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!

PRIVILEGE

I’ve been avoiding writing recently, I admit, because when I sit down to write something about mental health (that will speak to my ideal client and bring them in for therapy), something happens in the world that rocks me. It angers me. Muslim bans, Neo-Nazi’s and “free speech,” kneeling as protest, useless and greedy government officials, election tampering, the growing disparity between the rich and the poor, the attempt at healthcare repeal every three months, hunger, disaster responding, violence, mass murder, assault weapons. I could go on and on, and that is just in the United States. These things are not subjects for typical mental health blogs. Writing on those topics, anxiety, depression, parenting, feels pretty superficial these days because the problems are so much bigger than the individual’s reaction to the above current events. How can I help someone be less anxious or depressed aka feel safe and happy in such a world?

So I am going to begin with what I hear a lot in sessions. I hear a lot of what we are calling Privilege.

Privilege   priv·i·lege [ˈpriv(ə)lij]

noun

a special right, advantage, or immunity granted or available only to a particular person or group of people: education is a right, not a privilege

synonyms: advantage, benefit, prerogative, entitlement, right, concession, freedom, liberty

verb

grant a privilege or privileges to: English inheritance law privileged the eldest son

I am speaking to the concept of having an advantage. Being white gives you an advantage, as does being a male. It does not mean you have grown up with money. Obviously there are fewer and fewer people in that category so let’s not try to argue that point right now. Money is of course a concrete privilege, it doesn’t make you happy but it can solve a lot of problems. When I was a girl at PS 75, I was in a mixed community of white, Hispanic, African American, Jewish people. I was not wealthy, so when one of my African American friends asked if my barrettes was “real” as in “real gold,” I was confused. Why would I have real gold barrettes when I basically wore the same two pairs of jeans every other day? When I think about that now, I realize that they saw me as having an advantage, as having access to something that they did not. Why? You guessed it, I am white. And yes, I am privileged. My parents have advanced degrees, we had complicated books on the shelves, art on the walls, I traveled to visit my grandparents over the summers. The list goes on.

Now it is clear that while men have been feeling quite attacked on this subject as so many don’t feel like they’ve been privileged at all. Many are poor, undereducated, unable to make ends meet to support their families. Where they don’t realize they have been privileged: They can go for a 6AM run without being stopped by police because they’re “acting suspicious.” They aren’t racially profiled when they go for a drive. They aren’t sexually assaulted and told they shouldn’t have been jogging – in shorts – at 6AM. This list also goes on.

Laws have not been enacted to keep white people out of home ownership, or moving into certain neighborhoods or joining private clubs. Or drinking from a public water fountain, or using a public bathroom. It is not so long ago that these things were a reality in this country. We know where some of the most outspoken civil rights leaders are today – if they are not already dead/murdered. But where are the people who so passionately protested integration? They didn’t just disappear into obscurity. They became police officers, lawyers, members of government, the Attorney General. They used their privilege to undermine every layer of society. Slavery has not ended, it only looks different now (an entirely different subject but Google Industrial Prison Complex if you want more information).

The concept of being “woke” is about being educated about how all of these factors have led to the current situation and working to stop it. Working toward a real model of equality. However, it is hard to be Woke when every part of this culture is trying to convince you that it’s all okay exactly the way it is. They want white people to say, “it’s all too much, I can’t anymore…” and it is your Privilege to say that, because for the most part, you can. You don’t have to worry about being shot by police for reaching for your license and registration. No one asks you where you are from or tells you to back to where you are from. You don’t have to worry about being the victim of a hate crime. You feel safe. Putting yourself on the line is scary and has absolutely had consequences for some, but you, white person, are what is going to make the difference in the long run.

As a therapist, I am going to challenge you on these issues. I will correct you when you repeat myths of how immigrants are coming to the US and signing up for welfare. Therapeutically, it’s not my place to do this, but I feel I have some obligation to challenge you. If you’re not ready for this challenge, we aren’t going to be a good match to work together. I’m okay with that.

www.aliceriley.net

ARileyLCSW@live.com

Therapist Vacation

Therapist vacation

I came home from vacation late last night and got a message from a client today. She said, “everything goes wrong for me. Always, no matter what I do.” And unfortunately, a lot of lousy things have happened to her and It’s frustrating to see her continually experience set backs and disappointments.

On any other day, my response would have been different. But I just came home from quite possibly the worst vacation experience I have ever had.

Every couple of years, my two kids go to stay the summer with their grandparents who reside in St. Croix. I take them down, they stay, their dad goes and gets them (and visits his family). Travel there from Colorado is not direct and there are long layovers, usually in Miami, due to limited service to the island. This year, we went and I took my mom, and we planned a very relaxing, beach and sea focused trip with shopping, snorkeling, sunset watching and sight seeing.

