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Understanding Trauma And Post-Traumatic Stress Disorder (Part VIII)--Treatment Modalities: EMDR II
UNDERSTANDING TRAUMA AND POST-TRAUMATIC STRESS (PART VIII):
EYE MOVEMENT DESENSITIZATION AND REPROCESSING (EMDR 2)
By Cristina Casanova
Dr. Francine Shapiro indicates that, "EMDR treatment effects are based on the ability to
target
and access dysfunctional material. The initially targeted manifestations of this material
include
the image, the negative cognition, and the physical sensations associated with the
event." The
treatment with EMDR is done in eight phases designed to quicken the information
processing.
Phase One: Client History and Treatment Planning
Treatment with EMDR will stimulate the client's traumatic memory bringing into
consciousness
feelings, images, and physical sensations experienced at the time of the event. Dr. Shapiro
explains, "There is no way to predict exactly how a client will process a particular event.
Responses can range from a mild emotional reaction to a full-blown abreaction. In EMDR
we
define abreaction simply as the re-experiencing of the stimulated memory at a high level of
disturbance."
Taking a client history carefully assists the therapist to make an appropriate treatment
plan with
the goal of targeting the most apparent traumatic events. Because the most important
characteristic of EMDR is the rapid processing of information, it has the potential of
uncovering
very disturbing events very quickly. Therefore, the assessment of the client history is
extremely
important.
Phase Two: Preparation
During this phase, a relationship with the therapist based on trust and safety is
developed.
Clients need to feel safe to be able to tell the therapist or counselor the essential
information
about their situation. This phase also includes providing clients with information about
EMDR theory and addressing all their clients concerns.
Phase Three: Assessment
Together, the client and the therapist identify what target memory to work on. Then the
client
identifies a negative cognition about himself or herself that is connected to the original
event.
Negative beliefs that have been locked in the traumatic memory might include: "I am a bad
person," "I am unlovable," or "I am unworthy." Then the client chooses a statement that
best
reflects reality in the present -- e.g. "I am a good enough person," "I am lovable," etc. The
client also evaluates the level of disturbance of the memories, as well as the physical
sensation
they produce. These evaluations help the clinician assess how the treatment is making
progress.
Phase Four: Desensitization
The fourth phase, which concentrates on reducing the client's disturbance to zero on the
rating
scale, is called desensitization or the removal of all the dysfunctional material associated
with
the traumatic event. Glenn Schiraldi explains, "Clients are instructed to think of the
targeted
material, the negative belief, and disturbing feelings/sensations. While holding all this in
mind,
the client is asked to do a set of eye movements by following two fingers on the
therapist's
hand, held about twelve inches away and moved rhythmically back and forth across the
field of
vision. The head is held still as the eye movements are performed. Processing begins and
new
mental material typically emerges with each set." With each set of eye movements, the
client
notices the image and feelings change and supportive realizations emerge. The client is
encouraged to stay with the process until all the disturbing aspects of the memory are
processed.
Phase Five: Installation
Clients are ready for the installation phase after they have processed their traumatic
memories
and associated feelings enough to rate a 1 or a 0 in the distressing rating scale. At this
time, the
client is viewing the original event in a much more positive light than he or she had
originally
imagined. At this time feelings of shame, guilt, or failure associated with the original event
may
have evolved into feelings that "I am a worthwhile person" or "I am a lovable person,"
etc. This
positive cognition is then reinforced with additional sets of eye movements (or other
bi-lateral
stimulation techniques).
Phase Six: Body Scan
When the positive cognition reaches the highest mark on the rating scale and remains
steady
there after a few set of eye movements, the client is asked to hold both the image and the
positive belief in his or her mind while mentally scanning his or her body to identify any
remaining
feelings, tensions or other unusual sensations. If any distressing physical sensation is
found, it is
then processed through additional eye movements.
Phase 7: Closure
Dr. Shapiro indicates that, "Although a 90-minute session of EMDR will be sufficient to
process
successfully most traumatic material involving a single memory, this may not always be
the
case. This is why the clinician should always reserve time to close the session with proper
instructions, leaving the client in a positive frame of mind and able to safely return home."
Dr. Shapiro also stressed the importance of journal-keeping by the client between
sessions. This
will allow the client to report any memories, distressing feelings, or dysfunctional patterns
of
behavior while at home. Self-calming techniques are also given to the client for stress
management.
Phase 8: Re-evaluation
At the start of every new session, the therapist makes sure that the positive results
achieved in
the previous session have been sustained. New targets or memories are identified and
processed.
BENEFITS OF EMDR
Dr. Schiraldi lists six benefits of the EMDR modality:
- EMDR processes traumatic material very rapidly, which leads to rapid
improvement.
More than 90 percent of clients report significant relief in only three sessions.
- EMDR processes the varied aspects of traumatic memories together:
cognitions,
feelings, sensations, images, thoughts and behaviors.
- Control of the sessions rests with the client. The therapist does not tell the
client what
to think, it arises naturally. Clients have the choice to stop processing at any time. If the
client is
uncomfortable, he or she can signal the therapist to stop the eye movements.
- EMDR clears all aspects of the memory networks that may be associated with
the
traumatic memory. For example, a client may be clearing a recent traumatic memory that
involves feeling out of control and at the same time clear an earlier childhood memory of
feeling similarly out of control.
- Processing of one traumatic memory may also clear other analogous memories.
This
is particularly useful in the case of multiple traumas since the client may not need to
process
every single memory.
- The client does not have to discuss the traumatic memory in detail for the
treatment
to be effective.
SYMPTOMS THAT CAN BE TREATED WITH EMDR
- Post-traumatic stress disorders
- Disturbing memories that are not classified as traumatic
- Anxiety disorders, low self-esteem, addictions or other symptoms connected to
childhood abandonment or child abuse
- Self-defeating beliefs of unknown origin
- Fears of future events, surgeries, school, etc.
- Violent thoughts and behaviors connected with traumatic memories
REFERENCES
Shapiro,F. Eye Movement Desensitization and Reprocessing, The Guildford Press,
2001
Schiraldi, G., The Post-Traumatic Stress Disorder Sourcebook, Lowell House, 2000.
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