My name's Ashley Collins, and I am here to tell you good morning, and thank you for joining this breakout
session. We're happy to have Kara Berch presenting today for the session of Not Just Smoking Mirrors,
The Science Behind the Magic of EMDR. And EMDR is an amazing tool to have in your toolkit. And even
if you're not a clinician, it's great to understand how it actually works.
A quick housekeeping item before we get started, if you're planning to receive continuing education
credits for this session, please make sure that you've signed in on the sign-in sheet. There should
be one at your table. I have an extra one if your table happens to be missing one.
and you need to mark the time in that you arrive. Make sure to also sign out at the end of the session
and please stay until the end to scan your QR code and get the six digit code at close of the session
to receive your CEUs. I'm gonna turn it over to Kara. Thank you Kara. Hey everybody, good morning. Can
you guys hear me okay in the back? Can you hear me too okay?
No, okay, great, let me know if you can hear me too, okay, also let me know if you can't hear me, okay,
enough. So welcome, so glad to be here talking to you today, and I always kinda like to get a sense
of who I'm talking to. So we're gonna do just like an informal little poll here. Can you raise your
hand if you're a direct service provider, such as a counselor, a licensed social worker, a marriage
and family therapist, like a direct service clinician? Okay, and how about peer support?
Educators? Medical? All right. And let's see, students. There we go. All right. Welcome, everybody.
Anyone that I missed? Legal. Legal. Legal. Wave your hand in the air. All right. Thank you.
Again, I'm here to talk about EMDR from the scientific perspective because I know that it's a little
bit out there for somebody to walk into their office and somebody to say, hey, I'm going to go like
this and wave my hand in front of your face and you're going to feel better. That seems a little bit
like woo-woo. And so I'm here to talk about the science behind it, what research has been done to support
it, what EMDR is actually like.
in practice and how it can help. Another quick round of, or show of hands, if you feel comfortable to,
if you've ever experienced EMDR, had a family member, friend, or colleague experience EMDR. Okay, yeah,
so it's getting around out there. All right, so what are we gonna do today? We're gonna talk about the
theory and research behind EMDR. We're gonna learn about the adaptive information processing system,
which is sort of the lens through which we look at EMDR.
We're going to understand what trauma is, talk about different types of trauma, understand how traumatic
events are processed by the brain, which is actually key in understanding EMDR, and just learn about
the basic structure and practice of EMDR. What does it look like? What can I expect when I walk into the room?
So what is EMDR? Eye movement desensitization and reprocessing therapy. It is an integrative psychotherapy
approach. It's been extensively researched. It's very highly evidence-based for the treatment of trauma.
EMDR therapy includes a set of standardized protocols that incorporate elements from many different
treatment approaches. So it is evidence-based. The person who developed EMDR, Francine Shapiro, was,
very dogged about getting EMDR evidence-based because again, it sounds a little bit crazy to say, I'm
gonna go like this and you're gonna feel better. And so her mission throughout her professional career
after developing EMDR was to get at research to the point that right now EMDR and CBT are the two most
highly researched forms of therapy out there. So why eye movements?
So eye movements are thought to mimic neural processes that happen in REM sleep. You guys are familiar
with REM sleep, REM, rapid eye movement. And if you've ever watched somebody in REM sleep, you can see
their eyelids twitching, their eyes are moving back and forth rapidly during that stage of sleep. Sometimes
their eyes are halfway open and it looks really creepy. But that's that rapid eye movement in REM sleep.
It seems to activate the brain's natural problem solving mechanisms.
The mechanism, again, I use the word seems to be based in bilateral cross-body stimulation or dual attention
stimulation, meaning a couple of things happening at the same time. And different forms in EMDR, different
forms of bilateral stimulation can be used. We call it EMDR because that's when Francine Shapiro developed
it. Her first form of bilateral stimulation was eye movements. She was actually quoted later on in her
career saying she wished she just called it reprocessing therapy because everybody's like,
what's this eye movement thing, especially as different forms of bilateral stimulation, including tactile
and audio, can be used. So, Francine Shapiro's initial research. This was published in 1989 in the Journal
of Traumatic Stress. And she started out with a population of 22 clients with symptoms related to traumatic memories.
The clients that were part of this study or the participants that were part of this study had traumatic
incidents including having served in the Vietnam War, having been victims of some type of sexual or
physical assault or emotional abuse, childhood sexual molestation. And so the presenting complaints,
the symptoms that were recorded were intrusive thoughts and flashbacks, kind of classic PTSD symptomology,
sleep disturbance,
And then low self-esteem slash relationship issues. Sometimes we think about this in the clinical world
as feelings of worthlessness, right? Low self-esteem relational relationship issues. So in this research
study, and the reason this is important is because the EMDR protocol is actually kind of based on this
primary research. In this research study, the following measurements were used. The level of
anxiety or we would say disturbance, subjective units of disturbance scale, it's a zero to 10 scale.
Just like when you go to the hospital and they ask you how intense is your pain, zero means there's
no pain, 10 is the absolute most excruciating pain possible, and then we have in between with our SUD
scale or subjective units of disturbance scale, zero is no disturbance or neutral, 10 is the absolute
worst that that anxiety or that disturbance, that panic could feel, and then we have in between.
The second measurement is what we call the VOC, this is gonna make more sense later on, but the validity
of cognition. And this is a modified Likert scale, so a typical Likert scale, one to five, right? Strongly
disagree, disagree, neither agree nor disagree, agree, strongly agree. So a modified Likert stretched
out to seven so that we could see a little bit more nuanced movement of the positive self-statement, right?
Positive self-statement being something that feels like an adaptive resolution to the trauma. I am worthwhile
regardless. I am safe. I survived. Those are just examples of a positive self-statement. Things that
don't feel very true when we are suffering from this type of symptomology.
So of course, she split her subjects into two groups, the EMD group, which was just calling it EMD at
that point, eye movement desensitization, hadn't really added the reprocessing part yet. And there would
be short sets of bilateral stimulation, which is just following somebody's hand as they move their fingers
back and forth like that, or their hand out back and forth like that. Blank it out, think of the incident,
how disturbing is it now, zero to 10. If other incidents came up,
that interfered with the original incident, they would just continue the same intervention using these
bilateral stimulation. When the disturbance level reached zero, the positive thought was installed,
again, using eye movements to sort of increase how true that positive thought felt. The control group
was told to just think about the incident. No bilateral stimulation, blanket out,
Now think of the incident how disturbing zero to 10. And occasionally, intermittently would measure
that VOC. So the results here are pretty interesting. You can see in column A here, right, this is our
EMD group. This is the subject of units of disturbance. We started with about seven and a half
Average for that group, by the end of the desensitization, it was down to a little over one. The control
group, again, they were asked to just think of the disturbing incident, think of the disturbance, think
of the memory, without adding any bilateral stimulation. And you can see their disturbance actually
went up. So started around the same place as our EMD group, actually increased to almost nine.
So then Francine Shapiro did something that researchers are like, this is a big no-no. But she didn't
really feel okay about this because she's also a humanitarian. She was involved in founding the Humanitarian
Assistance Program and did not feel okay with this. So she came back and she retreated the control,
or yeah, the control group. And you can see that there,
ending result for the control group was about the same as the experimental group. And again, she was
criticized for that because they're saying, well, you can't do longitudinal studies on that. That's
not pure research, blah, blah, blah. And she's like, well, I'm not going to leave people suffering if
I have a thing that I think is going to help them. So like, amen, sister. So now we're going to talk
about the flip side of the coin, the validity of the positive cognition pre and post EMD treatment.
