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  #1  
Unread August 4th, 2006, 06:20 AM
troubledwaters troubledwaters is offline
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Default question about success of EMDR

Hello,

I'm not going to get into detail here because it could turn into a long post that's not necessary. I'd be happy to elaborate though.

I've been seeing an LCSW for approx 3 years. She's been trained to do EMDR. She assured me that I didn't have to trust it or believe in it, so off we went.

We did this once a week for approx a year, although it wasn't continuous - there would be breaks. Unfortunately, I don't feel like I truly benefitted from it at all. There were times that I knew I was putting up walls and tried hard not to, to simply relax and let what happened, happen. There were other times when we could both see my defenses kick in, whether I wanted them to or not - like when I'd first arrive for an appt and slowly but surely I'd become irritable. There was one time when I was angry at the thought of doing EMDR, so guess what?! She did a brief EMDR session about the anger - and got past it. I don't want to stand in my own way! It's frustrating. I don't want to put up walls and be angry and sabotage myself.

Good grief I've been in therapy off and on for close to 30 yrs. The last thing I want to do is drag it out and spend some more money. The goal was to get beyond old defenses so I could face my biggest 'hurts' - adoption, childhood, and infertility/sexuality issues.

Would you enlighten me as to why we were unable to do much in the way of those issues?

Sincerely, troubledwaters
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  #2  
Unread August 4th, 2006, 10:42 AM
Sandra Paulsen Sandra Paulsen is offline
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Default Re: question about success of EMDR

I am not sure what was being treated. I'll make some general comments which may or may not apply in your case.

EMDR is not a treatment for everything. It is a researched treatment for trauma related conditions, especially PTSD. It is used more broadly, though there isn't a lot of research to support its use with other problems. A lot of us find clinical improvement across a range of disorders. Most of us find a few situations that it doesn't help.

I find a few situations with which I need to use lots of things: EMDR yes, but also ego state therapy, somatic therapy, and other things to get past defenses to untangle the small "t" traumas that form defenses and habitual ways of responding early in life.

For people with a lot of trauma, who may be dissociative, there is quite a bit of preparation that needs to be done before EMDR.

Protective parts of self (also called "defenses") invariably have good reasons for stopping change. Those reasons must be well understood through some method so it can be determined if those reasons are still operative or if times have changed enough that its safe to allow change.

Any client who has not benefited from EMDR need not continue it and might well discuss the matter with the therapist or get another opinion. Any therapist who has a client not benefitting from EMDR may wish to 1) try something else, since EMDR is not for everybody or everything, and/or 2) consult with a senior EMDR consultant to see what if anything is being overlooked.

Last edited by Sandra Paulsen; August 4th, 2006 at 10:44 AM. Reason: spelling error
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  #3  
Unread August 19th, 2006, 07:48 AM
troubledwaters troubledwaters is offline
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Default Re: question about success of EMDR

Hello,

I'd like to follow up my first post with some additional information for you as well as a couple more questions. I checked with my therapist and my situation was as I thought - we were using EMDR for a number of small "t" traumas, as well as a couple of capital "T" ones. My official diagnoses are Bipolar disorder, ADD, PTSD, and probably Borderline pd (it's been an official diagnosis in the past, just wasn't most recently.) In the near future I'll be evaluated for adult attachment disorder. I have trouble accepting the bipolar diagnosis because it seems to be relatively mild as bipolar goes, but it's hard to deny a few episodes of barely sleeping or eating and feeling wonderful for several days, as well as a noticeable difference when I restart lithium after being off for a few weeks.

Testing results done the last time I was hospitalized (1999), specifically with regard to dissociation were: "specific rating of dissociation was inconclusive as to the degree of pathology, but evidence is present of a dissociative process throughout the history, observation, and testing process; DDNOS".

One question I had is if it turns out that I DO have an attachment disorder, would that explain the difficulty I had making progress using EMDR? and if so, would that have been due to trust problems?

Follow up question is, given what I think were problems previously using EMDR, is it likely that EMDR would work in attachment therapy? I believe attachment therapy uses EMDR, but also uses other therapies specific to attachment disorder that obviously weren't used when I did EMDR previously. As I understand it, EMDR is used because it bypasses our cognitive rationalizations, defenses, logic, etc and goes to the limbic system and that's what I was told would need to happen if I have attachment issues.

