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Unread February 24th, 2006, 12:12 AM
Sandra Paulsen Sandra Paulsen is offline
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Join Date: Jul 2004
Location: Bainbridge Island WA
Posts: 207
Default Re: What can I do to Help?

Its hard to predict and we don't do specific case consultations here, but I'll make some general comments.

1) If the diagnosis of bipolar disorder is correct, then it's not at all easy to say what will come of the EMDR, because EMDR is not a treatment of choice for bipolar disorder. Rather, EMDR is the treatment of choice for trauma related conditions. EMDR may help the person adjust to the fact of having bipolar disorder, which is a traumatic experience to have, for many. I wouldn't expect it to affect a truly biological condition.

2) If the diagnosis of bipolar disorder is wrong, many things may be predicted. Why do I bother to say this, when I have no reason to believe the diagnosis is wrong? Because in my experience, a) bipolar disorder is the diagnosis du jour, since insurance will pay for it by law in some states, b) biological psychiatry will treat it with pharmacology, and c) some therapists overdiagnose the condition, so it is sometimes diagnosed where it shouldn't be. Having said that, I am NOT saying there is no bipolar disorder in your husband's case, and indeed, perhaps the diagnosis is correct here, I'm sure I don't know.

I do know that many many people with complex trauma histories get diagnosed with bipolar disorder when they should in addition or instead be diagnosed with a trauma related condition, such as PTSD, DDNOS or DID. This is not an all inclusive list. This diagnosis happens because people with trauma histories have labile moods, first one state, then another, and that resembles bipolar disorder, which is presumed to be a genetic condition for some. But trauma isn't typically genetic, except for the trauma of inheriting a genetic disease.

The reason this discussion is important is the following. When a person with an undiagnosed trauma-related condition is a) misdiagnosed with bipolar disorder and b) treated with EMDR, the EMDR can either produce a good result or remove needed defenses prematurely. Specifically, When EMDR is used on a dissociative client wrongly diagnosed with bipolar disorder, the EMDR will sometimes take down needed dissociative defenses when the preparatory work has not been done to keep the person contained, stabilized and safe.

Now please hear this clearly, I have NO idea if the diagnosis for your husband is correct or incorrect, and I am offering no comments on this case, about which I know, really, nothing.

What I will do here is clearly repeat my mantra that I have been echoing since 1992, far and wide, to each and every EMDR practitioner whom I can buttonhole. To those therapists, I say this. Keep your clients safe by:

1) At the time of your initial intake with a client, as part of the history and assesssment and diagnostic process, identify with the DES or other instrument, just how dissociative the person seems to be.

2) Never do EMDR on a person that one has not assessed with at least the DES or some other reliable and valid method how dissociative that person is.

3) If a client is dissociative, only do EMDR on that client if and when one is trained in the treatment of dissociative disorders.

4) Ensure that the person has plenty of alternative coping skills in case the dissociative defenses come down and

5) make sure the dissociative person has containment skills in the likely event that the EMDR is incomplete.

Although I know nothing about this case, I know this. If you print this off and if the therapist is trained and experienced in EMDR, and an ethical person, as I am confident most therapists are, they will consider these points carefully, and proceed with EMDR if and when appropriate.

I laid this out in detail not because I'm sure it applies to your husband, indeed, I haven't a clue. I laid it out because I haven't said it here in a long time, it needs to be said often, and your question opened the door to this pontification.

Respectfully submitted,

Sandra Paulsen PhD
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