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  #1  
Unread November 23rd, 2006, 09:55 PM
cookee99 cookee99 is offline
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Default New to EMDR

Recently, I have been researching into EMDR, as the topic kept cropping up quite frequently in my investigations about PTSD, and as I looked for ideas on how to handle particularly difficult flashbacks.

A little of my story as a background ....

I am currently seeing a therapist (for almost 3 years now) and have been working on difficult issues in my life that have arisen due to past childhood abuse. I have been diagnosed with PTSD, and am currently stuck on one of the most difficult flashbacks I believe I have ever had! What makes the situation worse for me, is that I am too frightened by this particular memory, and these long-held magical beliefs that I will be punished by the person responsible (who incidently, passed away years ago ), that I am unable to talk to my therapist about the memory ... nor can I admit it to myself or write about it!
It is such a scary and helpless feeling to be held hostage by this memory, and not have the courage to talk openly about it ... I able able to mention a few of the body symptoms that accompany this memory, and some of the more intrusive sensations that I experience, but as to putting these symptoms into a 'story', or making some sense out of it, even to myself ... I am completely stuck!

In the research I've done on EMDR, I was really encouraged by the sound of it. Please correct me if I'm wrong, but it seems that there is less emphasis on being able to talk about a particular memory, but you focus on one or two of the components of the memory, and then do the eye movement thing, then the brain kinda takes it from there ..... simply speaking, I know ... but is that mostly correct?
That while you are focusing on the parts of the memory that you are aware of, and while the therapist guides you through the eye movements (or sounds, or lightbox or whatever) ... that your brain will be processing this memory and reducing the impact it has on your day to day life .... yes ...?
And then if you do need to talk about that particular memory some more, to try to make some sense out of it, then it should be alot easier for the person to do, as after the EMDR process has been completed, there wont be the same level of intrusion or anxiety associated with that patrticular memory. Is that all correct?

One of my major concerns about having this flashback intruding on my life, is the significant physical pain that seems to come with it, which is incredibly disruptive to my day to day life. This is yet another reason why it is so difficult to discuss this memory with my current therapist, as I am afraid of triggering the memory and hence, this disabling pain.

My therapist and I are in the process of discussing whether it would be helpful to me, to see consult with someone who is trained in EMDR, and see whether their input could help me get to a stage where this memory is no longer having such an impact on my life. I have done alot of distress tolerance, grounding, and crisis management skill training with my current therapist (that's how we spent the first 2 and a half years of therapy), but I find that even with all of those skills, I still feel virtually powerless in the face of a flashback memory of this caliber ... and I really have managed some doozies before!

So - my questions about EMDR are these .... (if someone could answer generally, I'd really appreciate it) -

1. Could EMDR help a person who is experiencing a particularly intrusive and difficult flashback, that they are unable to talk about in too much detail ....?

2. Does an EMDR therapist expect you to discuss memory content during the EMDR process?

I dont mind seeing another therapist for EMDR, but if I'm going to be talking about anything really painful, I'd rather do that with my current t. Would a consultant EMDR therapist, expect a client to do all of the discussion stuff in those sessions with him/her, if the client had a regular t they were seeing?

3. During the EMDR process if a client is working on a particular flashback memory, is it usual for the client to re-experience that memory while the therapist is directing the client through the eye movement technique? ie - Will EMDR trigger a flashback?

The reason I ask this, is that I want to avoid, if it is at all possible, triggering these pains that I get when I have this particular flashback .... and I just dont think I'd be able to concentrate on the eye movement thing, if I am in the middle of a flashback - I just tend to crumple and curl up physically when these flashbacks hit.

That's all the questions for now.

I apologise if I'm asking questions that are a bit ignorant or basic ... I'm really new to all of this. When I read about EMDR, is sounded too good to be true! Hearing that alot of people dont even meet the criteria for PTSD after they've completed their EMDR treatement, sounds unbelieveable ... but very very attractive!!


Thanks for reading
I look forward to your response.
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  #2  
Unread November 23rd, 2006, 11:39 PM
Sandra Paulsen Sandra Paulsen is offline
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Default Re: New to EMDR

You asked, " it seems that there is less emphasis on being able to talk about a particular memory, but you focus on one or two of the components of the memory, and then do the eye movement thing, then the brain kinda takes it from there ..... simply speaking, I know ... but is that mostly correct?
That while you are focusing on the parts of the memory that you are aware of, and while the therapist guides you through the eye movements (or sounds, or lightbox or whatever) ... that your brain will be processing this memory and reducing the impact it has on your day to day life .... yes ...?
And then if you do need to talk about that particular memory some more, to try to make some sense out of it, then it should be alot easier for the person to do, as after the EMDR process has been completed, there wont be the same level of intrusion or anxiety associated with that patrticular memory. Is that all correct? "


Your questions are good and your understandings are largely correct. A clever EMDR therapist would be able to do the processing with little talking - though it makes it harder for the therapist to "drive" the process. The brain does it, it resolves the memory so it feels done and over, no more flashbacks. The making sense of it can be done with EMDR and/or talking - usually it is part of the EMDR.