One issue I had during the entire time we did EMDR was the purely physical aspects of it. The first session, her preference would have been to sit directly in front of me, with only a few inches between our knees. That was way too uncomfortable for me, so she sat off-center a bit, and backed up a little. Then I was to watch her finger as it moved horizontally. I did that for a long time, but I never got comfortable with it. I would often get distracted by her face in the background and find myself thinking about that and how awkward I felt and trying to stop it, rather than thinking about what I should be. The alternative - tapping - whether my eyes would have been open or closed, was worse, with eyes being closed being the least bearable. Towards the end of the year that we did EMDR, she was having back pain and one day I asked if there was another way we could do it so she wouldn't have to move her arm. She said we could try the electronic gizmo that has a light to follow with my eyes, so we tried that. It worked fine and I felt more comfortable with it, so we stuck to it for the rest of the time. My question is - am I sacrificing anything by using the machine?

Another small part of the whole thing is when we're preparing to begin and she's asking me questions and making notes, one of the questions is always, "where do you feel it in your body". That question bothers me a lot. First, I can rarely feel anything in my body at that time. Second, I hate the word 'body' and the word 'feel' in relation to 'body'. Third, I frequently just indicate my diaphragm to be done with it, although it seems like when I DO feel something it's always there anyway. The worst part is, I've never mentioned this to my therapist because then I'd have to dwell on exactly what I dislike so much. I know - that's not being a very smart client.

Any answers appreciated, with my understanding that some questions may be too specific.

troubledwaters
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  #4  
Unread August 19th, 2006, 01:04 PM
Sandra Paulsen Sandra Paulsen is offline
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Default Re: question about success of EMDR

Hello again, Troubled Waters. First let me say your question is very very good and articulate both. It also takes us beyond what has been researched and well into clinical impressions, so that’s what will follow. My greatest challenge in answering you will be to make it clear throughout that the comments I’m making may not apply to you. I’ll make them generally, about these problems in general, rather than pretending I know enough about you and your circumstances to opine on your specific case. I’m going to respond in sections.


MECHANICS


Its fine that you like the light bar; I use it all the time. The point is to use something that works for the client. Bilateral stim can also be auditory through headphones. Sitting close can be either distracting or too much for lots of people. Some people thrive on tapping, hate the light bar. To each his or her own.


THE BODY


Lovely that you have articulated the difficulty of turning attention to the body. I’ll make a few general comments about that. Any time a client tells the therapist that they don’t like or know how or want to tune in to the body sensations, that’s a RED FLAG to not go any father with EMDR. This person is not ready for EMDR. They’ve got the brakes on and EMDR steps on the accelerator. Not a good combo. Of course, a therapist can’t know if a client doesn’t report it.


There are protocols of EMDR for developing resources, such as RDI (resource development and installation) which can be very helpful for many. RDI doesn't specifically address the body problem however.

In my office, because I’ve trained in Somatic Transformation as well as EMDR, I spend time gently resourcing my clients and gently “nibbling around the edges” of body awareness for as long as it took for them to reconnect the dash board wires to the body. This isn’t part of EMDR training though. Once accomplished, clients can tolerate the body awareness much better and become ready for EMDR.


AN EMDR VARIANT


There is also a protocol to “reset the emotions” as originator Katie O’Shea describes it, within EMDR. Although too lengthy to go into here in an already long post, it does seem to settle down the intensity of people’s experience of emotions so that they are on a more even keel. It is often followed by doing very early processing from birth to three, though obviously people may not have particular memories from that time. Once these two steps are complete, subsequent EMDR on later childhood or adulthood traumas goes easier. It is as if the prep steps go in under the floorboards and clear out the origins of the disturbances. Perhaps I’ll try to explain that better another day. This step isn’t good for true DID without other prep work, but may be suitable for some with DDNOS. Don’t know if this applies to you remember, okay?


