The EMDR Podcast

The full text of this episode is available on the EMDR Podcast here: https://emdrpodcast.com/2023/12/13/lettingthingsgo/ The script for the videotape approach mentioned in the podcast is here: https://emdrthirdweekend.com/posts/videotape-approach-script-with-complex-trauma-phases-three-and-four

A child's toy metaphor for the need to adjust your interventions to the nervous system you are working with.

When a SUDS of One, Two, or Three May Not be Ecological You are technically correct, quoting Dr. Shapiro in EMDR Therapy when you say that a SUDs of one can be ecological if it “sounds right.” Shapiro's example of an Uncle who died. Shapiro worked with really healthy people and what’s in a one with her clients may be different than what’s in a one or a two with clients with really complex trauma. With really healthy people, you can go to installation if the SUDs is a one if it “sounds right” and the debris will likely get cleared up in Phases Five and Six. You may be tempted to say that because I’m working with a complex client, a two is pretty good. Especially if we are starting at an eight to ten SUDs. And it is. Yes, we don’t want to make the perfect the enemy of the good. However, a lot can be hiding in that one or two with a client with complex trauma. If I had $5 every time the client said that the SUDs was a one, two, or three and it wasn’t going to go lower and it immediately went lower once they noticed it, I’d be able to go on a nice vacation. Out of the country. It’s simply good practice to identify what makes it that one, two, or three and ask the client to notice it a few rounds. And you know what happens, 97%+ of the time? It goes lower within a few sets of the client saying that it isn’t going to go lower. And yes, there are ways to do this respectfully what the client says to you, but also lets them fully and adaptively resolve that memory. Really good things happen when clients fully and adaptive resolve memories. Generalization occurs. Installation isn’t junky. Body scan isn’t leaving debris. A one or a two may also be an ember that may ignite other things between sessions. Don’t want to run the marathon and then sit in the lawn chair within sight of the finish line. If we can, finish it. Get your time. Get that race in the books. Whatever it is that makes it a one, two, or three, or whatever it is that makes the Validity of Cognition a five or six, notice that and it is highly to movie in a positive direction… unless it’s about something in the future or about other things from the past. That’s not your target. We’re in the business of resolving memories, not whole themes all at once and we don’t work in the past and the future at the same time. We have the future prong and future template for that. What is it that makes it a two? Notice that. If it doesn’t go lower, that’s okay. But it’s also okay to notice whatever that two is a few rounds before you assume that it’s good enough for this client on this day.

You May Do the Least Reprocessing with the Clients Who Need it the Most

Full text of this episode is at: https://emdrpodcast.com/2023/11/29/parts-work-is-central-to-emdr-therapy/

• The Impulse to Want to Avoid Causing Harm • Working with Trauma is Like Working with Lava • Confessions about Difficult Sessions • Most Basic Training Programs Can’t Train You to Work Effectively with Severely Complex Trauma in EMDR, You Will Need to Learn the Nuances of this On Your Own, But There is an Enormous Amount of Help Out There • Normalizing Mistakes and Missteps • The Real Risks of Not Doing Trauma Work with Clients • We are the Only Professionals on the Planet that Can Do This… Whose Job it is to Do This • It’s Like Everything Else… You Learn to Do This by Doing This • The Really Good News About EMDR Therapy: It Breaks in a Very Limited Number of Places • When Clients Struggle, There is Information in that Struggle • You can Dip Your Toe into Every Phase of EMDR Therapy • You will Develop More Trust in the Process • You will Get Better at Intuiting when the Client is Stuck and Strategically and Effectively Intervening • Not Everyone is Prepared to Do EMDR Therapy Right Now: We Can Help them Prepare

