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What can EMDR Therapy help?

9/27/2019

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EMDR is a therapy that was originally proven to reduce symptoms of PTSD like nightmares, unreasonable anger, suicidal thoughts, hypervigilance and hopelessness.  We know now that because of the unique way EMDR rewires the brain, it is effective on other conditions as well.

Do I have to have experienced a trauma for it to help?
The brain normally processes day to day events quickly and effectively.  A trauma is normally seen as a life threatening event like a fire, war, physical or sexual abuse or a car accident.  Tragic experiences and other painful events can affect the brain's capacity to process effectively.

What do you mean by Tragic or Painful events?
Verbal, sexual or physical abuse whether as an adult or child is an example.  Others include the sudden death of a loved one, being fired, being humiliated, divorce, miscarriage, mishandled potty training or weaning.  If you get that horrible pit in your stomach when you remember an event, it is a potential target for EMDR Therapy.  One way I think about it is feeling haunted by a memory.  

What about addiction?
Most people with addiction have experienced trauma at some time in their lives.  EMDR Therapy can help heal the trauma that is driving the need to alter our reality.  In addition, addiction causes us to violate our own values leading us to wonder what kind of person we are.  This is horrifying and EMDR Therapy can help reduce the self-loathing that results.

The triggers that we experience in addiction are very similar to trauma triggers: people, places, things, smells, sounds, or events (like Father's Day).  EMDR Therapy can target the cravings and the triggers and reduce the intensity so that it can be managed more successfully.  Some cravings and triggers resolve completely.

I'm clean and sober, how can EMDR help me?
There are several stages of recovery.  Getting clean is just the beginning.  Now you have to deal with feelings and life on life's terms.  EMDR therapy can help people tolerate feelings they used to use over.  It is especially good for reducing the shame of things that we've done in our addiction.  Of course, processing past traumatic events endangers many an addict's recovery.

You make it sound like it can resolve everything.
Nope.  It is an amazing therapy, but in my experience it does not cure depression caused by neurotransmitter imbalances.  I have had limited success with OCD symptoms.  It doesn't work well with some types of brain injury or if the brain is compromised due to benzodiazepine, marijuana use.  Other drugs including alcohol can interfere with processing.  A drug called propranolol sometimes used for depression, migraine prevention or to lower blood pressure interferes with processing as well.

That's it for me for now.  Stay tuned for more "Words of Wisdom"
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Dr. Amen on Bipolar Disorder

8/4/2017

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I admire Dr. Amen for being able to show through brain studies what is occurring with various conditions.  In the past we have only been able to guess what is happening to the brain with depression, anxiety, PTSD, etc.  That's why people feel like guinea pigs with different medicines being thrown at them until one (hopefully) works.

Read his blog and watch the video on Bipolar Disorders
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I can't have PTSD.  I'm not a soldier.

2/15/2017

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For some reason, I thought the word was out, but I had another client tell me he had been talking to friends about his struggles and they told him it couldn't be PTSD because he had never been in a war.  We went through the DSM-5 criteria and indeed he met most of them.  On the other hand, I am working with a soldier who has PTSD...but it's not from the 2 tours in Iraq.  It's from childhood trauma.

So what is a trauma?  Simply put it is a horrifying event.  You experience horror.  You almost die.  You think you might die.  You are beaten You see someone else die, or be beaten.  You are raped.  You hear about a family member who was killed.  In other words, you feel very intense fear and helplessness.  This cannot be happening, but it is.  Who decides what is traumatic to you?  You do.

Who gets PTSD?  Some people who experience horrific events are haunted by them later.  Some are not.  We are not exactly sure why.  There are some ideas about resilience and a strong attachment bond with family.

