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Unread April 14th, 2007, 09:58 AM
Lynne Johnson Lynne Johnson is offline
Join Date: Apr 2007
Posts: 4
Default Client falling asleep during EMDR

Hi, I'm new to the boards. Have completed levels I and II training and doing EMDR on a limited basis for several years. I've had two clients that fall asleep during EMDR EVERY TIME. They wake feeling better ( SUDS 1-2) but report no significant PTSD sx reduction following treatment. Feedback and suggestions please.
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Unread April 15th, 2007, 10:45 PM
Sandra Paulsen Sandra Paulsen is offline
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Join Date: Jul 2004
Location: Bainbridge Island WA
Posts: 207
Default Re: Client falling asleep during EMDR

There are a several reasons why someone might fall asleep during EMDR including:

1) Falling asleep is a general defense they use in life against experiencing emotion;
2) There is an ego state (part of the self) that has the job of falling asleep during or immediately after trauma, and that the EMDR then is pulling up that ego state as part of the chain of emotions associated with that memory. Said more concisely, falling asleep is part of the memory in this case, and it is held by a discrete part of self;
3) Someone might have cataplexy, which is a sleep disturbance that is biologically based, and which is evoked by strong emotion, or narcolepsy, a bio sleep disturbance where the person falls asleep at no particular time but at non-typical sleep times, or sometimes when there is insufficient stimulation,
4) someone is sleep deprived.

I'd rule out 4, and 3 if there is no evidence of this occurring during non-EMDR times, and if a sleep specialist has ruled out a sleep disturbance.

#1 would occur outside EMDR too so they would know about that history.

I have seen several cases like this in my EMDR travels -- in one case it was a general defense against engaging with material and more narrowly against engaging in material related to attachment and relationship, so it would occur in EMDR and outside EMDR if the content related to attachment and relationship; it was more likely to occur if the person was sleep deprived as well. This is an example of #1 above.

In two cases it was #2 -- it occurred with individuals who were quite dissociative and who had ego states that would apparently fall asleep after a molest, though they didn't really sleep it seemed, but appeared to sleep.

In order to determine if it is 1 or 2, if it happened in my office I would be sure to have done the DES (long before doing EMDR mind you) and been alert to evidence of dissociation. No matter what outcome to that, outside of EMDR I'd likely ask to speak directly to the part of the self in charge of falling asleep during EMDR and interview that part about its concerns. Whether there were an overt switch of states or just an internal awareness of answers reported to me by the front part of the self, I'd find out what its protective function was, and appreciate it.

I wouldn't keep doing EMDR without figuring this out. You haven't said if the person had any increase in symptoms. If the person is dissociative, their symptoms would likely worsen if you persist in doing EMDR with a defensive ego state with the brakes on (in the form of sleeping). If the person is not dissociative, but this is a defensive process, the symptoms wouldn't likely worsen -- it seems to me.

If it is #1 I'd be figuring out what's in the way of experiencing emotion and debugging that before doing more EMDR.

I'd like a post back here please when you detangle this mystery.
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