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  #1  
Unread November 29th, 2004, 11:04 PM
Anne-Marie Smith Anne-Marie Smith is offline
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Unhappy Ending EMDR before completion

How dangerous is it to the client to end EMDR in the middle of "treatment"? Say the client is an adult survivor of child abuse. Maybe things were going well and then took a turn for the worse - dissociating, flashbacks, body sensations, perhaps thoughts of self harm, not suicide, maybe even the inclination that there may be a co-consciousness present in a protective mode?
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  #2  
Unread November 30th, 2004, 12:44 AM
Sandra Paulsen Sandra Paulsen is offline
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Default Re: Ending EMDR before completion

Well, you might mean one of two things, 1) an incomplete session or 2) an incomplete course of treatment. I'm going to assume you mean an incomplete session.

I don't have enough information to make a case consultation valuable, but I'll say some general things that may or may not apply in your case. I mean that, the following may not apply in your case. I'm only putting out some general thoughts that explain the kinds of pickles some EMDR cinicians and their clients find themselves in.

EMDR practitioners must always screen for a dissociative disorder before doing EMDR to avoid premature lancing of dissociative barriers, or flooding. If a client is dissociative (and I'm not saying you are, because I don't know), a period of stabilization and containment is necessary to secure the safety and comfort of the system.

If and when EMDR is conducted on a dissociative client without appropriate protocol including stabilization and containment, the client may feel alot of pain (flooding) and be destabilized. The usual safety precautions must be taken, including hospitalization if the client is suicidal and can not ensure safety.

It is as if there were parts of the client sleeping, and their hammock was flipped upside down by the EMDR. Parts are startled and upset. The defensive amnesia barriers that have been protecting the rest of the self may not be available.

Sometimes the pain can be put in a container, like Tupperware, putting it in Tupperware, and putting the lid on the Tupperware, and putting the tupperware in a vault...and sending the vault down an elevator, can sometimes contain the pain.

The parts of the self can also do what they have always done, protect by building walls, brick by brick, brick by brick, to protect the self from the flooding.

Then the parts that got awakened by the EMDR need to be appreciated for their difficult jobs, promised that in due time they will have their story told and be helped (and that promise must be kept), and then tucked in, not forevr, but just so she can function and be safe.

After a period of upset, things will settle down and there is likely good that will come of the experience. However, EMDR should NOT be resumed until containment and stabilization are accomplished. The self system needs to be on board.

Now I repeat, the preceeding may be WAY off point and not apply. However, the above will address lots of the problems that occur with EMDR.

Any client upset by EMDR should talk to their therapist, and maybe show this post as well.
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  #3  
Unread November 30th, 2004, 09:36 PM
Anne-Marie Smith Anne-Marie Smith is offline
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Default Re: Ending EMDR before completion

Thank you Sandra, I did mean an incomplete course of treatment but your insight on an incomplete session was also valuable.

Dissociation is a correct diagnosis. Sometimes are better than others depending upon the preceding EMDR session. Flooding has been experienced although I didn't know what it was until after it happened.

We do have techniques to turn down the volume inbetween sessions, but I have not heard of containment and stabalization, neither of the examples seem familiar and I do not want to do any research on EMDR because the whole thing is confusing enough. I have not told my wonderful(and I mean it sincerely) psychologist about the protector who is beginning to surface - I will, promise.

However, I am wondering, if I don't know how to contain, how will I "get out" if and when I go into the dark pit?

I do not expect you or anyone else to give theraputic advice but if I have no guidelines, how will I know if my mind will stay safe? Has anyone ever been lost in those dark spaces and not come out? It sure feels like being sucked in sometimes, like being absorbed until there is nothin left of you.
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  #4  
Unread December 1st, 2004, 01:25 AM
Sandra Paulsen Sandra Paulsen is offline
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Default Re: Ending EMDR before completion

Again, the following may not apply to you but are some general comments. A client, dissociative or not, has every right to stop EMDR (or treatment) if they are getting worse instead of better. Protective parts of self are there for a reason, and sometimes they need to be listened to.