So we can see, again, our experimental group A, when they started, their positive cognition, their adaptive
resolution statement, I am worthwhile, I survived, I'm okay now, whatever that positive statement was,
we say the felt truth of it, not like logically how much your thinking brain knows that you survived.
because our thinking brains are frequently not, almost never, what's really driving the disturbance,
right? It's our emotional brains, it's our nervous system that's driving the disturbance. And so what
she saw with the research is that, again, starting with a very low validity of cognition, of positive
cognition, so we ask somebody when you think about the positive belief, I am worthwhile regardless,
And we say if one is totally false, you don't believe that, that doesn't feel true to you at all right
now in this moment. And seven is totally true. How true does that feel? Started around one, went all
the way up to six, which is mostly true, right? Again, the control group had very little movement. When
she went back and retreated the control group, it also increased significantly. So that was the initial
research. So the outcome, the desensitization of a highly traumatic memory
type of memory that's causing sleep disturbance, nightmares, and flashbacks. Cognitive restructuring
of the verbalized self-statement, which is basically a way of saying thinking about it differently on
a deeper level. Better sleep, fewer nightmares, reduction of flashbacks, startle response, all those
classic PTSD symptoms.
So that was her first published research study. Since then, there's been, as I said, so much study on
EMDR encouraged by Francine and the Francine Shapiro Memorial Fund. And so there's lots of research
out there now, and there's research out there about using EMDR with other presenting issues other than
trauma. I say other than trauma, but we know that trauma's underlying almost everything that we're treating
when we walk into the office.
including research on how is this working? So research on REM sleep, research on orienting response,
which is how our minds and nervous systems orient between something that is considered a threat, something
that's not a threat, and are we able to sort of like calm when we recognize a potential threat is not
a threat, that's about orienting response. Working memory, taxing working memory, which EMDR does through dual
stimulation to things happening at the same time, research on texting working memory and how that can
help move things into long-term memory storage in a more processed way so that when that memory is recalled,
it is recalled as a memory, not as something that feels like it's happening again.
Lots of meta-analyses out there, comparing EMDR to exposure therapy, comparing EMDR to CBT, and finding
that they were, in many cases, equally effective. And then, of course, randomized clinical trials. There
are over 40 randomized clinical trials at this point. So, I'm not gonna go through all of this research
line by line, but again, mechanism of action.
How does it work? EMDR contains many procedures and elements that contribute to the effect. So we actually
don't think it's just one thing with EMDR. Again, we're looking at taxing working memory. We're looking
at orienting response. We're looking at the alternating brain waves, REM sleep patterns, things like
that. So looking at a lot of different aspects
of the mechanisms of action that seem to contribute to it being such a robust therapy. And again, research
on a lot of different client populations. The initial research, of course, was on trauma because that
is how, or what EMDR was initially developed to treat. But you can find research at this point on using
EMDR with almost any client population, including substance abuse. It's very, very effective with substance
abuse. So again, not gonna go through each of these.
This is why EMDR has such a high evidence-based endorsement rate. So the American Psychiatric Association,
the VA, Department of Defense, SAMHSA, World Health Organization. This one I think is particularly important
because this particular study focused on trauma-focused CBT in EMDR.
as well as a few others, but trauma-focused CBD and EMDR are the only psychotherapies that were recommended
for PTSD. And when we talk about, okay, well, if these are our options, you know, is one better than
the other? Not saying one is better than the other, but. Some benefits of EMDR. EMDR does not involve
detailed descriptions of the event. And why would that potentially be a benefit?
Less re-traumatization, absolutely. When we retell the story, sometimes there's a risk of re-traumatization.
What else? Yeah, as the provider, you're actually at much significantly less risk for traumatic, sorry,
precarious traumatization.
If you don't have a complete memory of the event, which happens a lot, there's not a sense of like,
I must be crazy, am I making this up, I can't do this, it's not gonna work for me, because we don't
need all of that. Any other thoughts about why it might be useful to not have to do the detailed description
of the event? I don't wanna talk about it, yeah.
I mean, how many of you have heard that? I don't want to talk about it from a child, from an adolescent,
from an adult. I get a lot of first responders that don't want to talk about it. I get a lot of military
that don't want to talk about it. So yeah, I get people saying I'm so tired of talking about it because
talking about it doesn't help me. It hurts me, right? It doesn't involve direct challenging of beliefs.
We do have cognitive restructuring of beliefs, but it doesn't involve direct challenging of beliefs
the way that CBT does. And why might that be helpful for some people? Yeah, why might it be helpful
for some people to not be engaging in direct challenging of beliefs? Like not saying, well, can you
see how this is a cognitive distortion and it's really irrational or using that kind of language? Yeah.
Could be, yeah, could be hard to admit maybe that we need to change something. Yeah. I feel like it
avoids invalidation. Yes, exactly. It avoids invalidation. If this is the way I feel, and it's irrational,
and it's actually not helping me in the adaptive present, and somebody says, oh, well, let me tell you
your problem. You're thinking about this all wrong. How is that actually going to make me feel?
Now, as I said, it's not that we're not doing the cognitive restructuring, but we are doing it in a
way that is coming from the client as opposed to from the clinician. It doesn't involve extended exposure.
It does involve exposure because we need to be able to be present with emotions that are coming up during
the processing, but it doesn't involve extended exposure. Why would that be helpful?
Anybody in here do exposure therapy? It's great, it's really useful. And how many of your clients drop
out? A lot of clients will drop out of exposure therapy because it's really, really hard. So it can
be helpful with EMDR to not have that kind of extended exposure with EMDR. Generally what comes up,
even if it's really disturbing for a certain period of time, it will come back down within the course
of a session.
And it doesn't involve homework. Why is that helpful? There you go. I always tell my clients EMDR homework
is amazing because it gets done and you don't have to do it. So yeah, clients are very unlikely to do
homework. I'm unlikely to do homework unless I know somebody is going to be checking.
And my clients are very unlikely to do homework. So some benefits here of EMDR when we're looking at
it as a comparison treatment with trauma-focused CVT. Additional evidence-based, yeah, EMDR is really
evidence-based endorsed. There you go, ta-da. Again, other complaints that it's frequently used with,
anxiety, panic disorder, OCD, phobias, dissociative disorders, depression, bipolar disorder, complicated
grief, stuck grief, right?
Body dysmorphia, substance use disorders, pain disorders, they're pain protocols with EMDR. So all of
these different presenting complaints can be addressed with EMDR. I don't have complex trauma up there,
that's interesting, complex trauma. So now we're gonna talk a little bit about the neurobiology behind
EMDR. And so if you like neurobiology, you're gonna love this. If you don't like neurobiology, it won't
take long, I promise.