The good news is that there is help.  You do not have to be haunted by nightmares or intrusive thoughts or memories for the rest of your life.  EMDR is a proven treatment that alleviates PTSD.  There are also treatments that help manage PTSD.  EMDR can eliminate it.  Will it work for you?  Are willing to find out?
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A National Conversation about sexual assault

10/13/2016

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​I, as well as most of my clients and I'm sure, many of you have been reminded of the times we have been sexually harassed and assaulted.  For some the reminders are so painful they can't stop thinking about it, are crying and feeling jumpy, scared and angry.  Some of my clients are feeling physically ill.

My first assault was by a cousin when I was very young.  When I was 19 a city bus driver tried to groom me by telling me I had to sit at the front of the bus.  A few bus rides later he told me I had to kiss him to get off the bus.  Finally he grabbed me and pulled me to his lap.  I got away and never rode the bus again.  A coworker when I was in my 30's decided since our birthdays were the same day that I had to give him a birthday kiss.  I never went to work on my birthday again.  I can imagine how these men talked to other sexual predators about their hunt and conquests.  I never said anything about the bus driver.  It was years before I told anyone about my coworker and only then because I was called out on being angry with him.

There are of course more incidents that have occurred.  I think we have an opportunity here to talk.  To talk about our experiences.  To unearth the secrets.  To realize that this was not our fault.  We did nothing to bring it on.  There are some men on this planet who prey on women and children.  They have a strategy that involves being charming.

I invite you to let others know about your experiences.  Let's support each other.  Let's change the national conversation.  Let's challenge the norms that allow this harmful culture.  Let's teach our boys how to treat people respectfully, to take responsibility for their actions, talk about their feelings and experiences.  Let us treat ourselves and each other with respect.


On your mark, get set, go!
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EMDR Videos

10/1/2016

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Here are two videos about EMDR.  They are both old, one from 2008, the other 2012.  However, the information and descriptions are very helpful.

A news report from 2008 that follows a soldier who developed PTSD not after the war, but after being involved in a car accident at a busy outdoor market with fatalities and multiple injuries.

A Documentary produced in 2012 with survivors, therapists, neurologists and our favorite, Francine Shapiro.

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How to Fix an Addicted and Codependent Marriage

9/29/2016

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By Cristina Utti, MA, MFA|September 19th, 2016  Willingway.com