I'm going back to pick up your other questions and I'll answer them separately.

Bear in mind that we don't do case consultations here, so my comments are in general and may or may not apply in your case.
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  #3  
Unread November 23rd, 2006, 11:57 PM
Sandra Paulsen Sandra Paulsen is offline
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Default Re: New to EMDR

1. Could EMDR help a person who is experiencing a particularly intrusive and difficult flashback, that they are unable to talk about in too much detail ....?
Yes. I would want to do a standard screening to see how dissociative a person (ANY person) is before doing EMDR. The procedure is different if someone is highly dissociative. If the person has PTSD and not a dissociative disorder the EMDR can go full speed ahead.
2. Does an EMDR therapist expect you to discuss memory content during the EMDR process?
Its helpful but not absolutely mandatory if the therapist is very skillful. The client MUST be willing to say whether the scene is "stuck" or changing, even a little. If its stuck the therapist does something else. If its changing, the EMDR is proceeding just fine. Most people want to talk. If someone doesn't want to talk it is often because they feel so much shame. Shame is what people get with a trauma, the way people who get punched get a bloody nose. During EMDR, its very common that people realize that it wasn't THEIR shame, but someone else's shame they have been carrying since the event(s) happened. So then the client may want to talk and chirp and sing with relief.

I dont mind seeing another therapist for EMDR, but if I'm going to be talking about anything really painful, I'd rather do that with my current t. Would a consultant EMDR therapist, expect a client to do all of the discussion stuff in those sessions with him/her, if the client had a regular t they were seeing?
Some EMDR practitioners will do just EMDR with someone under another therapist's care and some won't. It is important for the EMDR person to check for themselves to see how dissociative if at all the client is. Commonly, therapists say the client isn't dissociative but hasn't really checked and doesn't really know how to check. I'm not saying this applies in your case - I'm sure I don't know -- but in general this is an issue.

3. During the EMDR process if a client is working on a particular flashback memory, is it usual for the client to re-experience that memory while the therapist is directing the client through the eye movement technique? ie - Will EMDR trigger a flashback?
It is very usual, I'd say every time, while working on a memory with EMDR, the client re-experiences the memory. However, as long as the client doesn't have a dissociative disorder, the EMDR just goes through nicely. It isn't typically experienced as a flashback, because the EMDR seems to make the intensity manageable. If the client has a dissociative disorder, the therapist needs to know how to fractionate or do a piece of the work in order to keep it from being overwhelming. Finally, in EMDR with a non-dissociative client, the client is kept in present time while visiting the memory. That's easily done and its not a big deal. With a highly dissociative client, the flashback can be consuming, and it can be hard to orient the client to present time. That is precisely why the screening for dissociative disorder MUST be done properly, so the client doesn't get lost in a flashback and overwhelmed with the intensity.

Any time a person has very serious and absorbing flashbacks I'd say the workup should be done to determine what's going on, how dissociative (if at all) the person is. Very kindly therapists often don't know how to do this, but it simply must be done for client safety, and to assure the proper approach is taken for treatment, with or without EMDR.

If someone IS dissociative, EMDR will often change their life, when done properly and with the correct procedure.
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  #4  
Unread November 24th, 2006, 11:42 PM
Sandra Paulsen Sandra Paulsen is offline
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Default Re: New to EMDR

I just reread this and the last bit reads a bit comically. I don't mean that kindly therapists don't screen for dissociative disorders, I mean that even the kindest therapist can overlook this step if they don't know how to do it or don't believe it is necessary. It is necessary.
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  #5  
Unread November 25th, 2006, 12:27 AM
cookee99 cookee99 is offline
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Default Re: New to EMDR

Thank you for your response/s ...I didnt read anything unusual in the last part of your reply. I know my current therapist mentions 'dissociation' with me ALOT, but we havent done anything 'formal', like a questionairre, or a structured interview to assess this factor.

Your answers to my questions have reassured me that EMDR is something that I would really like to try, if I can find a therapist who is properly trained in the procedure (or if my current therapist can locate a collague of hers for me), and someone who knows what to do if the client is dissociative, just in case I am.

Would any EMDR therapist know to screen for dissociation?
Or is this something to expect only from therapists who have got alot of experience, or done more training?

I spent yestersday's therapy session trying to discuss this particular memory that is disturbing me lately, but the anxiety I experience when trying to put these images and sensations into words, is just so overwhelming that I end up not being able to talk at all! The last few sessions I have left feeling so frustrated and disappointed with myself because I havent been able to get this stuff out of my head! And this memory just doesnt seem to be going away for me this time ... and it's taking such a huge toll on my emotional and physical resources in trying to keep the flashbacks at bay so I can function properly.

I believe I am (or at least, I have been in the past) what people call 'dissociative'. I have had these episodes where I 'blackout' (my name for it), where I mentally 'leave' a situation that is too overwhelming ... and later on, I will usually have no conscious recall of what I did, said or what occurred for the next few minutes, or sometimes a couple of hours. I dont choose to blackout anymore though ... although rarely it still will happen in extreme situations. I spent the first couple of years of therapy with my current t, learning how to control these blackouts, and resist the urge to mentally run away from difficult situations. I now have more confidence in my abilities and skills in staying present and cope what what's happening.