All right, so we're gonna talk about parts of the brain. All right, first we got our prefrontal cortex,
right? Sometimes we call it the forebrain. It's the thinking part of the brain. It's responsible for
processing and reasoning. Language, our language, both receptive and expressive language centers are
found in the prefrontal cortex, our thinking brain. Then we have the amygdala. The amygdala is the emotional
center of the brain. And it's also responsible for survival instincts.
emotions and survival instinct, all right in the same place. Great plan, not really. For survival, we
understand why it's helpful. When it comes to thriving, that can be a little bit tricky. It holds the
emotional significance of events, but it can hold them in a life or death feeling kind of way. That's
why I say the design on that is a little, it's definitely skewed towards what we would call privileging
survival, not privileging thriving.
And then the hippocampus. The hippocampus is sort of a middle person, middle man, in terms of our memory
storage process. If something happens, it's in your short-term memory. It goes to the hippocampus, which
is kind of like the little clerk here that's going to decide. How many of you guys have seen Inside Out?
Great, okay, so you guys know how this works then, okay? Hippocampus, they're in the control room figuring
it out, where's this gonna go? Okay, it's gonna go here, it's gonna get connected to this core memory,
and away it goes through the pneumatic tube into long-term memory, right? That's the job of the hippocampus.
So, when we are forming a memory,
Something happens, right, an event occurs that draws attention. Sensory information is sent to the amygdala.
So what we can see, hear, smell, taste, touch, that sensory information comes to the amygdala, which
assigns an emotional significance to it. Then our sensory cortices begin forming perceptions based on
that sensory information. But notice that the amygdala decides how important it is before any of our
sensory cortices, well,
except for smell, smell starts almost immediately. But before the other sensory cortices begin their
interpretation or their perception, the amygdala has already decided how important this feels. Then
the prefrontal cortex and hippocampus begin to categorize their experience.
Right, gets consolidated into long-term storage, just like Inside Out shows us, it kind of goes into
what I would refer to as a neural network, where it can be retrieved by the hippocampus as needed, updated
with new information, before being reconsolidated into long-term storage. And that's how we learn.
So like, how many of you, this is the first conference you've ever been to in your life? Okay. If this
is the first conference that you've ever been to in your life, you might have,
kind of thought maybe you knew what to expect from maybe people that you've talked to, but it might
have been really like, I don't really know what this is gonna be like. How many of you is this the 10th
or more conference that you've attended in your entire life? Yep, okay. You guys know. You got your
cushions, you got your water, you've got your blanket, you've got your fidget toys, you've got your
aromatherapy, you've got your snack because they said they'd have gluten-free, but what if they don't
have gluten-free, right? You've got all of those things because you have learned
by going to conference after conference after conference, what to expect. And every time you go to a
conference, your hippocampus is pulling up and integrating the material from this new experience into
all of the material that you have from all of these past experiences. And that's how functional memory
is created. Again, it's like working with a Word document on a computer. We've got the
new document, if you will, then when experience is new, once it's completed, it's saved, consolidated,
and stored on the hard drive. That's done by the hippocampus. And then if we want to update it in any
way, if we want to add to it, if we want to edit it, if we want to do anything to it, then we would
reopen it on our desktop, right, working memory, and then resave it in the hard drive. So it's kind of
It's not a perfect metaphor. There's no such thing as a perfect metaphor for the way our minds work
because they're so amazingly magical. But that's kind of a good analogy if you can think about how functional
memory formation happens. And so this is again how we develop what we would call an adaptive neural
network. So adaptive meaning helpful. Adaptive meaning useful. An experience occurs.
We have these perceptions, attitudes, behaviors. We often will talk about the Hebsaxium, neurons that
fire together, wire together, and when that happens, that creates that sort of word document,
if you will, where we have all of the things that go under conference. And then the next time you have
a similar experience, it reactivates the previous learning, pulls it out of long-term
memory, past and present experiences link and consolidate to an updated neural network that has all
of that new information in it. And so when we talk about adaptive information processing, we're talking
about keeping what's helpful, discarding what's no longer needed, and preparing for the next occurrence.
That is how our AIP, our adaptive information processing system, works. And then as
We experience more and more. We have a more robust adaptive memory network. Remember, adaptive means
helpful. And that's just sort of like a kind of conceptualization of what this looks like. So again,
when we come to how is this important for the foundation of EMDR, we need to know that events are emotionally
encoded according to their importance.
And that means our positive experience, but also our negative experiences. The more emotional significance
something has, the more deeply it's encoded. So for instance, if I asked you guys what you had for breakfast
on Tuesday, October 3rd, 1989, well half of you wouldn't be alive yet, but you wouldn't know. Now, for
a certain age group in this room, if I were to ask you where you were on the morning of
September 11th, 2001, and what you had for breakfast, you probably remember, right? Because emotional
importance was assigned to that time. So it's really important to remember that. Past experiences influence
present situations, present perceptions. We are always looking through a lens based on what we've already
experienced or what we already know, right? Always looking through that lens. Beliefs.
once language is available are the verbalization of emotions and sensations. That's an important one.
In just a little bit, we're gonna understand why that's an important one, but I'm gonna say it again.
Beliefs once available, or sorry, once language is available are the verbalization of emotions
and sensations. So why is that important? When I say the words, I'm worthless, right? Thinking about
a negative belief. I'm worthless. When that resonates with me,
on a felt sense, when I hear those words and I feel it in my body, I feel it in my emotions, the emotions
that go with that, despair, shame, humiliation, unwantedness, the words I'm worthless become much more
powerful than just words on a page, right? So that's gonna be really important when we start to talk
about what actually happens in the office, so to speak.
And then neuroplasticity, neurological plasticity, the brain's ability to change and update is essential
when we're talking about the AIP approach to psychotherapy, which is the foundation of EMDR. So when
I was in elementary school, I learned, and I think probably a number of you in this room did too, that
our brain, once we become an adult, there's no more development, there's no more growth like what you have,
what you have right and then they would show us those like say no to drugs commercials because they
didn't want us to like burn out our brain because what you have is what you have and and now we know
that's not true we know that the neurological plasticity or neuroplasticity is something that is available
to us throughout our entire lifespan we see stroke victims who are able to recover and
you know, parts of their brain that actually shouldn't actually even be able to talk to one another
are able to, are able to, because the brain rewired, right? And so neurological plasticity or neuroplasticity
is also a very important concept when we're talking about the AIP, EMDR, and how it all works. Okay.
Now we're going to talk about what is trauma. And I do want to say, I,
I try to be very mindful of not using specific or explicit case examples that are triggering, but as
we're talking about trauma, if something happens where you feel like you need to take a break, if you
need to step out or something like that, please do what you need to do to take care of yourself.
And again, I am mindful of trying not to use examples that can be triggering, but if something happens
where you need to step out, step out. Okay, so what is trauma? I've been talking for a while, you guys talk now.
Yeah, extremely disturbing situation, but it's person specific. Something that feels traumatic to one
person may not feel traumatic to another. What else? What other thoughts come up when you think about trauma?
the reaction or what did you experience with people, places or things. So trauma being, this is so important,
trauma being a reaction, trauma being what happens in you related to these experiences, absolutely.
What else? Any other thoughts about trauma? Changes you, yes.