​For a very long time, I could not decipher between ‘codependency’ and love. I thought if we loved someone, we put that person’s needs before ours, and make their happiness our business.There is a fine line. It is true that love is unselfish. When we have a baby, or children, their needs do have to come before ours. We are not going to let our baby cry for hours from hunger in the middle of the night because we feel like sleeping when the baby would rather be awake and eat. We will drive our children around to activities when we are tired or would rather be doing something for our self. This is love, and the responsibility of a parent.
When we react in the same ways of putting the other first in our adult relationships, this is a red flag that we may be codependent. Codependency is a learned behavior. We watch the actions of our parents when we are children. If our mother or father had a problem with boundaries, was always the martyr, could never say ‘no’ to people, and had unhealthy ways to communicate, we learn these behaviors, and bring them onto our intimate relationships.
Children who grow up with emotionally unavailable parents also are at risk for being codependent. They often find themselves in relationships where their partner is emotionally unavailable, yet they stay and stay, hoping to change the person. Hoping that one day, things will be good. The subconscious hope is that the other person will see all the love we give and change. If we just hang in there, give our love, understanding, and support, we will finally get the love that we desired from our parents. This thinking is noble in one sense, and destructive if we do not have healthy boundaries. The worst part is when we do not realize what is going on and continue to live in a loveless partnership because we have never learned what a good partnership looks like. Codependent people do not believe that they are worthy of love, so they settle for less, often taking mental, emotional, physical, and even sexual abuse from their “partner.”
People who are codependent often look for things outside of themselves to feel better.They form relationships that are not healthy, looking to ‘fix’ the other person. A person with codependent tendencies may find themselves in relationships with a person that has addiction issues, thus making them the ultimate of emotionally unavailability. Their partner or they themselves may be workaholics, or develop some other compulsive behavior to fill them. This is easier in the short term than looking within and dealing with emotions.
If you are married and think that you may be in a codependent relationship, the first step is to stop looking at the other, and take a look at yourself.
If you honestly answer yes to any of these questions, you may be codependent.
  • You tend to love people that you can pity and rescue.
  • You feel responsible for the actions of others.
  • You do more than your share in the relationship to keep the peace.
  • You are afraid of being abandoned or alone.
  • You feel responsible for your partner’s happiness.
  • You need approval from others to gain your own self-worth.
  • You have difficulty adjusting to change.
  • You have difficulty making decisions and often doubt yourself.
Since codependency is a learned behavior, it can be unlearned with help and mindfulness. If you love your partner and want to stay in the marriage, you need to heal yourself first and foremost.
Some healthy steps to healing your marriage from codependency are:
  • Start being honest with yourself and your significant other. Doing things that we do not want to do not only wastes our time and energy, it also brings on resentments. Saying things that we do not mean only hurts us, because we then are living a lie. Be honest in your communication, and in expressing your needs and desires.
  • Negative thinking. Catch yourself when you begin to think negatively. If you begin to think that you deserve to be treated badly, catch yourself and change your thoughts. Be positive and have higher expectations.
  • Taking things personally. It takes a lot of work for a codependent not to take things personally, especially when in an intimate relationship. Accepting the other as they are without trying to fix or change them is the first step.
  • Take breaks. There is nothing wrong with taking a break from your spouse. It is healthy to have friendships (of the same sex) outside of your marriage. Going out with friends brings us back to our center, reminding us of who we really are.
  • Marriage counseling. Get into counseling with your partner. It takes two to make or break a partnership, we cannot fix a marriage on our own. A counselor serves as an unbiased third party. He/she can point out codependent tendencies and actions between the two of you that you may not be aware of. Feedback can provide a starting point and direction. Change cannot happen if we do not change.
  • Boundaries. Those that struggle with codependency often have trouble with boundaries. We do not know where our needs begin or where the others end. We often thrive off of guilt, and feel bad when we do not put the other first. Learning where you stand in your own life, and having clear boundaries is not mean, it is healthy.
  • Take care of yourself. Learn to be your own best friend. Depending on how we are raised, most people do not know how to love themselves. It is not selfish to take care of yourself first.
Your marriage can be saved, but it will take an honest effort from both parties.
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What do peach pits have to do with relationships?  When you finish the yummy fruit, you are left with the source of life.

11/17/2014

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  The Bravest, Sexiest Thing You Can Do in an Uncomfortable Moment.
~ Garrison Cohen

Ever notice how most people tend to run from uncomfortable moments, especially in relationships? The truth is that there are always going to be moments that are painful, uncomfortable or awkward. It’s just the nature of being human. However, in our effort to avoid feeling any form of emotional turmoil, confusion or upset, we unintentionally create even more of it in our relationships and for ourselves.

I want to share with you a perspective shift that really started to turn it around for me. Several years ago I was in a relationship that was beautiful and fun and light and playful. It was great on all accounts… except for when things would get confronting or challenging. Then she would disappear for days at a time. It drove me crazy.

I could point a finger at her, but in my own ways I would run away as well by trying to be obstinately right, not considering her perspective or trying to get her to change.

One day during one of her disappearances I was driving by a fruit market and had an epiphany. I swerved my car over to the side of the road and ran inside. I needed to know something about how nature worked.

I had a question about peaches. I entered the store, found a peach, walked over to the first person I saw wearing a green apron and demanded an explanation. “Listen, most people like peaches because they enjoy the juicy, sweet, refreshing exterior and then when they come to the pit they simply throw it away. But doesn’t nature have a different perspective? We think the fruit is what it’s all about, but through natures eyes isn’t it pretty much all about the pit?”

The clerk was a college-looking student with dreadlocks and a thin beard. He looked at me for a long moment, taken aback my question. Then he simply said, “The pit is the source of life, dude.”

“Yeah,” I said, “that’s what I was thinkin’.”

