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SESSION II: Working with Couples/Anxiety Protocol
ABSTRACT:
The first half of this session focuses on the use of EMDR in working with couples. Advantages of and contraindications for using EMDR with both partners present are addressed. Evaluation phase then highlights how the trauma "story" of each partner intertwines with the other. Goals and treatment plan flow naturally from this.
Attention will be given to practical concerns, such as, how much of an individual’s trauma history needs to be cleared, how to physically set the session up, and what to do after the processing is complete, including attention to any change in patterns of behavior.
The second half of the session deals with anxiety and panic. Although to some extent, a review of material from the basic training, it highlights the need to "frontload", at times, preparation phase skills, to enable the client to gain some control over anxiety before doing anything else.
Attention is given to taking a thorough history, ordering of the target memories and setting clear goals with a treatment plan, not only as a way of organizing treatment, but also of giving the client hope that there will be a beginning, middle and an end.
Preparation phase material is based on the Response Cycle (Andrew Seubert), with an emphasis on creating immediate successes in dealing with anxiety before moving to EMDR treatment of the trauma list. During the processing phase, awareness and affect tolerance/management are stressed, as well as, at times, fractionating or pendulating (Peter Levine). Closure always involves "homework", as well as standard decompressing.
Case examples are employed in both halves of this session.
OBJECTIVES: Participants will:
In the first half participants will:
learn how and when EMDR can support couples’ work.
know when to include both partners during an EMDR session and when not to.
learn how to target memories and
know what to advise after processing and in between sessions.
In the second half participants will:
review evaluation phase, including target selection.
review the basics of anxiety psycho-education
learn the Response Cycle as a way of organizing skills in dealing with anxiety/panic
know how to choose target memories that will provide more immediate success and confidence in managing anxiety.
learn the importance of continuous affect management during processing of significant memories and
learn the importance of assignments and tracking in between sessions.
SESSION I: EMDR and Dissociation
ABSTRACT:
This session integrates material from Sandra Paulsen, Joanne Twombly, Carol Forgash and personal clinical experience. It begins with an overview of dissociation from Ego State conditions to DID, screening for dissociation and the need for training/supervision with this population. In addition to general and trauma histories, as well as screening for dissociation, the evaluation phase requires getting to know the "system" and strategies for accomplishing this primary task. Only then can there be movement towards agreed upon treatment goals and contracting. Preparation phase reviews various skills needed to proceed towards trauma processing: self-soothing, affect tolerance/management, grounding, and containment. Emphasis is placed on continuing to map the internal system (using the "dissociative table" or "conference room" strategies) and achieving agreements around trauma processing. Treatment of this phase ends with a list of "red flags" that serve as contraindications to trauma processing.
Phases 3-7: During this segment of the seminar, the initial focus is on how to explain EMDR to the "system" (if necessary) and how to prepare specific ego states or alters for the work ahead. The workshop then covers the importance of target selection (manageability), having the ego state/alters participate in bilateral stimulation (BLS), and titrating or "fractionating" (Catherine Fine) difficult material. Particular attention is given to various closure/containment strategies utilizing visualization. The use of BLS is incorporated in process of fusion/integration and is recommended in dealing with fears and future templates in the wake of an integrated, or non-dissociated, existence.
The final phase of treatment stresses continuous re-evaluation: safety, stability and internal collaboration in between sessions, the importance of reviewing and revising treatment contracts (where are we in this map?), and creating resources out of each and every success.
OBJECTIVES - Participants will:
learn the purpose of dissociation and see it as being on a continuum from its everyday to severe forms and need for supervision.
be aware of two different screening/diagnostic tools for dissociation and the importance of learning about the "system" during evaluation.
learn at least three "grounding" strategies for this population and
learn the kinds of adaptations that may be necessary during the processing phase as well as during closure.
SESSION IV: EMDR and Eating Disorders
ABSTRACT:
This session begins with an overview of the prevalence of eating disorders and prevailing theories as to why they occur. Safety first demands initial and consistent medical management by physicians familiar with eating disorders. This insistence also enables the therapist to stay out of the food monitoring process.