Exactly, something happens and it changes you. It changes you. So the word trauma comes from the Greek
word for wound and we know and when you hear trauma center, you're probably thinking an ER, a place
where acute wounds are taken. So the Greek word for wound is where trauma comes from. When we talk about
psychological trauma, we can think of it as a lasting emotional or psychological wound
meaning something is changed, there is a felt sense of change in you. It involves the perception of
life, health, or safety, something essential to your personhood being in danger. And when I say essential
to your personhood, that can be, again, a sense of worth, a sense of mattering. It doesn't have to be
someone has a weapon to
your body or you're in a plane that may be going down. It doesn't have to be that level of trauma or
that level of danger. Trauma is subjective. We had a few people that pointed that out, meaning that
what's traumatic to one person may not be traumatic to another person. So it's not the thing. I know
we talk about traumatic events, but it's not the thing. It's what it did to you, what reaction happened in you
has changed you in some way. Again, based in perception, not based in fact. So like I've actually had
somebody say to me that they were held up at gunpoint and later on they found out it was like a airsoft,
like something like it wasn't, it was not an actual firearm that could have done them in that situation,
in that range, lethal harm. And so they didn't understand why they were still having
these flashbacks and everything like that. I'm like, well, you didn't know at the time. So the way that
that was recorded was you're going to die. So it doesn't matter what the actual information is. It's
the perception. And it can be vicarious. We had one of our people pointed out that they are not having
to go through detailed stories and everything can help therapists reduce vicarious trauma. So vicarious
means it didn't have to happen to you. You didn't have to witness it, just even hearing about it.
create that, and we tend to see that more in service care providers that are, again, working with people
day in and day out that are highly traumatized. Types of trauma, acute trauma. Acute trauma is exposure
to a single overwhelming or dangerous event, some examples up there, an assault, a car accident, a natural
disaster, witnessing a violent event,
These are all examples of acute trauma. Then we have chronic trauma. Chronic trauma results from repeated
or prolonged exposure to highly stressful or dangerous events over a period of time. So undergoing treatment
for significant or major illnesses, exposure to war or combat situations, which could also be certain
neighborhoods that people live in.
domestic violence, prolonged exposure to bullying, prolonged exposure to a toxic workplace environment.
These are all examples of chronic trauma. So repeated or prolonged over a period of time, different
from acute. And then there's complex trauma. And the term complex trauma tends to get tossed around
quite a lot, sort of in this sense of like, oh, it's complicated trauma.
Complex trauma specifically, when we use the terms complex trauma, specifically results from exposure
to varied and multiple traumatic events or experiences from a young age. This is where the age comes
into play. And so nowadays, you'll frequently hear people refer to developmental trauma.
Right? Rather than the term complex trauma, to try to help people understand that when we're talking
about complex trauma, we are talking about things that happen from a young age, which means that it
is shaping our initial and early perceptions of the world that we live in. And, you know, I'll use the
terms or the words, sometimes I'll say what goes in early goes in deep.
Trauma therapists sometimes have a little sort of saying they use, which is the more hysterical, the
more historical, meaning the more desperate of the feeling that is evoked, likely the earlier the onset
of the trauma began. And this is also an essential part of complex trauma, frequently within the context
of an interpersonal relationship.
And we're talking almost entirely, really, we're talking attachment relationships. So extreme childhood
neglect, childhood abuse, repeated traumas perpetrated against a child, multiple ACEs, of course, probably
most of us, everyone raise your hand if you're familiar with ACEs studies. Yeah, mm-hmm, yep, so multiple
adverse childhood experiences.
A series of home removals, so we see this a lot with children whose families are involved with DCS,
even if they are reunited, if it happens multiple times, if there's a series of them, especially at
a younger age. All of these examples fall under complex trauma. And then finally vicarious, okay.
Vicarious trauma, I don't know where my second vicarious trauma slide went, but what's vicarious trauma?
Right, when listening to or hearing about, being exposed to other people's trauma, that you take that
on as your own. Frequently, like I said, frequently it's service providers and it kind of creeps up
and it can lead to compassion fatigue, burnout, and needing your own treatment.
So earlier we talked about how adaptive memories form. Now we're gonna talk about how traumatic memories
form and how it's different than your adaptive information processing. So event occurs that draws attention.
Remember how before I said the amygdala decides what's going on here before anything else happens? So
the amygdala perceives danger and floods the body with stress hormones to prepare for fight or flight,
to prepare for survival.
That intense emotional distress will say overloads the hippocampus or takes down the hippocampus, hijacks
the hippocampus, takes it offline, preventing functional memory storage and consolidation, okay? Now,
remember I said the hippocampus is sort of the middle person and plays a really important role in storage
of memories? One of the things the hippocampus does is stamp a date on this thing that happened, right?
meaning that it sort of places it in a temporal period, right? Oh, that happened and it's not happening
anymore, right? But that doesn't, if that doesn't happen, when the hippocampus gets knocked online,
the memory gets stored dysfunctionally by the amygdala in sensory fragments, right? So how our senses
experience the trauma as it happened, smells, tactile physical sensations, flashes of images,
you know, an impact, like kind of stores this memory kind of dysfunctionally in these sensory fragments.
And then when a trigger is encountered, the amygdala recognizes that as a sign of danger, produces a
stress reaction to prepare for survival. So it's like a fragment of that memory that gets triggered
and remembering becomes reliving. This is where the importance of what I was saying about the hippocampus
kind of putting a date stamp on it and we're remembering something. When that process doesn't happen,
and a trigger is encountered, we are no longer remembering. We are reliving the trauma when those present
triggers reactivate. And then over time, these repeated stress reactions in response to triggers causes
changes in our nervous system. It causes our nervous system to be more reactive. It makes it harder
for us to come, well, first of all, it makes our nervous system baseline a lot higher. A lot of the
time you'll hear people talking about living on fight or flight, living in a sympathetic,
part of their nervous system where they're always hypervigilant, they're always jumpy, they're never
relaxed. So it kind of increases our baseline. It makes it difficult for our nervous system to relax
into a more relaxed and adaptive state of being. And so it causes these changes over time and the nervous
system is just more reactive. So like all of us sitting in here,
In that area, if one of the catering staff were to drop a stack of dishes, we'd go, oh, right? We'd
all have this initial feeling of, ah, right? And then we'd be like, what's going on over there? And
then we'd be like, oh, okay, that's all right, they just dropped some dishes. And we'd kinda come back
and our nervous system would kinda settle back to wherever they are right about now. Except for those
of you whose nervous systems are carrying a lot of activation because of repeated trauma. For you,
It might take five, 10, 20 minutes for your heart to stop pounding and for you to feel like, okay,
I'm okay, to kind of come down from that activation. So these repeated activation and stress reactions
over time will cause the nervous system to become more reactive. And that's an important thing to be
aware of because I say trauma is formed by the mind but stored in the body.
So before we talked about acute trauma, single incident trauma, when somebody experiences a single incident
trauma, like a highly, highly disturbing single incident, what happens is the nervous system
gets overwhelmed, the amygdala fires the life or death emotions, that survival instinct, the intensity
of the emotions freeze the system. The hippocampus ain't working.
The amygdala limbic system encodes a fight, fight, freeze, numb, dissociate, collapse response. That's
part of the nervous system response when we perceive that we cannot fight and we cannot flee. And adaptive
neural networks are locked out. Adaptive meaning able to take in new information and update and consolidate
new information. What do I mean by that?
