I’m an EMDR Convert

Call me weird but my niche is trauma. Over the last 25 years I have gotten really good at hearing, discussing all kinds of awful stories from clients. I can hold these stories, and at the end of the day, I go home and live my life as if some spacey force field surrounds me from absorbing the pain into my own heart. Recently however, I decided that I could not be a trauma therapist if I did not know anything about EMDR therapy. The most I remembered from the first time I heard about it (in around 1993) was about watching a pencil eraser go back and forth and somehow people felt better afterwards. It seemed a little like voodoo to me. But after the last 3 months of training, I decided that it’s more like magic.

Real magic, like having my own wand in Diagon Alley with Harry Potter and friends and knowing all the right spells and potions at my disposal. Okay let me qualify this: I am a total newbie. I literally just finished the second weekend at the Maigberger Institute in Boulder, Colorado, with the amazing Barb Maiberger. Barb teaches four groups per month, then follows them up with online meeting consultations. I have had a private practice for a few years and many of my established clients were psyched to try this modality with me and I have been able to witness some amazing things in a short period of time. So before I say more – just what the heck is EMDR therapy, you ask? Well, I am here to tell you, since one of the assignments is to draft an explanation for my clients.

Eye Movement Desensitization and Reprocessing therapy is a modality that can be used with adults, teens and young children. It has been extensively researched and shown to reduce symptoms associated with most kinds of traumas and generally disturbing events and emotions. There are 8 phases that will take place as the client is ready for them.

The treatment will use one or more of the following types of Bilateral/Dual Attention Processing stimulation (BLS). This keeps the client and therapist in the past and the present at the same time: Each client can choose what they prefer: Eye movement by following an object, hand buzzers, tone through headphones, tapping by the therapist or self-tapping.

EMDR Therapy does not erase memories, it merely takes the emotional connection away from an event so that a person can recall and discuss the events without distress or disturbance. Research has also shown that the brain continues to re-process even after the session and well into the future. Clients may experience dreams, flashbacks, emotions and other sensations following the treatments especially after the trauma work begins. This is normal as it shows that your nervous system is doing its work.

Many of you may have heard that in June 2019 the creator of EMDR, Francine Shapiro, passed away at the age of 71. She discovered the properties of her theory quite by accident, as many good ideas come along, and being open to something that the Universe was trying to tell her. As a graduate student in Psychology, she followed up with good old-fashioned inquiry and research and started nothing short of a revolution. People with long term traumatic symptoms – war veterans, crime victims, people with chronic pain got relief! Even after years of traditional therapies, within a few sessions, they were able to think about or talk about their traumas without feeling as though it was happening all over again. Like I said: Magic.

Ok, magic and science. One image that came up in my mind when watching my first demonstration on Day One was the idea of hypnosis. In the movies, we always see some Victorian doctor in a gray suit with a curly mustache swing a big, gold, pocket watch in front of someone’s face until they become sleepy. In this state, the doctor is able to access memories, or implant some suggestion that later comes out unknowingly as a behavior the doctor wanted the patient to complete. Okay, that is pretty creepy and not what the purpose of any legitimate therapy is. But the bilateral stimulation has definitely been known for a while as a powerful method for brain stimulation. Plenty of new science on the brain is out there and practitioners, writers, researchers are clamoring to have the next breakthrough: like plugging our heads into a screen and making images appear. I’m not so sure that is a world I am interested in, as my reality, anyway. I’ll take it as science fiction instead.

I am a convert now. I don’t hear all the stories as much in sessions. I find myself taking deep breaths with my clients, nodding, and saying “go with that,” a lot while observing waves of emotion in my clients through their tears, twitches and relaxation responses. They end their sessions looking like they just came out of a nice dream, stretching and smiling, yet they were fully awake in the room the whole time. I tried it while in training, as we have to do on one another, and discovered that a number of things that used to get me going on an angry rant are no longer bothering me. It is a very peaceful feeling, to be able to let it go. I have studied for 25 years to do play therapy, Cognitive Behavioral Therapy (CBT), Solution Focused Therapy, art therapy, and this is becoming my go-to and I don’t have to give up any of the above! I hope to keep going to get certified, which will take a couple years to do, so until then I will keep practicing, training, and consulting. Advice? Interested therapists should find an EMDRIA approved training, and don't cheap out on this one. There is too much to learn in what might look like a bargain. Potential clients: always look up where your therapist got their training, just in case they did cheap out! 