So check it out. We all enjoy the juicy, crunchy, sweet, refreshing, moist, delicious exterior of fruit, and then when we finally come to the pit we throw it away.

The majority of the time we see it as worthless. That’s why you hear old sayings like, “Oh man, this is the pits.”

In relationships we all enjoy the fun, light, playful, juicy exterior of knowing someone. And then when we come to a breakdown (the pit) we want to throw it away, ignore it, treat it as worthless. The majority of the time we see “the pit” of relationship as a waste of our time, not what we want, not fun anymore.

I believe we’re missing the point. Just as the pit is the source of life for the fruit, breakdowns are the source of life for the relationship. Not just your relationship with him or her—but your relationship with everything and everyone, including yourself.

If we run from the breakdowns, we simply stay on the surface where we can only have light, fun experiences. When we allow ourselves to really experience the breakdowns, we start to see the core of who we really are. This can feel scary and vulnerable and yet, only by embracing the source of life can we continue to grow.

More often than not it is in the breakdown (the pit) that we find access to more life.  Nature is intelligent. Fruit is designed to be sweet and tasty because it attracts animals (us included) who eat them and carry them far from the tree and either drop them or poop them out and the seeds or pits go into the ground and grow new trees. This is nature’s doing. Nature is drawing us in so that we can help it to procreate.

Also, by our nature we are drawn to relationships because of the sweetness we naturally crave to experience. But that is just what draws us in. Just as the fruit draws us in to forward its own procreation, relationships draw us in by their own sweetness so that we will come to the pit, experience breakdowns, discover ourselves and be forced to evolve… just as nature does. Crazy, huh?

*Side note: In truth, to say “just as nature does” is kind of a silly because it implies that we are separate from nature. We’re not. We are nature.

So the point behind all of this is that there is no use in resisting it. Breakdowns are designed to happen. They are meant to happen for the purpose of our own evolution. So let them come, celebrate them, cherish them and let them be a source of life. Welcome them, instead of letting them be a source of destruction, stagnation or de-evolution by resisting them.

So how do you do this? It’s simple. Just don’t resist it. Let yourself be in “the pits.” The less you resist it the quicker you get to the feeling of being alive. This isn’t just for your romantic relationships. It’s for every relationship you have with everything and everyone in your life. Your work, your health, your family, your friends, your self. Any place where you could find yourself “in the pits” is a place that is a potential source of greater connection to life.

However, in our romantic relationships we have the opportunity to go on that journey together in a way that massively accelerates our own personal evolution. That is why relationships that choose to run toward the source of life instead of away from it are far richer and enjoy far more fruits than others.

Consider doing an experiment for yourself by simply having an awareness around cherishing and nourishing the pit when it arises in your relating.

It is the source of all the fruit you’ll ever want.


Garrison Cohen, former co-founder of AuthenticWorld Media, has spoken at over 250 colleges (as far away as Singapore) for audiences of up to 2,500. He is an award winning filmmaker, speaker, writer and honorary member of the Society of Leadership & Success, which hosts speakers such as Patch Adams & Jack Canfield. In addition to his work in education and entertainment, Garrison has been a voice in the field of transformational media for men & women teaching them to discover, embody and relate with the world as their most solid, sexy and authentic selves.

When I was a kid my Dad always said to me, “Don’t tell me, show me.” And I’d always say, “Okay, I will.
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Why would he kill himself?  He had so much to live for, so many who love him.

8/18/2014

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After such a great loss, the national discussion has turned to mental illness again. 

We've lost the king of comedy, Robin Williams.  Why?  What happened? 

There are so many questions.  Many people are speculating.  Talk shows, political leaders, friends, Facebook, Twitter, newspapers are buzzing.

People are confused, angry and sad.  If you have never been suicidal or experienced soul sucking depression, it makes no sense.