There is so much to say here. Broad overview. Each point could easily be a chapter. Very little of this is mine, the metaphors are mine, but this is a collection ways of seeing that are helpful for me in understanding where clients get stuck in reprocessing, why, and what might be helpful in getting them unstuck, and what we subsequently do with that information. When clients encounter difficulties in any phase of EMDR Therapy, that isn’t failure and it isn’t evidence that you have done something wrong. It’s important information about the client’s nervous system and means of survival. That information needs to come so that we can use the lessons in it in the service of the client’s recovery. We train you to stay out of the way, but if a client is stuck, your obligation is to try to help them get unstuck. EMDR Therapy with a client with complex trauma is a complicated task. We’ll explore some of the reasons why and how you might intervene when someone is struggling. How do you know when someone is stuck when they have really complex trauma? Sometimes it is ambiguous. Because they are often connecting something big with a small amount of adaptive information, the metabolization can be slow. Questions to ask. Clients can be stuck in high anxiety near panic that won’t shift, clients can be stuck in a shutdown response (100 amp breaker), they can be stuck in the big existential loneliness of childhood (particularly if working on an attachment wound), they can be stuck trying to figure something out that is existential, or they can be stuck noticing on channels that just aren’t productive right now (thoughts, memory, etc), where things aren’t moving and shifting and changing. Defining looping. When someone is stuck, they are probably stuck in a perspective. Office shortcut metaphor. Interweaves help clients change their perspective. Ideally, when we intervene, our interventions should match where the client is stuck. We shouldn’t just randomly throw something out. Car metaphor. They are not sure what their role in this dance is. Blocking beliefs. Hopefully, you will pick up on these in your Phase Two. Phase Two is the canary in the coal mine for blocking beliefs. What is a blocking belief and why is it a problem? Too big of a target too soon. The target memory is an attachment wound. Why attachment wounds are about everything. What might you do. Long resonance after sessions is common when not working with attachment resources. If the core of EMDR Therapy is activate a piece of difficult stuck information, notice what comes, while the brain gets a left-right stimulation, let’s evaluate potential stuck places. Activate: Are they activating in ways that are tolerable? Is the activation from the memory or from an agenda? Are they allowing too much memory content to connect too soon. We need memory content to come, but we need it to come at digestible rates. Notice. Noticing is the bright yellow line in the center of the EMDR road. Is the client noticing? Does the client know how to notice? We may need to be very clear about what noticing means. The difference between being aware and noticing clearly. Left-Right Stimulation. Always a possibility that switching bilateral may be helpful. Stuck in guilt, shame, blame, or responsibility. Appropriate and not developmentally appropriate types. Assessing for adaptive information, clues in Phase Three. How is your relationship with your client? The relationship is a key component in what is effective in EMDR Therapy. How is your client’s parts relationship with you and your parts? Did you ask consent to work on this memory, attempt to address concerns, and listen to a concerned part when that part has an agenda different than yours? If you didn’t, their parts are likely already aware of this quality in you. Working with a system always easier than pretending that you are not working with a system.

Many new EMDR therapists misunderstand where the magic is in EMDR Therapy. Trainings and training practicum experiences often send the impression that simply following the script is likely to result in memory resolution with the vast majority of clients. EMDR can be seen as a kind of magic wand that allows us to go up to almost any person and “dink” their memory. Some trainees may be left with the impression that most of the magic in EMDR Therapy is in the bilateral alone. While this is a key part, I describe it elsewhere as one of the three wheels of the EMDR tricycle. It takes all three wheels. Otherwise drummers would be the healthiest people on the planet. And, they are not. EMDR Therapy is a combination of activation, noticing, and left-right stimulation, but what is happening in EMDR is perfectly described in the Adaptive Information Processing model. This combination of elements helps connect old stuck information into right-now existing adaptive information… if you have enough of it. And Shapiro is very clear that if you do not have enough of the needed adaptive information for the target that you are connected to, there is nothing in the Eight-Phase Protocol that is going to generate the missing information. I have used the metaphor of a boat fishing in an ocean. The boat is the needed adaptive information and the fish you are hooked onto is the memory. You can’t land a bigger fish than your boat. You don’t simply get a bigger boat because you are hooked to a big fish. You have the boat you launched with today. Again, the magic of EMDR Therapy is that you can metabolize almost any old stuck information into existing adaptive information and we do this by using the Eight-Phase Protocol. Inside that understanding contains the logic and the worldview to account for when this therapy doesn’t work. Many of the episodes in this podcast focus on this core understanding of the Adaptive Information Processing model. It explains almost everything beautiful in working with clients who have adaptive information the size of a cruise ship and almost everything challenging in working with clients whose adaptive information is the size of a leaky intertube. This understanding explains why parts work is an important element in what we do as trauma therapists. It explains why we need to support adaptive information about what it means to have been born human. And, why our resources need to involve more than a few core mindfulness skills when working with clients with pervasively traumatized nervous systems. This understanding is the foundation, I think, to doing EMDR Therapy really well with clients with complex trauma—who have been saturated with the tasks of surviving, rather than bumping against the world and learning who they are, what they’re worth, and how they deserve to be treated.