EMDR for a dissociative person is a complicated thing --- the therapist must know both EMDR and how to treat dissociative disorders. There are many good therapists who don't know how to treat dissociative disorders, and who skip stabilization and containment phases because they don't understand it is necessary.

Even when a dissociative person is doing EMDR after appropriate stabilization and containment, the work can certainly be overdone. If the client feels s/he can't speak up for some reason, the therapeutic twosome are at risk for reenacting old traumatic stuff out of awareness. (The therapist uses the power, and the client complies but gets hurt).

EMDR can be overdone and flooding can occur. Dissociative barriers can come down prematurely.

I always ask my clients if they are feeling raw from the work - whether they are dissociative or not. I don't do EMDR on dissociative clients for quite a while usually. Anybody feeling raw SHOULDN'T do EMDR for a while, and needs to consolidate efforts and gains OR take steps to put back in place any walls that came down before they should have.

Its the therapist's responsibility to know what they are doing and the client's responsibility to speak up and say, "I want to stop EMDR" if they are getting worse or feeling overwhelmed. One doesn't have to comply to authority.

Now, let me say that the dark places inside won't ever swallow one up so there is no return. The dark places are the things that have been disowned or dissociated because it was too painful. Strengthening ones resources and mobilizing an internal team of protectors, helpers, resources will help prepare for future EMDR work. One just needs more strength or positive resources than there is pain and darkness. That's what the containment/stabilization piece is all about.

I don't know if this applies, but if you show this to your therapist, if he's as good a guy as you say, he'll get consultation if he needs it. We all need it sometimes.

Sandra Paulsen PhD
Bainbridge Island WA
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  #5  
Unread December 2nd, 2004, 07:09 AM
Anne-Marie Smith Anne-Marie Smith is offline
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Smile Re: Ending EMDR before completion

Thank You Dr. Sandra! You have been most helpful with your insight. Sometimes another persons educated view can get us back on track. "Regular" people have no idea how difficult and consuming this can be. EMDR gives me hope. God bless Dr. Shapiro and those angels who continue to develope techniques to assist others!
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  #6  
Unread December 9th, 2004, 02:04 AM
Piper William Piper William is offline
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Default Re: Ending EMDR before completion

Dr.Sandra Paulsen:

Okay this thread explains why my doctor has refused my recent desperate pleas to "do the real work" and fix this mess I'm in. I had a period where I was doing very well. Now I'm dissociating a lot again and experiencing the worst pain. And my head is spinning. I'm glad at least to find out that he was just trying to keep me safe, but what do I do now?

And now, therapy is over for a while. Money issues. Please tell me what I can do to help myself in the meantime until I can get back into therapy. I'm kind of scared to be going it alone. But it can be done, can't it?

I have Klonopin. I'm feeling hesitant to do the knee tapping on my own. Safe place isn't working anyway, conflict inside. I'm also worried like the other poster that the dark places will envelope me. I keep telling myself what you wrote to her, hoping it will sink in. Can I ride this out on my own somehow? What exactly does "stabilization" entail and do you absolutely need a therapist for that?

I know you cannot give out *personal case specific* advice, but any general comments would be most appreciated.

Thank you!
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  #7  
Unread December 9th, 2004, 08:06 PM
Sandra Paulsen Sandra Paulsen is offline
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Default Re: Ending EMDR before completion

There are ways to get inexpensive supportive therapy in many cities, or ways to make arrangements with ones therapist for adjusted frequency if the rate isn't adjustable, and it sometimes is adjustable if one asks about it.

I don't recommend people try to do EMDR for themselves, anymore than I'd recommend you drill your own teeth or remove your own brain tumor. The brain tumor is a better example, because you'd need the very organ you're working on to do the work and its hard to achieve. So leave the EMDR behind for now.