To understand how a person becomes suicidal, remember your worst day.  It may have been because of a divorce, death of a loved one, loss of a job or business or some other kind of event.  Remember what it felt like the next day.....the day after......the day after that....the week after that....the month after that.  You can't eat, or sleep.  You keep thinking about sad, discouraging things.  Nothing is fun.  You can't make decisions.  You are exhausted all the time.  You don't want to do anything.  You don't want to be around people.  You want to be left alone, but then again, you don't.  You can't concentrate.  You forget appointments.

Imagine feeling that feeling every day.  Every morning when you wake up.  Every night when you try to go to sleep.  Every Monday, Tuesday, Wednesday and every other day of the week.  Every holiday, birthday, vacation and workday.  During times you should be happy, times you are rich and times you are poor.  During times when you have loving friends and family and times you are alone.  Let yourself remember that feeling and imagine it dragging on.  It almost never goes away..

How do you deal with that much pain every day?  You don't want to infect anyone else with the depression.  Other people don't want you to feel that bad either.  They say the wrong things.  Eventually they stop saying anything at all.  You feel hopeless and alone.  Day after day after day.

You try everything you can think of to feel better.  If it works at all, it's temporary.  When the depression hits again, you feel even worse.

At some point you can't stand it.  You want the pain to stop no matter how.  Dying becomes an option.  It starts with, "It would be better if I just didn't have to live this way."  "If I die tomorrow, I don't care."  As you feel more helpless and hopeless it changes to, "Well, if I were to kill myself, how could I do it?"  It gets worse and you get everything ready, just in case you do decide to end it.  You think about family and friends and what you can do for them before you go.  You may give things away.  You wrap things up.  You make the decision.  It's such a relief to know that it will soon be over you feel almost happy.  Everyone thinks you are finally getting better.  You take action.

And here we are, those who are left behind, wondering what in the world happened and what we could have done, or what you should have done, or what professionals should have done to keep you alive.  While next to us in line at the bank, a man stands, feeling hopeless and alone. 
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May 29th, 2014

5/29/2014

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My latest Article about Co-Occurring Substance Abuse and Trauma (PTSD) treatment is published in the June 2014 issue of Counseling Today.  Read article:
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A Publication of the American Counseling Association
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Counseling Today, Features EMDR for the co-occurring population By Jeanne L. Meyer May 29, 2014

In my work with clients with co-occurring mental health and substance use disorders, it became clear to me early on that most have experienced trauma in their lives — trauma that they must resolve to achieve and maintain a healthy recovery.

These traumas are sometimes categorized as little “t” or big “T” traumas. Big “T” traumas include childhood sexual, physical or emotional abuse, natural disasters, war experiences, severe car accidents and rape. Little “t” traumas can be just as damaging, especially because they tend to occur over time and build on each other. This complicates the overall effects of the trauma as well as the trauma treatment. Some examples of little “t” traumas include ongoing emotional abuse or neglect, experiences of shame, being humiliated and being bullied. Incidents involving racism, sexism or homophobia could be classified as either big “T” or little “t” traumas depending on the severity. These traumas might involve one or two distinct incidents, or be more complex, ongoing experiences. The result is a primary belief that the world is not safe. In some cases, individuals who are traumatized learn to expect pain, dishonesty and betrayal from the people they love the most.

In the case of clients with addiction, even if they have not experienced trauma prior to the onset of their disease, they most likely have experienced violence, rage, betrayal, abuse (sexual, physical or emotional), incarceration, homelessness or a whole host of other negative experiences while using alcohol or other drugs.

There are two clinically appropriate strategies for treating posttraumatic stress disorder (PTSD) with people in substance abuse recovery. One strategy is to address the trauma or abuse immediately as the client enters the beginning stages of recovery. The other is to wait until the client’s ability to achieve and maintain abstinence has stabilized.

How do we know which strategy will be successful? Ultimately, the client is the one who knows. If the ability to maintain abstinence from alcohol or other drugs is precarious or impaired due to memories, suicidal ideation or self-harm, it is essential to treat the cause of these symptoms from the beginning. For these clients, recovery will likely remain elusive until their trauma is addressed. If the client is relatively stable, however, waiting until the later stages of recovery is indicated. Clients who are pressured into addressing their trauma issues before they are ready are likely to relapse into active addiction.