If I'm in a close call car accident, like if I'm in a situation where I'm in a car accident and I survive
and I'm maybe not even that injured, but in the moment the car accident was happening, I didn't know
that I was gonna survive and that I wasn't gonna be injured, I might have actually thought I'm going
to die. I might have actually felt I'm going to die. After that, because my adaptive neural network
was locked out, there may be a part of me
doesn't actually understand that I'm alive, that I survived, and that I'm not in danger anymore because
that adaptive recognition has been locked out. Frequently, sleep patterns are disrupted, which makes
things even worse because we, again, we do a lot of our natural problem solving, emotional processing,
and problem solving in our sleep.
And we get the nightmares of the actual event frequently because it's like the brain is trying to process
it but can't because the adaptive is locked out. So that is when we talk about a single incident PTSD
memory or a frozen memory. That's how those develop. Now, when we're talking about the more chronic
or complex forms of trauma, we're talking about something a little bit different.
So when we're talking about a single incident trauma, I love single incident traumas. I adore it. When
somebody walks into my office and they tell me that they had this, we do their biopsychosocial assessment,
and they had a pretty decent childhood, relatively speaking, and things are going pretty well, they
feel pretty good about their life, and then they had this one horrible thing happen. I love that. I
don't love that. I mean, I don't love that that happened to them. But as a provider, I love that because,
generally that kind of a presentation, one to three sessions of EMDR and they're good, they're fine,
they're ready to go. But how many of those clients do you think actually walk into my office? There
are very few people actually out there that have that experience of everything's good in life. They had a
parents that were appropriately emotionally responsive. They've got really robust, healthy adaptive
neural networks and this one thing happened to them and totally, totally threw them for a loop. More
frequently, much more frequently what we see is the development of what we would refer to as an isolated
neural network that happens over time, again, due to chronic or complex or vicarious trauma.
So what happens in these situations? Negative emotionally charged memories develop into a negatively
charged neural network. So again, disturbing events encoded. I'm worthless, like again, think about
that example of I'm worthless as a negative belief that is putting words to the feelings, the
body sensations, and the emotions that go with that. So in my weird little amorphous
A picture there, we have an adult chastising a small child, right? Shaming, humiliating, right? And
this child's felt sense is unworthless. They may not actually have that word yet, if they're three,
four, five years old, but the felt sense that they have is that of being worthless. And when that happens
again and again and again, especially in family of origin, especially before age five,
It builds into this negative neural network of all of these repeated memories of being treated in ways
that made that child feel worthless. Now, adaptive neural networks can form in other environments. Maybe
there's that teacher, that grandmother, that coach, somebody that made this kiddo feel good.
Which of these do you think is gonna be stronger? A girl goes in early, goes in deep. Which of these
is gonna be stronger? Yeah, the negative one. Yeah, yeah. But if there is some adaptive neural network,
which I believe that we can always find some, right, we need to be aware of its presence because what's
actually happening when present triggers activate past emotions or sensations,
it's triggering that feeling of I'm worthless. So now, you can see this example of here's a kiddo at
school, or no, actually that's not a kiddo at school, that's a guy working at a desk, and there's the
boss, right? And even if this is a person who's like, you know, 30, 35 years old, when the boss comes
up to check on what they're doing, what's triggered is I'm worthless, right? There's generally not gonna
be a triggering of that adaptive neural network of that one kind teacher,
who would come up and encourage them in class. That's generally not what's gonna be triggered here.
It's gonna be a triggered, I'm worthless. And so these emotionally charged networks become isolated
and they are, again, unable to link with the adaptive neural network. That is important because, again,
that means that when we're in a situation where that negative neural network is activated, the feeling
of I'm worthless because of
being shamed, humiliated, criticized again and again as a child, it's not possible to access this adaptive
I'm worthwhile that maybe a coach or a teacher or a mentor made this person feel. They get stuck, they're
frozen, they're stuck, they're isolated, they're unable to consolidate with adaptive neural networks.
And the reason that is important is because as I said,
I don't get that many people walking into my office that were like, yep, they might tell me everything's
fine, but when we actually do the biopsychosocial, it rarely turns out to be true that this person has
a really healthy self-awareness, that they had a secure attachment growing up, that they have a healthy,
appropriately healthy self-esteem, which is mirrored in their relationships with others.
We don't get that so much in the office. What we get are people who have these negative neural networks,
things that built up over time. Sometimes we call it like death by a thousand cuts. So you can conceptualize
psychological problems as negative emotional neural networks. They're unable to link, bind, and consolidate
with functional adaptive neural networks. And so what that means is that when
my boss makes a critical comment about my work, I feel like I'm worthless. And any sense of like, I'm
worthwhile regardless, I can't get to it. It is not reachable. So the main difference between CBT and
EMDR, and the reason I focus on CBT here is because there are some elements that sound very similar,
but the main difference
is that in the CBT approach to psychotherapy, the idea is, the concept is disturbing experiences create
thoughts, cognitions, which generate emotions and sensations. Something happens, we have a thought.
Sometimes we label it as a cognitive distortion or a thinking error or a maladaptive thought that creates
the emotions and sensations.
And then the clinical interventions are gonna challenge the cognitive distortions. We're gonna change
the thought to change the feeling, right? EMDR approach to psychotherapy. Disturbing experiences create
negatives, emotions, and sensations. The felt sense of I'm worthless. The felt sense of I don't matter.
The felt sense of I have to be perfect to be loved. The felt sense.
And so these emotions and sensations are identified with those words that come across as negative or
irrational beliefs. But it's really starting with the emotions and the sensations. And so in EMDR, our
intervention addresses the emotions or sensations, the distortions there, to help update to the adaptive
present. So we're changing the feelings to change the beliefs. And that is how the cognitive restructuring
occurs. Both models.
Do involve cognitive restructuring. CBT says change the thoughts to change the feelings. EMDR says change
the feelings to change the thoughts. That's it. Now there's a little more. Any questions about any of
that? Does it make sense? Okay. All right.
So I talked a little bit before about mechanism of action. Eye movements reduce image vividness and
emotionality. So eye movements are especially helpful in situations where people are having intrusive
images, flashbacks, nightmares with vivid imagery. There's also been research on the alternating brain
wave frequency between high wave REM sleep and low wave hippocampal activity. Taxing working memory.
Right, this is where we're kind of making the hippocampus, or I'm sorry, making the mind work a little
bit harder. It's kind of hard to focus on something highly distressing when somebody keeps interrupting
you and making you pay attention to something else. So that's taxing working memory and that can help
increase the hippocampus' ability to move memories into long-term memory storage in a more functionally
stored way. Orienting response. Orienting between experiencing and reflecting.
Right, I'm asking you to step into the memory and sort of have that felt sense of being in the memory
and now I'm asking you to step out of the memory and I'm asking you to tell me what you're noticing
now, back and forth, we're in, we're out, we're in, we're out, so orienting response. All of these are
mechanisms of action in EMDR, which again is why, I believe why it is such a robust form of treatment
because of a number of different mechanisms of action working together. I always laugh when like,
All the researchers are like, no, it's this one, no, it's this one. I'm like, I don't care. It works.
Because again, I'm a very pragmatic person. I'm a clinician. And I want something that works. And when
we talk about why it works, yeah, it's great to know why it works. But I don't really think fighting
over why it works is super helpful. Yeah.
That's a great question. Yeah, that's a great question. So are there times the EMDR does not work? What
would that look like? Who are those individuals? What I'm going to say, actually, if I promise that
I'm going to answer this, can I defer answering it to a little bit later on? Awesome. Okay. Cause it'll
make more sense once we get to the what actually happens in the EMDR part. All right.