I am also a person who 'gets lost' in a flashback - would this make EMDR a problem? (well .... generally speaking, for a person is gets lost in flashbacks, would EMDR be a problem?)

Just within this last year, my current therapist and I have been working on several flashback memories, and I have been trying to develop the skill of keeping one foot in the 'hear and now', while still having access to the content of the flashback. I do find this very difficult though, and sometimes I get 'sucked in' by what I'm remembering ... but with my therapist's help, I try to pull back from the memory when its getting too intense, so I dont totally lose control of what's going on in my head. But I'm not very good at it yet ... this is all pretty new to me and I find it difficult to remember painful and traumatic events, without it totally engulfing me.

I know you cant answer for me specifically, but for a person like me ... ie - someone who is still learning to talk about flashbacks without getting overwhelmed by them ... and who can sometimes do it quite well, but at other times gets lost in the flashback - would EMDR be tricky for a person in this sort of situation?

I see that you've mentioned in your reply here that EMDR uses a different strategy for people who dissociate, but that doesnt mean that it wont work, does it? I would just need to make sure the EMDR therapist is trained to work with people who dissociate at extremely stressful moments ...yes?

Quote:
If someone IS dissociative, EMDR will often change their life, when done properly and with the correct procedure.
I DO like hearing that!

A 'changed life' would be awesome!!
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  #6  
Unread November 25th, 2006, 01:07 PM
Sandra Paulsen Sandra Paulsen is offline
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Default Re: New to EMDR

People who are quite dissociative have a particular issue or two that must be addressed during EMDR, and they must have achieved quite a bit of stabilization and containment before doing EMDR, so their therapy may go for a couple of years before doing EMDR.

Any EMDR practitioner trained by the EMDR Institute is supposedly trained to screen for a dissociative disorder using the DES, but I can tell you after consulting and facilitating for 15 years, most people don't do it. They don't do it because they think they don't need to. They think that they don't have any highly dissociative people in their practice, but they are wrong. They think if a highly dissociative person was in their practice, they could tell by looking and that is wrong. They think that a highly dissociative person would be evidently so by overt switching between personalities, but that's not the case except very rarely. They are just plain wrong.

So they fail to screen. They use the standard protocol on an undiagnosed highly dissociative person and the EMDR, being an associative procedure, pops through the dissociation. If the client doesn't have other means of coping, then they just lost the only tool in the toolbox. This is a harmful thing for some people, which can precipitate a crisis internally.

Now for a highly dissociative person that has other tools in the toolbox, the EMDR could go ok. So some people luck out.

Here's the other thing that clinicians sometimes miss. It is not good to do EMDR on a highly dissociative person without having worked with the dissociation first. I don't mean just by grounding and stabilization techniques, which are great but insufficient. I mean working with parts of self, getting them on board. When one does EMDR without having a sufficiency of the self on board by means of having gotten consent from the parts, the EMDR will just abort, loop, shut down. It can be quite uncomfortable.

So here's the unspoken piece -- if EMDR is done on a highly dissociative - and here I mean DID -- client, without the groundwork being done by working with parts of self, protective parts of self will get quite concerned and close thing down. If the parts of self are on board, that's different. The parts need to have a chance to be educated and to talk about their concerns, and to have a game plan for fractionating the work, that is, doing a manageable piece with the cooperation of the parts of self.

Protective parts of self are right on when they worry about doing EMDR with someone who doesn't work with parts if the client is highly dissociative. It is right to be concerned, so protective parts often are the very ones to ask the questions on the phone, lest a compliant part of self just say oh well.

Now we aren't doing a case consultation here and I don't know if any of this applies to you. In general, it is true that one of the biggest red flags for dissociative disorder is losing time, not remembering what one has done, and that amnesia isn't explainable by drugs, alcohol or a medical condition.

In sum, and to make it brief, EMDR for a dissociative person should be done not just by a trained EMDR practitioner, but by an EMDR practitioner who knows how to screen for it, who does that customarily, and who is trained in treating dissociative disorders, according to the treatment guidelines of the ISSD. Any reader who needs more info about those treatment guidelines, go to www.issd.org. Their name just changed two weeks ago, but I think their website it the same for a while. They have names of members by state and town. So does EMDRIA and the EMDR Institute. One can actually look for names that are on both, but that's a short list -- maybe non-existent.

I hope this post is helpful to the poster and to many readers whether they are an EMDR therapist or a prospective client.
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  #7  
Unread November 25th, 2006, 05:04 PM
cookee99 cookee99 is offline
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Default Re: New to EMDR

Well ... I know your replies have been very helpful for me !

Sandra!

I think one thing that has been highlighted to me from the replies here, is that if I do decide to try to find a therapist who does EMDR, I will most certainly ask them if they screen clients for dissociation first ... and then ask what (if anything) they do differently with dissociative clients in EMDR.

I am quite sure that I dont have DID, and so is my therapist .... (I asked!).
But I do believe I could be way up there at the meaty end of any dissociation scale!

Thank you again Sandra for your comprehensive and prompt replies
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