According to recent brain research described in Uri Bergmann’s 2012 book Neurobiological Foundations for EMDR Practice, when someone experiences an event or multiple events that cause intense fear, it can change the neural pathways, or maps, in the brain. Whenever something is experienced as a reminder of the trauma, clients can relive that trauma, making them afraid of certain places, tones of voice, objects or even other people with certain body types. Smells can also trigger intense anxiety and fear. The repetitive experience of anxiety and fear can result in panic attacks, health problems, chronic pain, sleeping difficulties and eating difficulties. The individual eventually becomes self-centered, focusing so much on self-protection that there is little objectivity or ability to have empathy for others. This makes every relationship unstable.

The good news is that several proven therapeutic techniques, including eye movement desensitization and reprocessing (EMDR), can alleviate symptoms stemming from past traumas. EMDR uses the mechanism by which information from frightening and horrifying events is processed into memory and stored in the brain. By manipulating the brain’s intrinsic information processing scheme, a practitioner can help clients release themselves from the intense hold those memories have on them. EMDR combines sensory bilateral stimulation (visual, auditory or physical sensations) with emotional memory and the underlying belief system to lessen the intensity of the experience. It does not erase the memory, but it can reduce or alleviate many of the associated symptoms.

The mystery of EMDR

It is not known precisely how EMDR works, but various research studies have verified its effectiveness in the treatment of trauma. Twenty-four randomized controlled (and 12 nonrandomized) studies have been conducted on EMDR. Most of these studies address simple rather than complex trauma. For a list of these studies, visit the EMDR Institute website at emdr.com and click on the “Research Overview” link under the General Information tab.

In developing EMDR, Francine Shapiro postulated that PTSD is caused by a disruption in the adaptive information processing system. Because the fear and helplessness experienced by clients stays attached to the memory of the traumatic event, it creates havoc in their lives. It is as if the trauma is continuing to happen to them. Because it is still occurring neurologically, it cannot be processed as a memory.

EMDR changes the configuration of the neural connections or map of that event, detaching the dysfunctional physiological and emotional components so that it becomes a more manageable memory. This helps the client “let go” of the past because the neurons are literally letting go of some connections and replacing them with new ones.

In my experience, EMDR is the fastest, most effective and least intrusive way to help clients release trauma, regardless of whether it stems from childhood abuse, sexual abuse or assault, accidents, disasters or combat, and regardless of whether it is the result of a single event or multiple experiences. I have also seen EMDR reduce or eliminate chronic pain, headaches, fibromyalgia and cravings for alcohol and other drugs. One of the best things about EMDR is that it doesn’t require clients to retell their horror stories. In my view, when people don’t have words to describe what they are experiencing, don’t remember the original incident, have somaticized their pain or are too emotionally raw to put the experience into words, it is essential to offer treatment that does not require verbalization.



 The eight phases

To practice EMDR, a clinician must have a master’s degree, counseling experience and the proper EMDR training. Although the process may seem simple to an outside observer, it requires both an understanding of how the brain and emotions work with trauma and a specific protocol. As shown in the table below, there are eight phases of treatment.

We’ll use “Carrie” to highlight how each phase of the EMDR treatment protocol might be carried out with a client.

  • History taking and treatment planning (Phase 1): This is used in most counseling therapies. The therapist and client review biopsychosocial history and trauma history, assess client resources and strengths and determine the frequency and level of any dissociation symptoms. The therapist will suggest different targets and strength-building skills depending on the overall emotional stability of the individual.
“Carrie” comes to the clinic requesting help with night terrors and anxiety. While obtaining her background history, it becomes clear she has survived many traumatic events, has few financial or social resources and is currently separated from her abusive husband. She smokes cigarettes, uses marijuana, uses some mindfulness tools and practices breathing techniques to manage her distress and anxiety. The therapist determines it is essential to improve her emotion regulation and distress tolerance skills, along with targeting various symptoms such as her recurring nightmare.