Okay, how does this work again? Bilateral simulation mimics neural processing in REM sleep. Using this
process in an intentional and focused manner while conscious assists the brain in the process, even
when a trauma has interrupted the brain's natural processing. It enables the consolidation of isolated
neural networks into more adaptive networks and reprocessing of traumatic memories to the appropriate
location in the brain.
Okay, I put that in quotes because the neuroscientists have nosebleeds whenever I say that,
but it's really, it's an analogy, kind of getting it into where it belongs, meaning something in the
past, something that's no longer true, something that's no longer happening to me rather than something
I'm reliving every time that it gets activated. That's the neurological, or sorry, the neuroscience
basis of EMDR. Okay, most of you are still awake. Okay, those of you that are not,
We're gonna talk about practice now, so I promise, neurobiology is as over as it can be. What does EMDR
look like in practice? In trauma treatment in general, we think about a three-phase process. We think
about preparation. Pierre Genet actually came up with this model in the late 1800s. He called stage
one containment, stabilization, and symptom reduction. Containment, stabilization, and symptom reduction.
We kind of think about it as preparation in case conceptualization, sort of planning out what are we
going to do here, helping the person get the resources that they need to sort of have that symptom reduction
and some stabilization, getting ready to do the work. The second stage in trauma treatment, modification
of traumatic memories. We just call that processing.
Right, it's processing. And then the third stage of trauma treatment, Pierre Genet called it personality
integration and rehabilitation. We just call it integration, right? So what you can think about in terms
of this three stage process, stage one is somebody comes into your office, they're probably pretty highly
dysregulated, pretty highly distressed. We're gonna help them to be able to find a less disturbed, less
distressed state of being.
Right? Symptom reduction and stabilization. We're going to do whatever preparation is needed to have
them ready to do the processing. And that can be psychoeducation. That can be more, you know, using
skills for grounding and stabilization and nervous system calming. And we're going to sort of plan what
is it we even need to process here. Stage two is the processing.
And in EMDR, we sort of split that into four different parts, but I'll talk about that in a moment.
And stage three is integration. What are you noticing now that's different from before?
What has shifted for you? What has changed for you? How do you want to integrate this into your life?
What changes do you need to make based on the work that we did? A lot of the shifts and changes are
happening internally in this person, but we generally have to make some external shifts too, right,
to kind of accommodate that cognitive restructuring difference in the way that we're looking at the world.
A lot of the time my clients that I've worked with over time kind of start to have this sense of like,
oh, you know what, maybe I actually don't deserve to be in this relationship with this checked out,
emotionally abusive person. All right. But that's definitely positive change. But the realization and
the felt sense of I don't deserve this crap, we still need to actually work through behaviorally what's
going to happen next. So that's that stage three of integration.
We also talk about EMDRs being a three-pronged approach, past, present, and future. The bad stuff that
happened in the past, the current stuff that's triggering that.
and or the not ideal relational and occupational settings that we find ourselves in because of the past
trauma. And then the future. What do we want the future to look like? We can talk about a positive future
view. We can also look at what are the fears in the future? What are the things that we worry would
re-trigger some of those old feelings of I don't deserve to be alive or whatever the negative belief
is. So we kind of have that awareness as we're going through the treatment.
So I'm gonna talk you through the eight phase model. And can somebody remind me when lunch break is?
Oh, I don't have a person in here, do I? Great, thank you, 1150, that's what I thought. It was like
40, 50, something like that, okay. Did they update you all that they changed the schedule, they pushed
the schedule back? Okay, they pushed the schedule back because Shelley Yoder got caught in traffic.
I'm just gonna haul it out and look at it, so I apologize if they didn't update you on that before.
Session two, 10-20 to 11-50, lunch 11-50 to 12-50, all right. Okay, so an eight phase model. Phase one,
history taking. Now in practice, we don't actually start with phase one, so thanks Francine
you know, confusing us all. But in practice, we don't actually start with phase one because a lot of
the time we need to do some good resourcing, some good preparation before we can get too deep into what
happened. We do, of course, always start with a biopsychosocial assessment, which is history taking,
right? But we try not to get too deep into the trauma, right? Why do we try not to get too deep into
the trauma during a biopsychosocial? Say that again?
Well, they might leave. It might be totally overwhelming to their system. They're like, I'm not coming
back. That was horrible. What else? Yeah, it defeats the purpose of, well, I mean, of EMDR, but I would
say that it really kind of can defeat the purpose of therapy in general, right? Because when we get
in too deep before we're ready,
We can have this system overwhelm and it can be re-traumatizing and it can turn people off and like,
nope, I'm not gonna do it. How long do you guys have for biopsychosocial assessments, you providers?
Any ideas? Really good agencies give you 90 minutes, most places give you 60 minutes. Do you think that
you can really sit with a person and listen to all the details of their trauma history
in 60 minutes with a, right, okay. So with a biopsychosocial, we don't get too deep into the trauma.
We have to complete our treatment plan, right? At this point, this is where generally we will move into
phase two and we'll do affect management skills. There's a reason I have these guys next to each other.
We'll do affect management skills, resources, calm place, breathing,
nurturing figure, you know, resources that clients can use, I'll say, to be able to bring themselves
from a more distressed, disturbed, preoccupied, anxious state to a less distressed, disturbed,
anxious state. So we teach these skills in phase two, all right? The more complex the trauma, the longer
phase two is likely to take. Does that make sense? Yeah, okay. The less resource the individual, the
longer this phase is likely to take.
also probably makes sense. So we've done phase one, we've done a biopsychosocial treatment plan, then
we're gonna bump over to phase two and we're gonna do the affect management, the grounding,
the stabilization. Then we're gonna come back and do psychoeducation about EMDR. And I always say don't
over explain it. Your client doesn't need to know everything that I just talked to you about in the
last hour. All they need to know is that when really bad things happen,
either individual bad things or things that feel bad over a period of time. Our minds don't really store
that information in the most adaptive or useful way, and the EMDR is something that can help these different
parts of our brain, thinking parts, the feeling parts, the body, nervous system aspect, can communicate
with each other better. That's basically it, and answering any questions. Part of phase one is, of course,
relationship and rapport building.
And then when we talk about a target sequence plan, that's just fancy words for saying, what is it that
we're identifying that we need to actually address here? So again, I think about phases one and two
as more of a sandwich than as something that happens one and then the next. But those two phases are
our preparation phases before we get into the main work. Phase three.
Phase three is the assessment phase. And phase three, I think about, and I actually got this from the
person that founded the training program that I work for, I think about it as a pre-flight checklist.
We are lighting up aspects of the memory in a way that is activating it and getting it ready
to be reprocessed. So we'll ask, what's the worst part of it? I'm gonna use car accident as an example.
Anybody find it horribly triggering if I use car accident as an example?
All right, so I asked my client, okay, when you're thinking about that car accident, what was the worst
part of it? And the client says, just the image of the headlights coming straight at me, and it was
raining, and I couldn't do it. There was nothing I could do. Okay, there we go. We've got a really strong
image, car lights coming straight at me. Doesn't have to be an image. In some cases, it might be a sound.