The Work Book

After working with a particular child for a short while I found myself re-creating the same exercises in session that I've done with many kids in the past. I thought, I should just make this child a book that we put all these worksheets in. But then something better popped into my head: the work we were doing could help a lot of kids.

Below I pasted in the introduction to my book, and I cite The Kempe Center for much of the framework. I don't understand why this content has not become standardized to all mental health training. It can be used in so many situation with so many clients. It was designed to treat sexually abusive youth, initially. But it is truly universal. It should be viral. Teachers should know these skills as well. So please consider using this with your client caseload - each child should have a book of their own to document their progress and ability to self-regulate and plan for their own safety. You can find it on Amazon.com and search "Preventing and Treating Abusive Behaviors: A Workbook for Children and Teens. 

This workbook is a mixture of various exercises and treatment concepts that I use in my work with children and adolescents in therapy. It is based on the principles of Perpetration Prevention developed by the Kempe Center, in Denver, Colorado. I was trained by Gail Ryan, MA to teach others how to address sexual behaviors in children and teens including problem behaviors and abusive behaviors. Over time it became clear that these concepts can be applied to a number of situations where children’s behaviors become abusive. The concept is simplified as “Abuse is Abuse” meaning if someone is doing harm to another person, an animal, to property, or themselves, it is still abusive behavior and needs to stop. We do this by teaching children the goals of Communication, Empathy and Accountability. We also do not want to diminish the needs of the child engaging in problem behaviors. Therefore, we use many of the exercises to explore identity, assets versus risks, what their high-risk cycle looks like leading up to their abusive behaviors. Children still need to learn pro-social behavior and make friends in typical environments despite having experienced or exposed to violence, trauma, and loss. The table on the following page outlines the types of abuse we wish to stop and ultimately prevent.

A cautionary note to parents: This book is ideally used within a therapeutic relationship. If your child is engaging in problematic behaviors, especially sexually abusive behaviors, please seek professional help. This book can be used in conjunction with a multi-disciplinary treatment team for the management of sexually abusive behaviors. A professional will have the background to utilize these concepts to their fullest benefit.

The High-Risk Cycle exercise introduces the concept of a Trigger – something seen more and more often in the media. However, it is more than a place, or subject in our case. We want children and teens to identify the emotion associated with the triggering topic or event. Some examples are:

Not feeling liked, valued; feeling policed; feeling left out or rejected; feeling unsafe; afraid; feeling unheard or misunderstood; being mistaken, falsely accused or assumed guilty, feeling jealous, feeling uncomfortable with compliments or comments on appearance.

When a parent or caregiver is aware of situations that are potential triggers for their child, they can mitigate the child’s risks by observing and addressing the issues directly and as quickly as possible. Remember that if your child had a trauma, it is not a predictor of future behavior. Having plenty of normal activities and interactions can balance out their development. That is what the scale activity is meant to achieve. Children and Teens often feel that they will not be able to change their destinies, even if they have experienced consequences of their behaviors. It is critical that they believe in themselves.

In the exercise about their body, children and teens can learn to identify where they hold onto their anxieties and other emotions. Some hold tension in their throats, or trapezoid muscles, others may get stomach aches. This tuning in helps children and teens connect back to their physical selves and create the mind-body connection that is important in mindfulness practice, and not relying on dissociation to cope with difficult feelings.

Of course, there is more that can help your child engage in self-discovery and healing.

I hope you find this workbook useful for your kids and your clients! I believe it has been needed for a long while!

Animals in Therapy

The vast majority of people love animals – a cat, a dog, bird, lizard, rabbit, horse or even a mouse. They show us love as much as we show them, and it’s completely unconditional. Almost any domesticated animal can be a comfort animal or have therapeutic benefits – there is no certification for this but it helps to have a therapist write an official letter indicated a child or adult needs their companion to address mental health symptoms. Often therapists are asked to do this so a family can move into a new apartment with strict rules about pets. There is an enormous amount of research already on the books about how animal contact can improve post surgery outcomes, improve social contact in older adults, increase walking times and distances for dog owners, experience a generally higher sense of well-being through their pets.