The evaluation phase must include the usual histories, as well as the development of the disorder, and the diagnosis of any other addictions and/or mood disorders, both prevalent with this population. Attention to themes and schemas during the taking of the trauma list is important. A relating of the case formulation, using the facts and events of the client’s life, tells them their "story" in a way that makes sense of the eating disorder to client and family. This in turn makes it easier to establish goals and treatment plan. Caution must be taken, however, with regard to the goals since the client is often not willing to give up the disorder.
The preparation phase is extensive. The first part stresses continued medical safety and case management. Education about eating disorders, awareness, affect education and competence and resource development begin this phase. Self-awareness and the need for assertiveness are stressed. The use of ego state work (Watson and Watson), imaginal nurturing (April Steele) and helpful ego states (Shirley Jean Schmidt) are introduced as potential aides in strengthening the client’s healing potential and getting cooperation with the eating disordered "part" of the client.
The second part of this phase is devoted to building skills and successes. This includes "pendulating" (Peter Levine), tolerating and managing strong affect, particularly anxiety, and using BLS and EMDR with future templates and recent events associated with the disorder.
Processing begins with present triggers to reduce the flight into disordered behavior once the client begins to target the trauma list. Recent events are targeted, realizing that the disturbance won’t resolve to zero, but knowing that this will build confidence and affect tolerance. The use of EMDR is described both within the classic exposure/response prevention approach as well as within A.J. Popky’s addictions protocol. Any and every success becomes a new resource.
The trauma list is then addressed, at times employing John Omaha’s "traumaphor" procedure in which the addictive substance is seen as a replication (not a substitution for) some earlier dysfunctional relationship. The re-evaluation phase reinforces all successes, while continuing to monitor medical conditions and any behavioral changes as a result of the processing. Present triggers and future problematic situations are targeted. Finally future templates of desired behaviors are processed with BLS. The need for social and group support is strongly emphasized as part of this phase.
One or two case studies will end this presentation.
OBJECTIVES - The participants will:
learn about the prevalence and theories of eating disorders.
know the need for medical safeties and history taking specific to this population.
learn summary psychoeducation about affect management and eating disorders.
learn importance of developing self-awareness and assertiveness skills
learn four three different forms of resource development helpful to this population
learn the usefulness of ego state therapy
learn the need to build small successes, to tolerate anxiety and deal with addictive triggers before proceeding to trauma processing.
know the importance of processing future templates and developing social support.
Note: each of the following sessions can be extended to one- or two-day workshops with more opportunity to practice and/or focus on case consultation
Advancing EMDR - Applying EMDR with Specialty Groups
4 half-day Seminars
ClearPath Training Center
Your Path to EMDR Certification... and beyond
SESSION III: Mindfulness and the Courage to Feel
ABSTRACT:
The ability to tolerate and manage emotions is of paramount importance to clients who are about to enter trauma work. Therapists need to be educated themselves, not only with regard to explaining emotions to clients, but also as to how to give clients the experience of gradually tolerating, managing and, importantly, learning from feelings.
This session teaches how to increase the client’s emotional competence from the first session on. The very structure of a trauma-informed model does this gradually. During the evaluation phase, the practice of awareness is also introduced, enabling the client to at least recognize and report any emotional responses to the history taking.
The preparation phase consists of teaching why we have feelings and how they work (in non-technical terms), and the four steps to emotional competence (eminently teachable to clients). The remainder of attention given to this phase focuses on strategies to support tolerating and managing affect: awareness, breathwork, visualizations, container, and pendulating.
This phase ends with (1) reworking recent events or using a future template with newly acquired skills and BLS and (2) the application of EMDR to recent memories, moving from lower to higher SUDs in order to increase confidence.
Trauma processing and closure provide opportunities to use this new mastery over and over. Directing the client’s awareness with simple reminders or process questions during EMDR is often required At times, it may be necessary to return to the preparation phase to reinforce or add to the client’s repertoire of MindBody skills.
OBJECTIVES - The participants will:
learn the importance of a trauma-informed model in increasing affect tolerance and the use of awareness during the evaluation phase.
learn a teachable emotional psychoeducation
learn five affect management skills
learn how to provide experiential practice with emotions for the client
know how to reinforce these new skills during processing and closure.