In some cases, it might be a smell. It might be a tactile feeling, but what's the worst part of it?
then we identify that negative belief. In the case of a car accident, we work with the client on figuring
this out. It might be I'm powerless. It might be I'm going to die. It might be I have no control. What
is the negative belief? The words that encapsulate that feeling in that moment. The positive or adaptive
belief, what would you rather be able to believe and feel the truth of?
when you let yourself step back into that memory. Instead of I'm powerless, what would you rather be
able to feel the truth of? I can control what I can, or I'm able to recognize the choices I have,
or whatever. If the negative belief was I was gonna die, what would you rather be able to feel the truth
of right now? I survived and everything's okay, great. So we're gonna identify the negative, the positive belief.
The validity of the positive cognition, right? This is where our scales come into play again. When you
think about being in that car accident, and you hear the words, I survived and I'm okay, how true do
those feel? Not how logically true do you know they are in your head. I mean, clearly you walked into
my office, you're probably not dead. I don't say that. But not how logically true do you know them to
me, but the feeling
and what people will almost tell me is one or two. Yeah, it doesn't really feel true. Then I'm gonna
ask them what the emotions are in this moment as you're thinking about I'm going to die and those headlights
coming at you, what emotions are you noticing? Helplessness, fear, terror, anger, panic. And then we
can ask from zero to 10,
How bad did those feelings feel? Zero is not really there. Ten is the worst they could feel.
It's an eight. And where do you feel that in your body? I actually flip-flopped those last two, but
technically this is where you're supposed to go in. Where do you feel that in your body? My stomach
has a pit in it and my chest is tight and I feel like I can't breathe. Okay. So we've now activated
this memory.
using all of the different components of memory. So we have in there sensory information, like an image
or sound, a sight. We have cognitive information, the words of the negative belief and the adaptive
belief. We have how bad it feels. We have how true the positive belief feels. We have how bad the distress
is. We have the emotions and we have the body sensations. That's all aspects of memory.
right there, and that process takes about two minutes or less, right? So that's why I call it a pre-flight
checklist. It's not, we don't talk about each of these things. We identify it, we move on, right? I
just toss this up here because I keep throwing out these examples of negative beliefs.
that people can have in different situations. And I think this can just be kind of a useful way to look
at these negative beliefs around developmental themes or plateaus, right? I was talking about sort of
a survival level of like I'm going to die, that sort of thing. But when you look at it from a developmental
stage, when we're looking at survival level, we're actually tend to be talking about young
things that happened to children when they were young, the sense of not deserving to exist. And all
the way up through, you can almost tell, depending on what people's negative core beliefs are, you can
almost tell when the developmental sort of plateau was that the bad situation or bad situation started.
All right, and these are just some different examples of negative cognitions and then the adaptive or
preferred or positive. And it's certainly not an exhaustive list. But these are different ones that
you might come across. All right, so phase three is the pre-flight checklist. We're not talking about
it. We're just identifying it, boom, boom, boom, flipping the switches, getting ready to take off, right?
Phase four is where we start desensitization. This is the back and forth movement.
For eye movements, it's either, most clinicians use their hand, you can have a light bar. Teenagers
love the light bar because you can change the color on it. Of course, it could be purple, why wouldn't
you? If we're using tactile, people can use self-administered tapping like this. We have tappers where you hold
some paddles and they just vibrate back and forth. Audio tones that go back and forth. You probably
see a lot of ads for calm nowadays. It's like based on EMDR inspired bilateral stimulation, but that
back and forth side to side audio. These are all forms of bilateral that are used for desensitization.
And what actually happens here, because this is what people are always like, we actually do. The client
is instructed to notice without trying to control anything.
Notice their inner experience during the bilateral stimulation, meaning just notice what comes up. It
could be thoughts. It could be emotions. It could be body sensations. It could be memories. It could
be images. It could be inner dialogues. I had one client that processed almost entirely in color, and
I'm like, oh, this is interesting. I don't really know what's happening, but it worked. So just noticing
what comes up inside.
And over the course of the reprocessing, the client may notice, well, they will notice a shifting of
these different components of inner experience. Clients generally will experience higher levels of emotional
and sensorial or sensation arousal because they're really allowing themselves to access the material
on a deeper level than talking about it. It may take multiple sessions. And generally what's gonna happen
is that the disturbance is gonna be really,
reduced to zero, or as low as it will go, what we call ecologically appropriate. Meaning that maybe
somebody started out with a set of eight when they were remembering a really painful memory from their
childhood, and maybe it comes down to one, and they're like, I just don't think it's gonna go any lower,
and it makes sense to them. I'm just always gonna carry that. My dad died when I was eight. There's
always gonna be some upset around that. It's like, yeah, absolutely.
But something that's in that one area is something that we generally can say handle, but can make sense
of, can understand, can incorporate into sort of our narrative of who we are as a person. Whereas that
eight before kind of had us frozen there, had us stuck, had us not able to get past it. So we see this
reduction in disturbance during phase four.
And then phase five we call installation. This is where we're gonna, when I'm processing through the
client and that disturbance is coming down and down and down, at some point, generally when we get to
that sud, that disturbance to zero or pretty darn low, I'm gonna come back and I'm gonna check in on
the validity of cognition again. How true does that adaptive belief feel now, right?
And then we use the bilateral stimulation again to strengthen the positive belief until it's at a seven
or as high as it will go. Now, that's how the textbook describes it. Like, okay, yucky stuff, sud, goes
down and down and down and down and down and down and then it's gone. And good stuff, access to adaptive belief.
then starts to go up. That's not actually how it happens. These two things are actually happening at
the same time. And I like to use this analogy. Imagine you're looking in like a flooded basement,
all right? Unfinished basement of a house. You know, a lot of the time they have like the beams that
support the floor. The ceiling is the floor of the house above, right? So imagine that this support
beam is the adaptive belief, right? I'm gonna go back to my favorite, I am worthwhile regardless. Now
I want you to imagine that basement is flooded with gross yuck mucky murky water.
And that gross yuckiness, so to speak, is the disturbance, the negative emotions related to the idea
of I'm worthless. As we're processing, as the yuck is processing and the floodwaters are coming down,
we're getting more and more access to that adaptive neural network that says I'm worthwhile. And so
generally when I've completed phase four with a client and then I move into phase five and I ask them
where their SUD is, it's already quite high.
Not necessarily always seven, but already quite high. And then we'll do a few more sets to strengthen
the positive belief. And then phase six, body scan. We're checking for sensory memories, implicit or
sensory memories. So now think about the car accident and this adaptive belief, I survived and I'm okay.
Hold those together, scan through your body. Just notice what you find there.
