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Unread January 25th, 2007, 12:31 PM
Sandra Paulsen Sandra Paulsen is offline
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Join Date: Jul 2004
Location: Bainbridge Island WA
Posts: 207
Default Re: How to skillfully work with "overeager" clients?

I just reread your original post, because I thought perhaps I should add something about how there are a few people who CAN begin EMDR early on, like second session or second half of a long initial session.

But I see you said those people were fairly unstable people, so by all means you are right to make sure everything is in place.

Let me describe a scenario where it may go fast: On the initial phone contact the client says she has had a history of therapy that was highly successful, and she has previously had EMDR and it was helpful. She is seeking to work on a specific thing, and she obviously knows how it all works. In your initial interview (when you DO get a history because we can't delegate our own assessment/diagnostic process to the client) you not only see she's right but it is clear she has tons of resources. She has a range of coping strategies she successfully uses commonly. She takes the DES in the waiting room (NOT taking it home, since it wasn't normed for that) and the score is low, which is consistent with your clinical findings.

Next appointment you can do EMDR.

Now another client isn't so clear, there's more symptoms and diagnostically there is more going on. There's no evidence of a dissociative disorder on DES or clinically. She responds well to safe place. That client may not need RDI. Francine Shapiro has recently reminded us that not everyone needs Resource Development before EMDR.

Another client has a 24 on the DES (not DID) but you can see she is quite labile and overwhelmed. She'd benefit from RDI or other ego strengthening methods before EMDR.

Another client is not overwhelmed but seems rather flat. Low DES but you sense she's overcontrolled. As you proceed cautiously you see she is affect avoidant, doesn't think its okay to have needs and feelings, so the brakes are on. In no way should that person's EMDR begin yet.

So as usual, EMDR is not a cookie cutter, we have to use clinical judgment. But client urgency should not move us if we see signs that cautious forward movement is the responsible thing to do.
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