A shocking amount of talk online about EMDR and grief goes against everything we know about both. This episode highlights effective ways to use EMDR with grief-saturated targets.

In EMDR Therapy, the pathway for healing is that stuck information has to connect to right now adaptive information. The process that facilitates that linkage is the Eight Phase Protocol. The Boat and the Whale Metaphor The boat is the amount of the needed adaptive information that is have accessible right now. The fish that you want to hook and land is the trauma. You cannot land a fish bigger than your boat. However, you can get a bigger boat by catching smaller fish. You can also build a bigger boat through developing relationships—including the therapeutic relationship, through parts work, through resourcing, by expanding the window of tolerance, through psychoeducation [particularly psychoeducation about what it means to be born human], and through a wide assortment of other means. Implications of this metaphor: The Mount Everest Metaphor Shapiro says that if we tackle the mountains of memory first, everything after that will feel like a small hill. And, she is right if you have adaptive information the size of mountains. Again, clients with complex trauma have very little adaptive information. You cannot metabolize a trauma the size of Mount Everest into adaptive information the size of a walnut. You simply can’t do it. Also, if you’re not an Olympian, Mount Everest is a terrible place to start. The are over 200 dead bodies on Mount Everest right now because it’s too dangerous to remove them. And, if you need to tackle Mount Everest, you had better tackle some smaller hills then some smaller mountains first. To be fair, Shapiro acknowledges that with complex trauma we do want to work with smaller and more recent memories first, but many people graduating from EMDR foundational trainings misunderstand the nature of the magic that is EMDR.

What Do Container Resources Do? Long story short, containers help you expedite the process of returning difficult content to the limbic brain. Library metaphor. Containers very often are a cognitive strategy or intention not to engage with something right now. A container can also be a somatic strategy, because if we only address the cognitive aspects of rumination we may be leaving a lot of distress in the body, which can reactivate the mind. Containers are also a helpful ritual in pivoting away from activation. It’s a ritual that signifies something to parts. However, the reasons why we need to container matter. Many, many, problems with containment come from the assumptions that clients make about what containment means… what it means to current functioning, what it means for their past, and what it means for their recovery. For example, many clients say “wait a minute, Tom… I have locked this stuff up all of my life… I come to see you to get it all out… and you’re telling me to do something I’m coming to you stop doing.” Again, we need to explain that the reasons why we container are very important. All of these are good/healthy/adaptive reasons for containing something that has been activated: Ultimately, we want to emphasize that it’s okay to container because we have a plan to resolve this issue in an effective way at a later date (a transformational psychotherapy) Ways that are not a good idea to use in containment, since parts may react to the implications of these approaches (although clearly these are preferred methods by some parts): Containment is one of the best adaptations of human evolution. The limbic brain is a container. I tell my clients that the reason we’re not all in the psychiatric hospital all of the time is because of the containering qualities of the limbic brain. We are information processing systems and when we encounter information that we cannot assimilate because we were too shut down, too overwhelmed, or lacked the needed adaptive information at the time, it is helpful to have a place to put it until we can try again to assimilate it. Clients often come to us with a lot of ambivalence about carrying a lot of containered experiences. On one hand, they have been consciously and unconsciously trying to process (or at least manage) this information using incredibly ineffective strategies likely all of their lives. One the other, they have visceral experiences (all of them bad) from trying to purposefully interact with containered information. Containering isn’t a neutral activity. Asking a client to simply let go of information that is both existentially salient and intractable is not a neutral ask. Everything we container, past interactions with container, past strategies to try to process trauma, and the fact that we are carrying stuff that needs containment are all implicated in what makes purposeful containment difficult for many clients with complex trauma.

Client and therapist agendas are frequent blocks in EMDR Therapy reprocessing.

Effective time management strategies in EMDR Therapy.

Using age, space, and topography to find an individual representative memory related to a presenting issue, theme, current trigger or emotional state. • Identify a negative cognition. • What age do we need to work related to that theme and negative cognition? • Home, school, or community? • Where (what room) in that space do we need to work? • Where in that room or space (what chair at the table) do we need to work? • Put yourself in that space at that age and related to that theme and negative cognition, what is the first memory that comes? • Target that in EMDR Therapy.