  • Preparation (Phase 2): The therapist explains the adaptive information processing system and how trauma disrupts it. The mechanics of treatment are reviewed. Emphasis is placed on clients nonjudgmentally observing their reactions and awareness, and communicating those observations to the therapist. Rapport is established. Relaxation and self-soothing techniques are taught and practiced.
In Carrie’s case, she is able to best understand the adaptive information processing system with the help of a simple illustration the therapist draws to engage her in the therapeutic relationship. The therapist says, “I will show you exactly what the technique looks like. We can use eye movements, sounds using headphones, or I can tap the back of your hands. Which feels most comfortable to you?” When Carrie chooses eye movements, they arrange the chairs so Carrie and the therapist are facing each other. The therapist holds a pen in front of Carrie and asks, “Is that comfortable? Do I need to change the distance or the pen I’m using? What I will do is wave my pen back and forth, and you follow it with just your eyes.” The therapist does this, and Carrie follows the pen easily.

  • Assessment (Phase 3): The client and the therapist determine exactly what the target is, including any images, physical sensations or memories that are associated with the emotionally loaded material. They rate the intensity of the feelings that are attached using the Subjective Units of Distress Scale (SUDS). An “irrational belief” (as defined by Albert Ellis) is identified by the client as the negative cognition. The client chooses a more reasonable belief to use as the positive cognition and rates the perceived validity of this statement.
In Carrie’s case, she remembers parts of her dream: She is in a dangerous situation with people looking for her; she crawls through a hole in a wall to discover she is in a bunker with gunfire all around her. She rates the fear she feels as she recalls the nightmare at a SUDS score of 9. She identifies her belief when these feelings come up as, “I am never safe.” The therapist asks her what she would rather believe.

Carrie responds, “That I am safe, I guess.”

“Are you safe?” the therapist asks.

“No, not always,” Carrie says.

“But sometimes you are safe.”

“Yes, sometimes I am safe.”

The positive cognition becomes “I can be safe.”

The therapist asks, “How true does that statement feel right now?”

Carrie rates it on a Validity of Cognition (VOC) scale as a 1, indicating it feels “like a lie.”

  • Desensitization (Phase 4): The cognition, the emotion and body awareness are combined with bilateral stimulation. The therapist changes the bilateral stimulation speed with eye movement, tapping and sounds throughout and between sets. A set is composed of a series of bilateral stimulations. For example, moving the eyes back and forth 10 times would represent a set. The therapist varies the length of a set depending on the intensity of the material the client is experiencing. In between sets, the therapist determines that the process should continue by asking the client if he or she is noticing any changes. This pattern continues until the client reports no change between sets and the SUDS score has been reduced to a 0 or 1.
For example, the therapist tells Carrie, “Bring up that memory, crawling through the hole and being in the bunker. Remember the sounds and smells. Notice how your body feels. Allow the thought, ‘I am never safe,’ to float in your mind. Do not try to direct your thoughts. Let your mind wander. Wherever it goes is where it’s supposed to go.”

Carrie watches the therapist move the pen back and forth, causing her eyes to move from left to right rhythmically. After a set of 10 eye movements, the therapist stops and says, “Take a deep breath. Tell me what you are noticing right now.”

The therapist makes a note of Carrie’s response and starts another series of bilateral stimulations. The process continues until Carrie reports several times that she feels “nothing.” When recalling her nightmare, her SUDS score is 0.

  • Installation (Phase 5): The positive cognition is strengthened for the client. The bilateral stimulation is used as the client thinks of the positive cognition. The sets are shorter and slower to allow the positive experience to establish itself. The VOC is measured again until a score of 6 or 7 (“completely true”) results.
  • Body scan (Phase 6): The therapist asks the client to pay attention to the way her body feels from head to toe (or vice versa) and report it.
Carrie notices some trembling in her hands. The therapist uses more sets of eye movements until the trembling ceases.