To sum it up: 3 cancelled flights, one of which had been rebooked to St. Thomas, then cancelled. My over night hotel fee is in dispute right now since we could never have made it. No rebooking opportunities for 3 days. Stranded in Miami 2 nights, one night in Charlotte, NC. Miami was apparently in some kind of rainy season. Luggage was all sent ahead to St. Croix the next morning while we remained in Miami. An excursion I planned to take my mother to St. Thomas on the seaplane was accidentally mis-booked and we had to pay change fees to get on the sea plane. I really had my heart set on flying that way – The plane takes off and lands on water and it’s 20 minutes between islands. Four days in St. Croix and we had to go home, saying our tearful goodbyes to my kids. That is never pleasant but I was worried about their return travels already! Flight home was St Croix to Miami, Miami to Chicago, Chicago to Denver. Flight from Chicago to Denver was cancelled. No rebooking. No seats on any flights for 3 days. I booked two one way tickets on another airline. I was not going to stay 3 days. Another hotel, a full day waiting in Chicago, before getting home at 1:30AM.

With that many turn of events, it was very hard to keep my chin up and not feel the way my client expressed. I was furious at the airline for cancelling so many flights, for so many people and not adding any to accommodate them. How many travelers had to go home because the extra expense would be devastating? I had been to St Croix two other times and I had expectations and plans. I wanted to swim laps every morning on Rainbow Beach… and I never even got to dip my toes in the water. I went to the beach three times the whole trip. And only once on St. Croix.

Now, despite being very put out… I forced myself to make a list. Several good things resulted from these mis-adventures!

1.       I went to South Beach (Miami) for the first time, saw a cousin of my kids who works for a large Hotel company who got us the family rate. He lives on Miami beach and we went out to dinner on Ocean Ave and had a beach morning the next day. When it began raining, we walked over to his apartment.

2.       My best friend lives in Charlotte, NC and her fiancé gave us his very beautiful home for the night, then they brought us breakfast in the morning before we had to go.

3.       I rented a car in St Croix and having my own wheels there for the first time (vs being chauffeured around by in-laws) was liberating. Driving on the left isn’t that hard.

4.       I got to ride on the sea plane and went to St Thomas, running an errand I had planned at a local shop. Also got to lie under a mangrove tree on a nearby beach.

5.       I met my new niece and got to see/hug/kiss my nephew, who lives there

6.       My kids are getting to spend time with grandparents, uncle, aunt, cousins, learn to cook Dominican food and speak Spanish

7.       My brother lives outside of Chicago and came to the rescue. I got to see/hug/kiss him and his family.

8.       I got to see the Art Institute of Chicago.

It’s important to make these kinds of lists when it seems like everything, well, sucks. It’s what I ask my clients to do every day – re-frame the experience. Trying to find the silver linings. Doing this tells your brain that you will NOT allow it to go down the dark path. Every time we only see the negative, our brain becomes more and more accustomed to going there as the default. It doesn’t make the experience any better, but it is certainly helping me not hate life right now! Things don't just go badly for you, but the cruelty of depression will tell you that it is you and that everyone else is living a wonderful life. I still had a vacation, just not exactly the one I had planned.

Jedi Mindfulness Trick

You hear the word all the time: Mindfulness. "Be mindful" to reduce stress, improve relationships, treat that Borderline Personality disorder, etc. What does it really mean?

mind·ful·nessˈmīn(d)f(ə)lnəs/ noun1.
the quality or state of being conscious or aware of something.
"their mindfulness of the wider cinematic tradition"
2.
a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations, used as a therapeutic technique.

Aahh, now you get it... blog entry done. No, not really.

Some of you may recognize the Star Wars reference in the title. If you will recall Yoda, (Empire Strikes Back) telling Luke, that he was impatient, that he never had his mind on the tasks at hand, instead his mind always wandered into his fantasy of becoming a pilot "like his father." Now, I have issues with the Jedi philosophy, because they teach that emotions are a hindrance and should be repressed. I think that if Anikin had been allowed to grieve the loss of his mother when he left her to train, he might have turned out better. But getting back to the point. When we meet Rae, whose parentage has yet to be revealed, she is a scavenger. She spends all of her days picking off parts of grounded Imperial Star Cruisers on her desert planet, washes them in, trades them for food. At night, she waits to be rescued. When her powers are awakened, it takes her very little time to connect to them, her mind is clear, she can focus, and she wins. 

She can do this through mindfulness. Yes she has a fantasy life, but it doesn't interfere in her daily life. She can put it all aside until the right time. 

I have been listening to meditation recordings on the Calm app. The voice of the guide is pleasant, which is important to me. The message is that constant thought about everything all the time is exhausting and can make us sick, physically or mentally. It helps you learn to clear your mind and not judge yourself when thoughts peek their heads into your brain. But to just go back to the clear, open blue sky. Thoughts are little, white, puffy clouds that float away. There are YouTube channels as well that offer guided meditation, body scans etc as well, just so I don't plug the one thing I like particularly. 

If you do this a little every day on a scheduled basis, you can do this during times of stress. You can do this during times you need to focus. You can be present in your life instead of being distracted by the noise either around you or in your head. You might even get some good sleep! 

What would it be like to have a conversation with someone you care about where you were completely attuned to them? Or you were sitting on the grass under the tree and felt the breeze, heard the leaves rustle, smelled the flowers on the air? Just present? Not thinking tomorrow is Monday and there are 100 things waiting for me to do... Thoughts and anxiety are ever present, but they don't have to control you. So even if you think what you are doing is mundane, being focused on that mundane thing can translate into other parts of your life when you just might need to save the world!