Strategies for managing flashbacks in session and between sessions.

Understanding the Difference Between A Complexly Traumatized Nervous System and a Non-Pervasively Traumatized Nervous System Via the AIP Lens In the AIP model, the difficult stuff has to connect with right-now existing adaptive information. One of the key things that we appreciate about complex trauma is the large size of the trauma and the typically small amount of adaptive information that the difficult stuff must connect with and metabolize into. Again, back to the boat metaphor. If client’s have adaptive information the size of a canoe, we really need to be careful about what they hook. You can’t land a fish bigger than your boat. Clients that are really healthy, but who have had some trauma have adaptive information the size of a cruise ship (the privilege in The Field and the Municipal Dump Metaphor There is another metaphor that I like here related to following memory content or maybe taking a restricted approach to memory content. Imagine a space about the size of large sports stadium. The field of this sports stadium is the entire lifespan of the client up until this point. Almost all of it is clear and open. But even as we survey the field, there are some piles of things. If this is the client’s system that we are working with, we want the client to just walk around the field and pick up things, sort them a little, and put them in a knapsack. We don’t want to micromanage that. The client can walk around, form connections, knapsack the needed things, and everything in that knapsack can be resolved. If we over intervene, we are interfering with the client’s work. Imagine another stadium and this is the stadium of the complexly traumatized. Except instead of piles of things, it has been used for 46 years as a municipal dump. In fact, old garbage bags, mattresses, food disposal, packaging, are piled so high that the whole inside of the stadium is filled to the highest seats at the very top of the stadium. Now, we’re going to drop the client into the 37th yard line and put them 25 feet down, with a knapsack. Do you see the problem? Everything connects to everything else there. There is the impuse to try to knapsack it all, but there isn’t the means. And this is one of the things that is really unfair about being on the receiving end of other people’s stuff for decades. The mistake we make is that we consistently underestimate how much there is and the client can only carry what the client can carry. What’s the Problem with Too Much Memory Content Coming In? They very quickly get outside of their window of tolerance. If you want to have a big window of tolerance, start with having a really good life. Absent that, it’s a lot work. Other podcast episodes cover how the ways that we help clients develop a bigger window of tolerance often ask the client to sit with things that go (or feel like they go) directly against their survival strategies. Deciding: First, Time Two, How are You Doing, Distress-Wise, With the Current Content Is the Memory Adjacent or Feeder? Conclusion Regardless, when you do initial reprocessing, you are going to have information even if that information is clarifying about the narrowness of the client’s window of tolerance. We can’t move it all at once. We can’t move everything that needs moved right here right now. Clients need to know this. One of the things that really sucks about being someone who is carrying all this stuff that was done to you is that we have to be both the jail to this stuff and the jailer. Memories don’t get paroled when a riot is happening. We have to work intentionally. And we start by starting. One piece, one purposeful and careful step, at a time.

Introduction to the next handful of episodes.

Many clients with complex trauma will come to us convinced that they have already failed mindfulness and that they are about to fail EMDR. Some of the approaches that I have seen to teaching mindfulness to clients assume a non-pervasively traumatized nervous system. Which is simply something we should not assume. Many approaches throw the client into the deep end of the present, the body, or noticing without much preparation or guidance almost as though they are running every client through the same mindfulness machine. How we approach a client system with severe trauma needs to be different than how we approach a system that relatively healthy. Our interventions should match the client we are working with. So, maybe the problem isn’t that many clients simply can’t do mindfulness. Maybe they can’t do it the way we have been teaching it. Complex trauma is not a special case. It’s nearly the only case we see in community mental health contexts globally. A large percentage of pervasively traumatized clients struggle with even the most basic forms of mindfulness for reasons that we will explore, but also because of how we teach it. And, the easiest thing to change in this equation is how we teach it. Even in EMDR Therapy, the assumption that “Ok, now we’re in Phase Two and I’m going to teach you these resources so that you can calm down when you get activated.” This is true, but do you hear the therapist agenda in the way we may be introducing it? As you will see, when we are working with clients with extreme trauma what we are looking for is information about the client’s nervous system and not necessarily the relaxation response. I want to show you how to use that information that surfaces in the service of the client’s recovery. What We are Asking Clients to Do in Mindfulness Feels Like it Goes Against Common Survival Strategies The Present Bodies Noticing The Mind is Taxed with Survival Tasks There is Performance Anxiety in What they Know We’re about to Ask Add to all of these things the performance anxiety of trying a skill focused on these places of discomfort and knowing that the therapist is going to ask them about their experience with it. These are clients that are accustomed to being what other people need them to be and performance anxiety associated with “Is this working?” “Am I doing this right?” “What does it mean that I don’t find this relaxing?” Etc. Step One of One Way to Do this Differently: Normalize the Difficulties Normalize the difficulty using all of the information above and all of the information you have learned about the client’s survival. You know how to do that. Do it. “Of course mindfulness and the way we have been approaching it hasn’t worked well for you. Would you be interested trying this differently?” Step Two of One Way to Do this Differently: Appreciate the Role of Parts and Get Consent Step Three of One Way to Do This Differently: “Dip Your Toe In” by Decreasing Exposure Time Step Four of One Way to Do This Differently: We’re Not Necessarily Looking for Something that is Calming Step Five of One Way to Do This Differently: Recalibrate what “Working for Me” Means—The Car Metaphor Step Six of One Way to Do This Differently: Bridge Resources Step Seven of One Way to Do This Differently: Send Clients Home to Practice at their Baseline, Not When Triggered Putting It All Together And while there are a lot of other ways to do the same types of things, what we don’t want to do is simply pronounce that the client isn’t ready. We need to meet them where they are with modifications and accommodations. Otherwise the client will die not ready. We need to identify the difficulties, work on them every session and between sessions until they are prepared enough for trauma reprocessing.