  • Closure (Phase 7): The therapist ensures clients are safe to leave the session and navigate their way to their next destination. They are guided through self-calming rituals. The therapist explains that the client may feel spacey or very tired for anywhere from one hour up to a few days. Clients are given an assignment to journal their experiences, emotions, thoughts and dreams until the next session.
  • Reassessment (Phase 8): This phase occurs at the beginning of the following session. The targeted material is recalled and the client’s SUDS score is determined. The VOC of the positive cognition is also reevaluated. Any residual processing that occurred between sessions is discussed. If there is a change in either the SUDS or VOC score, it indicates there are more aspects of the target to process.
At Carrie’s next session, she reports the nightmare has not returned. When she remembers it, her SUDS score is 1. The positive cognition, “I can be safe,” is rated at a VOC of 7 (“completely true”).

Conclusion

When I work with a client, I keep meticulous notes about the intensity of the individual’s negative emotions and the perceived validity of the positive cognitions before and after a treatment. I keep this record partly so that I can review it with the client in the future. Many times, the client possesses no memory of having the original problems and emotions. The client still remembers the traumatic incident and has feelings about it, but the incident does not haunt the client any longer.

My experience of utilizing EMDR with clients has been no less than amazing. I continue to be surprised at its effectiveness addressing a number of concerns. It works relatively quickly, and its results are maintained. After the initial setup, it relies on clients’ own processing and therefore validates their experience completely. With EMDR, there is also a shorter period of intense unpleasant emotion that clients experience than with other talk or exposure therapies. It engages the parasympathetic nervous system, leading to relaxation or drowsiness when the process is complete.

Whether EMDR is used at the beginning of addiction recovery or after a period of abstinence, clients are able to manage their recovery more easily and more successfully when PTSD symptoms are alleviated.

****
Jeanne L. Meyer, a licensed mental health counselor, licensed professional counselor and master addictions counselor, is a co-occurring therapist with Choices Counseling in Vancouver, Washington. She is also a member of the American Counseling Association Trauma Interest Network. Contact her at jmeyer@ChoicesCounseling.org.

Letters to the editor: ct@counseling.org

Tags:
eye movement desensitization and reprocessing, PTSD, Substance Abuse & Addictions, Trauma and Disaster

2 Comments

This is why I do what I do.

2/28/2014

2 Comments

 
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"There are times these days this experience feels almost like a dream.  Truthfully the suffering and inner tangle feels more like a memory than something I actually experienced.  You were correct when you said that would be the case.

A life I was determined to end, hmmm.  Thank you a thousand times for not giving up.  Being the professional, kind, understanding, non-judgmental and sympathetic human that somehow in all my misery I was able to find.  I am so grateful that you never once made fun of or dismissed my genuine suffering. ... I couldn't have asked for a better outcome.  Even though the situation hasn't changed, I have.

You have done more for me than was imaginable in just six short months.  My life has taken some incredible turns during our time together and knowing you were there has been a tremendous comfort.  I would be lying if [I didn't say] what lies ahead has me a bit terrified but my brain feels unscrambled so I will deal. . . . Thank you Jeanne."
                                      - H 2/5/14
I volunteered as a Mental Health Counselor at the Wellness Project in Vancouver, WA.  The Wellness Project accepts clients who do not have mental health insurance and need counseling and/or medication.  I do so as a way to give back to the community, as well as have regular contact with other professionals.  Having a private practice is wonderful in so many ways, but it can be isolating.  I miss working with a team.

I worked with a woman for about six months.  This is average for clients at the Wellness Project.  When we finished our work together, she surprised me with a letter.  Her experience is what brings me satisfaction and happiness.  I feel blessed that I was able to work with her, that she was able to heal so much, and that she shared her feelings with me.  This client told me I could post her whole letter, but this is an excerpt, taking out any information that could identify her.
 
2 Comments
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    Jeanne L. Meyer, LMHC, LPC, MAC is a private mental health therapist in Vancouver, WA.

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