So why would someone need a therapy animal? All you have to do is adopt a pet and all your troubles are gone, right? I am writing this because I have an amazing dog, a 6 year old black Labrador retriever named Rocky. He’s calm, intuitive, quiet, completely harmless to kids and older adults. I do not have any certifications at this time in doing any “real” therapy work with him but often kids or adults ask me to bring him in. I let everyone know that while he’s healthy, has all his shots, but I am not covered to use him officially. They don’t care; and I am not worried that he’ll hurt anyone. I’ve seen toddlers manhandle him and all he does is lie down and get comfortable. When you stop patting him, he’ll nudge you or put his paw on your knee to remind you that he’s still there. I have a security system because frankly he would just lick a robber to death.

To use an animal for therapy, you need a therapist. The animal can’t go to school for that. The animal should pass a screening for the right behavioral attributes and have basic training for obedience. Many therapists have their own pets – horses at a ranch, dogs, cats, goats. People who are anxious benefit from talking while petting the soft fur – that tactile stimulation can help ground people in the present moment, and help them connect back to their body (see my NARM post) as so often people will disassociate when stressed. Children who have impulsive behaviors learn more empathy so see that their rough treatment might not be the right way to get the animal to “make friends” with them.

The animal therapy has specific goals for treatment. It is the primary intervention for the client. The other type is animal-assisted therapy (AAT) where the animal’s presence is secondary to the therapy going on. An animal can get a reticent child into the office, or motivate a teen to engage, or be a surrogate face to talk to when in distress.

My favorite example of Animal therapy is from the first book written by abduction survivor, Jaycee Dugard. She wrote that for her first session she was handed a saddle and assigned to saddle a horse (something she had never done before). Her two daughters did fine. She could not do it, after many failed attempts. Her therapist then asked her why she did not ask for help? This then spurred a discussion and realization that for years she could have asked for help while living with her captors. Everyone brings something different to therapy, and animals can offer something different and unique to each situation either as the therapy or as a jumping off point. 

FIX MY KID

I see a fair number of adolescents in my practice. I enjoy them a lot because when I was in High School I was in therapy and it damn near saved my life. Not because I was suicidal, but because I was able to process out all of the stupid, silly, stressful and annoying parts of being a teenager and decide what was right for myself. I mentioned before that the therapist wasn’t perfect but he did his best and sent me out into the world a little better than I was before.

I wanted to go to counseling – I asked to go. It meant my mom spending a little money on me every week but I babysat a lot and I often paid for my own luxuries that way so why not? I could walk to the office on my own, and I was a good client – only missing one or two appointments. Parents now ask for counseling for their kids – and they should. I always ask if the teenager wants to come, and usually they do. I explain that I am not the snitch for the parents – in front of them both. The kid needs to be able to tell me things without the parent hearing ALL. But the parents also need to be involved to a degree, so they know what progress is taking place and any changes that need to happen so they can support their budding adult.

I cannot “fix” anyone’s kid. There are times, when the teens behaviors are direct result/rebellion of their parents’ behavior. In those cases, I help that teen learn healthy ways to deal with their parents so they can move out someday and lead a healthy life. These are very difficult situations from my point of view. But when it works, the parent sees “improvement” because the teen stops butting heads with the parent as much. They see the end date ahead – college and independence. Often teens don’t realize until you point it out, that they WILL grow up and they CAN live somewhere else. The ability to imagine the future is located in the pre-frontal cortex of the brain, which is not yet fully developed until we become adults. But we can give them a little nudge.

In discussing this with some colleagues, after being “fired” from a teen I had a nice rapport with, because her symptoms weren’t gone after 2 months, we came up with a few ground rules:

1.       The above rule – I’m not your snitch

2.       I can’t fix your child. Therapy is a process and it takes time to dive deep under the surface. Some symptoms are serious and debilitating and your teen may need at least a year of work.

3.       Therapy isn’t forever – my goal is to get the parents to learn to be the supportive adult in the teen’s life. You should grow alongside your child. You are forever.