And if there are any uncomfortable, any negative, uncomfortable, unpleasant body sensations, we bring
in the bilateral stimulation until the body releases that, which it does. I know it sounds kind of ooh,
but it does. And we have a neutral body scan. So that is the processing piece of EMDR. And again, that
can take multiple sessions for really disturbing or big
painful memories, or it might just take one session for this memory, one session for this memory, so
it can look a few different ways. All right. Phase seven. Phase seven is closure. When we're coming
to the end of a session, whether or not we consider the memory having been completely
processed, we're always going to make sure and stop in plenty of time to provide any stabilization that's
needed because again big feelings can come up during EMDR processing and we want to make sure that there's
time to kind of get them back to a good baseline. We remind the client the processing may continue because
we've kind of jump started a natural process and encourage our use of resourcing skills and then phase
eight reevaluation when your client comes back. We check
Previous processing outcomes, what's new, what's different since the last time we met? New insights,
new changes, any changes in symptoms. We continue processing the target if it feels like there's still
more there, but if it feels like the target's been completed, meaning that when they think about it,
they're like, yeah, it's not really activating me anymore. Yeah, that adaptive positive belief feels
true. Even when I think about that, then we can move on and we can identify another memory if there's some,
Almost always there's more than one that needs to be processed. Or we may be talking more about integration
of behavior change and things like that. So it really depends. So that is our eight phase model. And
I'm going to come back to that question of population. Does EMDR not work in populations it doesn't
work with? What I will say about that is that EMDR, because it is a full eight phase protocol,
including history taking, including resourcing, including the recognition of how these things that happened
to me shaped my self view, right? Because it includes all of that, I conceptually think of EMDR as being
a lot more than just the processing. So I will say that those aspects of EMDR I would do with any client,
regardless of whether I thought we were going to get into the processing part or not, which sometimes,
depending on time limitations, doesn't happen. But are there situations where processing, EMDR processing,
is not effective? I'm gonna say probably more that the clinician maybe doesn't have the competence or
skills that they need because when you've got a very highly protected system,
Lots of defense mechanisms and things like that. Processing really needs to slow down and we need to
be able to use processing adaptations to sort of help the client through. Also in the case of window
of tolerance issues. If you think about the window of tolerance, it's like a place where you're able
to engage with your memories, able to engage with what's happened to you, able to engage with an emotional
experience without becoming hyper aroused,
too activated or hypo aroused, like dissociation. Maintaining a window of tolerance is a skill in art
form in itself. Most people that tell me that they had a bad time with EMDR and they tell me about what
happened, it was because they exceeded their window of tolerance and either the clinician didn't recognize
it or didn't know what to do about it, and then it did end up being re-traumatizing.
Other situations where EMDR is contraindicated, not gonna do EMDR with somebody who's an active manic
episode, not gonna do EMDR with somebody who's in a psychotic episode. We wanna make sure that there's
a level of stabilization before we start engaging in processing, because again, we're generally looking
at some pretty painful stuff, so we wanna make sure that the person has what I refer to as the internal
and external stability.
Internal stability, meaning I'm not manic, I'm not psychotic. I have enough of a window of tolerance
that I can talk about this stuff without becoming entirely dysregulated. External stability being what's
the support system look like? What's going on in their social emotional world? Are they up for a big
promotion at work?
probably not time to dig up the childhood trauma, right? So there's sort of that external stability
and internal stability that we look at. All right, other questions? I wanted to make sure I hit that
one since I promised I would.
Good question. So a local provider that says they won't do EMDR with a client until they're 30 days
sober, there have been a few iterations of this idea. Back in the day, they were like, you can't do
EMDR until somebody's been 90 days sober. Okay, well, for a lot of people, that means that they're not
gonna get to do EMDR, right, because they're gonna relapse before that.
What I will say again, and again, I come to the provider, their level of skill and competence and what
type of EMDR they're providing. For people who are struggling with substance abuse issues, they are
chronically under resourced. That's what the substance is for, right? The substance is not a problem,
it's a solution to a problem that they had, right?
not trying to say substance abuse isn't a problem, but when you think about this conceptually, the substance
is the solution to the feelings of dysregulation, the feelings of emptiness, the feelings of disconnection,
the pain, right? And so they're gonna need a significant amount of resourcing. So in my model, we're
probably not gonna be doing any processing in the first 30 days anyway.
because we're still focusing a lot on resourcing. That being said, I will use a crisis intervention
with somebody, whether they are, you know, 130, 60, however day's sober, because then the other piece
of it becomes like, what are we focusing on and how are we focusing on it? Like I said, we're probably
not going to open up the big bad
of painful childhood trauma at the beginning. There are a lot of different ways, and this is where again
I kind of look at like,
you know, the training of the provider, EMDR providers, they all have like what we would call a basic
training. But then from there, do they have training in managing window of tolerance issues? Do they
have training in dissociation? Do they have training with substance abuse? Because it's really about
titrating the experience and making sure that it's not more that the client can handle. So I don't myself
find like arbitrary timelines to be so helpful as more like, what am I doing when?
I'll desensitize a trigger or an urge anytime because that's going to help them stay sober. Yeah. Yeah.
Great question. If I'm looking for an EMDR therapist, how do I know if they're basic or advanced or
where they are?
So you can go to, there's a website, MDRIA, E-M-D-R-I-A, which just stands for EMDR International
Association. Oh, look, there it is, MDRIA.org, and they have a find a therapist tool.
And if you use the Find a Therapist tool on imdria.org, they can show you, does this person
have certification? Now certification is advanced training, advanced training and consultation. It generally
takes one to two years for people to get their certification. And so it'll tell you, are they certified?
It'll tell you if they're a consultant or a trainer, which means that they've done even more work in
there. So you can kind of get that idea.
There are clinicians who are very good EMDR providers who are not certified though. I just wanna say
that because I know many of them. Because certification is a pretty big investment in time and money.
And so there are really good EMDR clinicians who aren't certified. So I'm gonna ask questions. I'm gonna
say, how long have you been doing EMDR? What are your areas of specialty? What extra trainings have you done?
And you know, I mean, if you have a decent BS meter, you can kind of get a sense of that. But I always
say no matter what we're talking about in terms of like the type of modality or whatever, ask questions.
When you call, make an appointment. Yeah. Yeah. I would say for me personally,
I don't wanna waste my time, I don't wanna waste my money. And also, when you think about how difficult
it is to access services, how difficult it can be to access services, to get yourself there, to start
the process, I don't think it's fair to expect somebody to get started and then find out like, oh, this
provider doesn't have the skills that I need.
Great question. So when it comes to people pleasing, I'm going to move this along to your QR code because
we are about
five minutes ago. When it comes to people pleasing, there's a few different ways we can handle it. One
of the considerations for me is does this person have the insight to understand their tendency to people
please? If so, we can talk about it. And I really emphasize curiosity and openness. I tell them there's
nothing that is supposed to happen, that anything that they tell me is just information, and that I'm
not looking for anything.
Which is actually true, I'm not looking for anything. And I'll use the words like accurate. Like this
is gonna be the most helpful for you if you can be as accurate as you can be. I don't use words like
honest or transparent because they're so value laden and people pleasing isn't about lying, right? It's
about a survival response. So I'll use the word accurate. And sometimes I just leave the numbers out.
Sometimes I just leave the numbers out
I tend to be really circumspect in how much I even come back to the numbers at all because it can create
feelings of pressure. Or it can kind of knock people out of their emotional processing because they
get really focused on like, well, I don't know, is this a four or a five? I don't know, how do I figure
that out? And it's like, well, okay, there we go, totally out of the emotional processing of it. So
there are definitely different ways like that because when it really comes to the EMDR, when it comes
to the numbers, when it comes to all of that,
When you have a felt sense, and I'm very big on what I call right brain to right brain communication,
when you have a felt sense of what's happening in your client's nervous system, you kinda know anyway.
Yeah, great question. Probably have time for one to two more. Alrighty, well, I think we're gonna turn
it over to Ashley for whatever's supposed to happen now.
Yeah, so thank you, Kara, for being here. That was great.