ATTACHMENT


Attachment injuries commonly occur in the first few years of life, so it’s hard to use the standard protocol on them. We can target relationships in present time or remembered from childhood, which can be beneficial, with standard EMDR. The EMDR variants I described are helpful for attachment issues, again without research on it, clinical impression only. Attachment issues can cause trouble with EMDR processing both because of difficulty being present in the body (for some) or because of the challenge of working closely in a trusting relationship with the therapist, which feels too evocative for some.

EGO STATE WORK


Often it is necessary to address internal child ego states and their relationship to internal parental or “introjected” ego states, which are sort of holographic likenesses of our parents that everybody carries around in their head. Even when parents are long gone or far away, their introjected likenesses create havoc in peoples heads, sometimes interfering with EMDR. My work on ego state therapy and EMDR specifically addresses this matter in workshops I have taught since 1993. I have a book on the subject which will be forthcoming, which is intended for both therapists and clients. Clients with DDNOS and certainly those with DID will nearly always require the addition of this element in my experience.


In my experience, individuals carrying diagnoses of Bipolar, PTSD, BPD and/or DDNOW very often benefit from ego state work and EMDR, used in a careful combination that involves lots of strengthening and resourcing before doing EMDR. Don’t know if this applies in your case.


ADD


Individuals with ADD/ADHD often need to be taken back to target more frequently than other people, because they may wander off from their EMDR material. In standard EMDR, we don’t keep a tight tether on the client’s attention, but with ADHD one has to do so. As an aside: some people say ADD/learning disorders in some cases related to early trauma. There is an entire approach to healing that uses sound to remediate processing problems hypothesized to originate in the womb when developmental milestones weren’t met due to disturbances in the environment communicated to the fetus. I don’t know the status of that hypothesis, but the early processing protocol of EMDR can help clear very early disturbances apparently, based on what I’ve observed clinically. May not apply to you and there is no research on point.


So there are some general thoughts on these important subjects.


Good luck!


Sandra Paulsen PhD
Bainbridge Island WA
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  #5  
Unread August 22nd, 2006, 01:23 PM
troubledwaters troubledwaters is offline
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Default Re: question about success of EMDR

Thank you, Sandra. Lots of interesting information.

Quote:
Any time a client tells the therapist that they don’t like or know how or want to tune in to the body sensations, that’s a RED FLAG to not go any father with EMDR.
Eeek! Obviously I didn't know that! LOL We've done a good deal of resource development, both before we started and as needed. I've also taken a full course of DBT, and that's been helpful. We had talked about the healing touch, but I couldn't help it - instant "no". And I think that's one that you don't even actually touch, hands just kind of hover. The whole body thing is pretty pervasive with me; I don't even like going to get my hair cut.

Quote:
It is often followed by doing very early processing from birth to three, though obviously people may not have particular memories from that time.
hmmm...I sense that that age is one of the areas I'm most afraid of.

Quote:
In my experience, individuals carrying diagnoses of Bipolar, PTSD, BPD and/or DDNOW very often benefit from ego state work and EMDR, used in a careful combination that involves lots of strengthening and resourcing before doing EMDR. Don’t know if this applies in your case.
It feels like it fits, mostly because of my previous statement. Don't know if it makes sense or not, but it feels as if the 3 year old is 'streetwise' with regard to early ages, and if I, as the adult me, go wandering around in there alone, I could get into a bad neighborhood. But if she were to talk and let me know what to expect, I could go in without fear of being mugged. LOL I love analogies.

Quote:
Individuals with ADD/ADHD often need to be taken back to target more frequently than other people, because they may wander off from their EMDR material.
That definitely seems to fit with me. There were many times when my mind would get stuck on my awareness of my therapist's physical presence, or I'd float off onto something completely irrelevant, but humorous, and I'd end up laughing. All of my diagnoses are relatively recent. I was a substance abuser from 15-45, so was misdiagnosed with clinical depression. It wasn't until age 43 that I was diagnosed with Bipolar Disorder, and not until age 47, which was after the year of EMDR, that the ADD was recognized. You know what's really sad? Ever since I can remember, I fully believed it was all my fault, that I was simply 'bad', unacceptable, flawed, defective. I didn't think of any of my behaviors as "P"roblems because that would imply that there were causes outside of my control, which we knew wasn't correct, and that I was making excuses for my behaviors, and that wasn't allowed. So the fact that nothing ever improved meant that I wasn't working hard enough because everyone knows if you work hard enough you can change anything, right? So I routinely failed, which translated in my mind to I am a failure. I think being adopted may have played into that, also. So, while I'm feeling some relief at finding out that some of this was beyond my control, I feel incredibly sad that so many years were wasted because of my belief systems. I acted out so much in grade school, including kindergarten, that they put a desk in the principal's office and put my name on it - it's where I was sent to do my work when I misbehaved in class.