4.       If your child is being treated for trauma – their “bad” behaviors in school or at home are often a direct result of the trauma. Punishing them for their trauma responses is counter-productive. Setting limits is good. A good resource on this topic is Heather Talbot Forbes’ Beyond Consequences.

5.       Check in and participate once a month at a minimum. Ask questions about how you can help support your child grow into an adult.

Unfortunately, a little “getting over” on parents is part of growing up, and very common. Be patient with your teen. They’ll make mistakes and they’ll learn from them. It won’t usually ruin their whole lives. You can warn them but they’ll still insist on finding some things out the “hard way.” Listen to them, ask questions, repeat back what they say and ask if you are understanding them right. “What do you think about that,” and “Hum, interesting,” will go a long way. And I am here to help!

Book Report

I have been reading and listening to Healing Developmental Trauma by Drs. Heller and LaPierre that is mostly about the Neuro Affective Relational Model (NARM) of working with people (adults) who have experienced early trauma. What is interesting about it is that it is about more than "shock trauma" which is what most of us think of - child abuse, neglect, a severe accident. They define Developmental Trauma as much more encompassing, even pre-natal insults like a surgery, or a depressed mother. I thought right away, if that is the case then we all have some kind of trauma, and a lot of it makes us different from one another. I used to think that "bad things" happening (and subsequent survival) make us just that more interesting as people. Most of us go on from there, to survive and thrive.

Obviously, my focus in my work is on the adults (and kids) who experience the shock trauma. But as simply as I can explain NARM, here it goes. Our bodies are regulated by our mothers, at first, through gestation, and then through the bonding period. Our parents hold us, feed us, sleep by us and we learn to feel safe and calm and "regulated" neurologically. We become organized and our brain and endocrine systems function optimally. We enjoy good nutrition, health and connected relationships to others assuming that love continues throughout our childhoods.
When that bonding and meeting of needs is disrupted, both early on and throughout our development, our bodies become disorganized and dis-regulated. We learn adaptations to survive the abuse or neglect. Humans (and animals) have three autonomic responses to danger: Fight, Flight, or Freeze. An infant can only do one of these things: Freeze. They will stop crying and disassociate from the body to ignore hunger, a wet diaper, pain. Babies and children will cease to recognize needs and have needs to preserve the minimal bit of relationship with the parent that they can get. As they get older they continue to protect the parent relationship by appearing compliant and good. They are not however, connected to themselves or others, they are not developing their own identity or knowing what they need from the environment. They do not recognize that the failure was in the environment. Instead they just know they "feel bad" and later they simply "are bad."
I wanted to cry listening to and reading this, for the babies out there who are enraged when they even have to "cry it out" as some professionals propose. There are many people who are now adults who experienced this, and just this lack of responding can create lifelong effects. Frequent disassociation, anxiety, panic attacks, health problems, relationship issues. I feel vindicated as I recall my own parenting - I held them, responded to them, bonded to them and I still strive to meet their needs as they grow.
There are five adaptive styles/organizing principles that can become survival mechanisms that go on into adulthood. I can list them but going into all of the traits and treatment here is way beyond my blog scope: Connection, Attunement, Trust, Autonomy and Love/Sexuality. Surviving as a baby or child is one thing, the problem arises as adults because we're not babies anymore. We were abandoned, but no longer. We were harmed, but no longer. Yet people are going through life as if the trauma is still happening and they often can't even put their finger on WHY they still feel bad. NARM does not focus on repeating the past traumas, it focuses on helping people remember without re-experience of it through connecting back to the body and learning to regulate their own biological systems. Developing identity and the ability to deeply connect to another person.
The use of this model in treatment is complex and requires a lot of study, practice and supervision. One of my goals is to do the 12-18 month program. For now I have to say that just having this understanding of the brain's development has made a difference in my practice. I do have a fair number of clients (in person and online) who seem to have one of the Adaptive Survival Styles and trying to do this kind of work online while completely DIS-Connected to them is potentially disastrous. I am ambivalent about continuing as an online therapist for this reason. After all, connection and relationship is what therapy is about, and then sending clients back into the world to try to connect and build relationships with others. It is important to continue learning, be humble, genuine, self aware, regulated and Connected.