Trauma has the potential to promote disconnection from the present, from experience, from the body, from the self, and from more full engagement with the broader world. These responses were in the service of survival. They may have been essential. Sensory grounding is a go-to resource in trauma work because our senses bring us home. They can help bring us into the “safety” of the present when we want to be or when we need to be more present. Sensory grounding is a needed resource in trauma work, where we ask clients to “glance” at a traumatic memory, but advise them not to fall into a memory. Sometimes, simply interacting with the memory in any way can cause it can cause us to fall or dissociate into it. Sensory grounding in the present brings you home. It brings you into a place where the bad thing isn’t happening right here, right now. Script: When we have difficult experiences, those experiences may be stored in the part of the brain that doesn’t or can’t know that the experience is over. Sometimes, accessing a memory takes us out of the present and puts us into an experience when we did not feel safe. I’d like to show one strategy that you can use to find your way back into the present. Often the present may not feel “safe,” but it is likely to be safer than the experience from the bad memory. The exercise will ask you to very briefly engage your senses, one at a time. We will spend only a few seconds at a time getting information from each of the senses. If we keep it very brief, many people are able to tolerate this exercise well. If anything difficult comes up, we can stop. Is this an exercise that any part of you might object to, assuming that we do it quickly and that you can stop anytime you like? If there is an objection. Stop and explore that objection. See if there is a way to do this that is not objectionable to that part that allows us to continue. Otherwise, full stop (parts will need to know that they can stop). Vision: I invite you to look around the room and notice several things you see. Notice several objects and notice the color of those objects. Also notice that if you were to go up and touch these objects, would they be hard, soft, or some other texture? [Wait 5-10 seconds] Touch: Place an open hand on the table or furniture next to you for just a moment and notice if it is colder, warmer, or the same temperature as your hand. [Wait 2-5 seconds] Good. Move your fingertips across the surface and notice if it is completely smooth or has a texture. [Wait 2-4 seconds] Good. Move your fingertips across the texture of that surface and just notice if the temperature changes as you move. [Wait 2-5 seconds] Good. Hearing: I’m going to be very quiet, notice whatever you hear in order of loudest first. [Wait 5-8 seconds] Good. Smell: I’ll give you a few moments to smell the essential oil [or other object] that you selected. [Wait 5-10 seconds] Good. Taste: I’ll give you a few moments to taste, smell, or feel the temperature of the drink that your brought to session. [Wait 5-10 seconds] Good. How was that? [explore] What was your experience with that exercise? [explore] Which of those senses seemed to be the most helpful in bringing your awareness more into the present? [explore] As with all resources with client with complex trauma, send the client home to practice first at their baseline and not when something has happened that has severely triggered them. Once the nervous system becomes comfortable with this resource, then use it as a fire extinguisher.

Full script for this is at: https://emdrthirdweekend.com/posts/dip-your-toe-in-approaches-to-body-scan