Quote:
There is an entire approach to healing that uses sound to remediate processing problems hypothesized to originate in the womb when developmental milestones weren’t met due to disturbances in the environment communicated to the fetus.
Whew ..that would fit too. I'm the result of an incestuous rape, so I'm sure my 15yo mom wasn't just breezing along during her pregnancy like life was rosey.

Now I'm feeling lost again. I feel such an urgency and am so motivated to get through a lot of crap once and for all - even if there were residual stuff coming up from time to time (and there probably would be) if I could get to the heart of some of this my life would have to be better than it's been up until now. I had already decided to end therapy with my current therapist and had planned on seeing an attachment therapist if the evaluation indicates that it would be appropriate. I wasted so many years in therapy, not realizing, even after being told, how much of an impact substance abuse has. It was something I had to experience to fully appreciate. The thought of seeing a new therapist for another 2-3 years only to find out that one wasn't right for me either is close to intolerable. I don't doubt his qualifications, but I don't know if the therapies he uses would be the best help for me. HA! I don't know what therapies would be best for me. I'm not an expert, so just because something sounds like it would be appropriate doesn't mean it would be. Any thoughts?

troubledwaters
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  #6  
Unread August 23rd, 2006, 01:40 AM
Sandra Paulsen Sandra Paulsen is offline
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Default Re: question about success of EMDR

Oh boy, I wish I could make recommendations, but it would be irresponsible to do so. You've been very articulate and have provided alot of information, but I haven't formally assessed you and the decision will be an important one, so I simply must refrain.

And I don't know about the qualifications and expertise of either of the therapists you are considering -- and this isn't the place to do that either.

It is a terrible truth and very sad and frustrating that the innocent victims of childhood abuse end up having to work very hard and spending alot of time and money recovering from something that they didn't sign up for.

I often make general comments though.

There are many pathways to healing. EMDR is one, Somatic Experiencing/Somatic Transformation is another, Attachment therapy may be another, Ego State Therapy is another, DBT is another. The relationship with the therapist is also important.

In my experience and to the best of my knowledge, the first thing for anyone (speaking generally) who has trouble connecting up their dash board wires to their body is to find a way to get in touch with body sensations in a way they can tolerate. My two favorite methods are 1) ego state therapy, in which internal conversations are conducted with parts of self, which takes away alot of fear, increases insight and tolerance for self; and 2) somatic transformation, which very very gently helps the client track their personal experience, with the empathy of the clinician for strength, which allows connections to the body to happen in a gradual way with support. Once either of those has been used to establish a connection to the body that is acceptable and tolerable, EMDR can be used to metabolize trauma, including with the early processing protocol I discussed before.

I have been speaking generally and without full knowledge of your case, so the above may or may not apply to you. If you print it off you can discuss it with your therapist or prospective therapists.

Good luck on your healing path!
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  #7  
Unread August 23rd, 2006, 02:24 AM
troubledwaters troubledwaters is offline
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Default Re: question about success of EMDR

Thank you once again, Sandra. You've been more helpful than you probably know. I feel like I'm looking at the forest for hints of pathways rather than standing in the middle of very tall trees, unable to see anything but what's right in front of me.

Quote:
I often make general comments though.
<grin> Yes, you do, and this forum is lucky to have you.

peace, troubledwaters
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  #8  
Unread August 23rd, 2006, 12:06 PM
Sandra Paulsen Sandra Paulsen is offline
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Default Re: question about success of EMDR

And you have helped more than you probably know. Because your description of your experience was so clear, many will see themselves in it. You are quite welcome.
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