Stabilization is an ancient thing that goes by many names: relaxation, meditation, mindfulness are all pieces of it. Anything that helps one get grounded --- I have people concentrate on their five senses in the present time - smelling tea bags, feeling the ground beneath you, look at the shadows, feel the rain. These are all PIECES of stabilization.

Stabilization really happens when the parts of the self start pulling in the same direction, and some folks can just arrange that internally and some folks need help with it. Sometimes one can make a promise internally that one will, for example, save up for therapy for a specific period of time and then promise to follow through, if the self can help contain what needs to be contained.

No need to pick at scabs tho, memory work for dissociative folks is best done with help.

Those are my generall comments, and regrettably they aren't tailored to any given individual's situation, but best wishes to you on your personal pathway.
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  #8  
Unread July 29th, 2005, 09:43 PM
Margaret Lockwood Margaret Lockwood is offline
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Default Re: Ending EMDR before completion

This is regarding a client of mine; I am trained but am new to counselling using EMDR and I felt my concern was similar to this topic and so I thought I'd continue on this thread.
My client was and is not dissociative in the usual psychological sense. However, after one session of EMDR, she reported not just 3 hours of crying the next day, but also a fever lasting 4 days and a throat or tonsil infection which she said she was prone to when younger, but not the las 15 years or more. She wondered if these physical symptoms where the result of the session. During the actual EMDR, she reported several physical sensations, gave very little verbal commentary even though she is verbal and is a person who can readily identify feelings. When she phoned me several days after this difficult session and when the symptoms were still present but abating, I reminded her of her "safe place". For our second session. I began with returning to the safe place but she reported feeling shame around having a sanctuary and so I abandoned thoughts of returning to the EMDR; I loaned her an CD that has relaxation visualizations on it. I am not sure, but I am indeed wondering if my client was dissociating to her body, even as she was very present. I should note perhaps, that this client reports no physical abuse/violence to her self. I'm thinking, if she stabilizes, if we should go back to that initial pesenting issue and memory and try and get it completed (we were incomplete at a 2) but to perhaps not continue with EMDR after that on other issues? Any comments would be appreciated.
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  #9  
Unread July 29th, 2005, 11:20 PM
Sandra Paulsen Sandra Paulsen is offline
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Default Re: Ending EMDR before completion

Very interesting case. There is such a thing as somatic dissociation, certainly, and a person doesn't have to be DID to have it. If a person had chronic childhood illness with body pain, that could be dissociated in childhood and then associated in EMDR. An incomplete EMDR can continue for days.

On the other hand, maybe she had a coincidental sore throat.

In EMDR we always check to see at the next session how the work measures on SUD and VOC. If its resolving well, the EMDR is working. I wouldn't think, if the sore throat was somatic dissociation that kept percolating slowly after the EMDR, that the intensity of response would continue at that level.

When any client has a bad patch, its wise to regroup, restabilize, synthesize gains and so forth before proceeding to EMDR. I wouldn't let an intense session deter me if the client is actually functioning better and healing as a result of the difficult patch. If a client is getting worse I'd definitely back off EMDR until such time as the client is resourced and regulated affectively. My hunch is the client will be able to relate to the childhood memory of the physical illness differently now, and that the intensity won't repeat itself.

That's just a hunch, I don't have sufficient data though. So do please post back and let us know the outcome. Thanks.
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  #10  
Unread August 15th, 2005, 11:28 PM
Margaret Lockwood Margaret Lockwood is offline
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Thumbs up Re: Ending EMDR before completion

Sandra,
Your hunch was right. Your ready comments were greatly appreciated.
We continued on with EMDR on the same issue/memory etc., even though the client was feelling badly enough to be still off work - almost 10 days. Another intense session followed. The good news is that my client reported by phone (two days afterwards) feeling much much better both physically and emotionally. The session was however, still incomplete: the SUDS became a 1 but the VOC did not move!! I looked for a blocking belief and I guess we need to work more with that. To be continued.
Margaret Lockwood .
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