a history of or current eye problems, a diagnosed heart disease, elevatedblood pressure, or is at risk for or has a history of stroke, heart attack, seizure, orother limiting medical conditions that may put him/her at medical risk. Due to stressrelated to reprocessing traumatic events, pregnant women should consider postponingEMDR therapy. _________(INITIAL)

inform therapist if he/she is wearing contact lenses and will remove them if theyimpede eye movements due to irritation or eye dryness. The therapist willdiscontinue bilateral stimulation (BLS) eye movements if client reports eye pain anduse other dual stimulation (tapping, sounds)to continue reprocessing._________(INITIAL) assess his/her current life situation to determine approach to EMDR treatment.Client may need the ability to postpone demanding work schedule immediatelyfollowing EMDR session. _________(INITIAL) before participating in EMDR, discuss with therapist all aspects of an upcoming legalcourt case where testimony is required. The client may need to postpone EMDRtreatment if she/he is a victim or witness to a crime that is being prosecutedbecause the traumatic material processed using EMDR may fade, blur or disappearand her/his testimony may be challenged. _________(INITIAL) consult with his/her medical doctor, before utilizing medication. Some medicationsmay reduce the effectiveness of EMDR. For example, benzodiazapines may reduceeffectiveness possibly due to state-dependent processing and/or regression mayoccur after ceasing anti-depressants. _________(INITIAL)

I HAVE READ AND I UNDERSTAND THE POSSIBLE OUTCOMES OF EMDR LISTED ABOVEAND UNDERSTAND I CAN END EMDR THERAPY AT ANY TIME. I AGREE TO PARTICIPATEIN EMDR TREATMENT AND I ASSUME ANY RISKS INVOLVE IN SUCH PARTICIPATION:NAME (PRINTED): ______________________________________________ DATE: _________________SIGNATURE: _____________________________________________________

Patient: ____________________________

DE Scale

Directions: This questionnaire consists of twenty-eight questions about experiences that youmay have in your daily life. We are interested in how often you have these experiences. It isimportant, however, that your answers show how often these experiences happen to you whenyou are not under the influence of alcohol or drugs. To answer the questions, please determineto what degree the experience described in the question applies to you, and circle the numberto show what percentage of the time you have the experience.

For example: 0% 10 20 30 40 50 60 70 80 90 100%

(Never) (Always)

1. Some people have the experience of driving or riding in a car or bus or subway and suddenlyrealizing that they don’t remember what has happened during all or part of the trip.

Circle a number to show what percentage of the time this happens to you.0% 10 20 30 40 50 60 70 80 90 100%

2. Some people find that sometimes they are listening to someone talk and they suddenlyrealize that they did not hear part or all of what was said.


3. Some people have the experience of finding themselves in a place and have no idea how theygot there.


4. Some people have the experience of finding themselves dressed in clothes that they don’tremember putting on.


5. Some people have the experience of finding new things among their belongings that they donot remember buying.


Patient: ____________________________

6. Some people sometimes find that they are approached by people that they do not know,who call them by another name or insist that they have met them before.


7. Some people sometimes have the experience of feeling as though they are standing next tothemselves or watching themselves do something and they actually see themselves as if theywere looking at another person.


8. Some people are told that they sometimes do not recognize friends of family members.


9. Some people find that they have no memory for some important events in their lives (forexample, a wedding or graduation).


10. Some people have the experience of being accused of lying when they do not think thatthey have lied.


11. Some people have the experience of looking in a mirror and not recognizing themselves.


12. Some people have the experience of feeling that other people, objects, and the worldaround them are not real.


Patient: ____________________________

13. Some people have the experience of feeling that their body does not seem to belong tothem.


14. Some people have the experience of sometimes remembering a past event so vividly thatthey feel as if they were reliving that event.


15. Some people have the experience of not being sure whether things that they rememberhappening really did happen or whether they just dreamed them.


16. Some people have the experience of being in a familiar place but finding it strange andunfamiliar.


17. Some people find that when they are watching television or a movie they become soabsorbed in the story that they are unaware of other events happening around them.


18. Some people find that they become so involved in a fantasy or daydream that it feels asthough it were really happening to them.


19. Some people find that they sometimes are able to ignore pain.


Patient: ____________________________

20. Some people find that they sometimes sit staring off into space, thinking of nothing, and arenot aware of the passage of time.


21. Some people sometimes find that when they are alone they talk out loud to themselves.


22. Some people find that in one situation they may act so differently compared with anothersituation that they feel almost as if they were two different people.


23. Some people sometimes find that in certain situations they are able to do things withamazing ease and spontaneity that would usually be difficult for them (for example, sports,work, social situations, etc.).


24. Some people sometimes find that they cannot remember whether they have donesomething or have just thought about doing that thing (for example, not knowing whether theyhave just mailed a letter or have just thought about mailing it).


25. Some people find evidence that they have done things that they do not remember doing.


26. Some people sometimes find writings, drawings, or notes among their belongings that theymust have done but cannot remember doing.


Patient: ____________________________

27. Some people sometimes find that they hear voices inside their head that tell them to dothings or comment on things that they are doing.


28. Some people sometimes feel as if they are looking at the world through a fog, so thatpeople and objects appear far away or unclear.


Debriefing advice: After your EMDR treatment sessionsPlease note: The material below is in addition to advice supplied by your therapist in your

specific case. Therefore the material below is not comprehensive nor is it exhaustive. If youhave any doubt about what to do, contact your therapist promptly on (telephone number or

email address).

The first half hour or so after an EMDR treatment session:EMDR is not like other therapies. Treatment generates a certain amount of 'momentum' toyour thinking and conscious awareness. In other words treatment doesn't just stop immediatelyon leaving the session. It is best if you use half an hour after the session to readjust to thepresent moment.

If you can manage it, I also advise that you do not drive during this period as you may find yourconcentration wanders off easily. The same advice goes for running and catching a bus or train.The best way of spending the half hour is to ground yourself properly in the 'present' such asbeing mindful of what you are doing minute by minute. This can be achieved by mindfullyreading a book or magazine, talking to a friend, walking around the neighborhood or watchingwhat is going on around you. You can observe how someone is walking, the effect of wind inthe trees or birds coming and going, or listening to sounds. Really any attention you can pay tothe 5 senses will be grounding (touch, taste, sight, smell, sound). Other helpful activities mightbe going to a coffee shop, window-shopping or relaxing in a local park.

Things that may (or may not) happen in the days that follow:You may experience a headache after the session; this is most likely due to not beingsufficiently relaxed during the session itself. Your eyes may feel different because you’ve usedthem in a way that you’re not used to. You may experience increased dreaming in the daysafter a session. This is nothing to worry about. If you recall the dreams it is likely that they won'tmake much sense, dreams that may "seem chopped up into pieces". Other clients report noincreased dreaming, indeed sometimes no dreaming at all. Again don't worry, as this doesn'tmean the EMDR is not working.

You may become aware of new insights about what is being treated, this is a direct indicationthat processing is continuing between sessions. Similarly, feeling more emotional can beregarded as important information for your therapist to know, so try to keep a record of what ishappening, when it happened, and in what order; this information can be very difficult to recalland use at a session a week or more later. If feeling more emotional between sessions, you maywant to make your partner, significant other or close friends aware of your need for support. Ifyou are still worried do not hesitate to contact me using my direct line: 617-643-8068 or at themain desk 617-643-8080.

emdr treatment initial packet - christopher carter,...

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