Click here to contact John and/or see his GoodTherapy.org Profile

Exposure types of therapies such as Eye Movement Desensitization and Cognitive Restructuring have the best outcomes in the treatment of Post Traumatic Stress. Exposure therapy might be good with an accident victim who is afraid of driving through an intersection. The therapy is combined with desensitization strategies and relaxation techniques so the person can safely visualize driving successfully through the point of an accident. However, with more complex PTSD cases related to long term abuse or with a person who has long term symptomology, exposure therapy could be dangerous.

I recently began using EMDR after beginning my training in this phenomenal approach. I also utilize ongoing clinical training from two mentors. One has been providing EMDR treatment for 20 plus years; the other specializes in the field of clinical hypnotherapy and the treatment of trauma. It was drilled into my head many years ago to constantly seek clinical training because the lives therapists serve are actually fragile.

So far I have helped a few people along the way. In using any type of new approach my policy is to seek guidance from the experts. EMDR is is no exception. One needs to use caution any time a traumatic memory is explored. With EMDR images and memories emerge. It is like riding on a train gazing out the window as one’s life experiences pass them by. I’ve been a psychotherapist for 20 years and a PTSD survivor as well, so I am very cautious with every person I serve.

EMDR, or Eye Movement Desensitization and Reprocessing, is more than just an approach. It is the belief of myself and others that EMDR is a successful means of treatment for PTSD and for those who are affected by unresolved childhood issues.

Trauma, critical childhood experiences, memories of abuse or neglect, and the associated feelings become stored in the amygdala part of the brain. A scent in the air, the time of year, a simple taste or a sound can bring the experiences to consciousness often in the form of anger or fear! People who have been affected also tend to redefine who they are and what they can do. Irrational thinking errors and beliefs evolve, often affecting self-esteem, level of confidence, and social, vocational and recreational functioning. Examples of irrational beliefs could include, “I’m not important. I’m a failure, I’m defective or I’m worthless.”

Irrational beliefs can also evolve from something a person in authority might say on a continual basis. For example, I was never good at math but my high school algebra teacher made the statement, “I don’t know how someone could be so stupid and still breathe.” Another person I knew was a great baseball player in grade school. He won awards, etc. but then was assigned a coach who decided to single him out. The coach began to make fun of him and was overly critical of his every move. This person quit playing and never picked up a baseball bat again, truly believing he had failed the game. Even though this wasn’t an obvious sign of abuse, it did have a lifelong impact on the person. EMDR and cognitive restructuring helps people challenge irrational thoughts and beliefs to redefine who they are!

Traumatic or abusive events that resurface take over the emotional hemisphere of the brain and shut down the rational or intellectual part of the brain. By following the therapist’s fingers the eyes move back in forth as in REM sleep. During REM sleep the eyes also move back and forth bringing up images or at times unresolved issues from the past. Images or pictures from the past do come up! This becomes complex with abused or long term trauma folks, especially those who may have a tendency to disassociate.

With EMDR both the emotional and the rational hemispheres of the brain are engaged. This is a huge component of its efficacy to help the patient resolve childhood and traumatic issues. This is where the baseball player resolved what the coach had to say and began to play baseball again. This was an easy one. The case below was a little more difficult.

With this person’s permission, I am sharing what recently happened during a session with me. This person is a successful salesperson who is currently going through a divorce after 20 plus years of marriage. The person felt betrayed because their spouse was cheating and was flaunting that it is not against the law to cheat on a spouse. This person works and has always taken great care of the children. Their background included a lot of childhood neglect. Many years ago they evolved irrational beliefs: “Nobody loves me. Everyone else is happy except me. I’m not valued. I’ll never be happy.” I began to see this person for anger control issues. I’ve used hypnotherapy and Brief Cognitive Therapy to address their belief system and try to build up their level of confidence. I’ve also used relaxation exercises to reduce their anger.

Recently, this person presented for a scheduled session almost in a rage and was unable to focus or concentrate on work. An agreement to use EMDR was facilitated. Following the protocol and from earlier sessions an imagined safe place evolved. EMDR therapy began after the person calmed down utilizing some hypnosis techniques focusing on the five different senses of smell, touch, hearing, sight and taste. They were relaxed and experienced a childhood scene with feelings of safety and security. Having the person imagine their own personal safe place is key, as shown below.

Focusing on the scene from their past, EMDR began. After about five minutes feelings of anger began to evolve and the therapist redirected the person to their safe place. A few moments later the tears began and painful images of their childhood surfaced. An image of a forgotten childhood birthday emerged. At this point, the person’s heart rate began to escalate and the EMDR was stopped. The person was led back into hypnotherapy using breathing and progressive muscle relaxation. Through hypnosis the safe place was imagined, heart rate returned to normal, and the person had the feeling of exhaustion. The process of restructuring beliefs into positives such as “My kids value me!” was processed with more EMDR. The disturbing feelings were contained while building on the person’s resources to handle any stress that might come up during the week. This person left my office feeling emotionally drained, with no signs of anger and an irrational belief partially resolved.

The person later that afternoon returned to work and was able to complete all of their work tasks. Two days later, the person is experiencing a continued state of calmness with no signs of distress. We have an agreement that if stress is experienced, they are to call my office at once.

EMDR is not magic. There is a lot of work left to do. Recovering from childhood issues is like peeling an onion, one layer at a time. That afternoon we chipped at just a piece of that layer. EMDR is a gradual safe process that has a proven track record when done according to protocol and with the right therapist who is properly trained in this therapeutic technique. It is not for the novice, nor to be tried on oneself! Whenever any traumatic or childhood memory is explored it needs to happen in a safe place, in a safe way, and with a skilled therapist.

©Copyright 2010 by John Lee, LMHC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact John and/or see his GoodTherapy.org Profile

Click here to contact Beth and/or see her GoodTherapy.org Profile

The intense and painful experiences of grief are generally considered “normal.” However, when those experiences are extremely distressing, unduly interfere with day-to-day functioning or do not subside to a manageable level over time, the bereaved may be experiencing complicated or traumatic grief. Complicated grief has been proposed as a new diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and suggested components of the diagnosis include (1) that sufferers experience bereavement by death; (2) that their reactions include intrusive and distressing symptoms, including yearning, longing and searching for the deceased; and (3) that the bereaved exhibit at least four marked and persistent trauma reactions, which may include: “avoidance of reminders of the deceased, purposelessness, feelings of futility, difficulty imagining a life without the deceased, numbness, detachment, feeling stunned, dazed or shocked, feeling that life is empty or meaningless, feeling a part of oneself has died, disbelief, excessive anger or bitterness related to the death, and identification symptoms or harmful behaviors resembling those suffered by the deceased” (Mitchell et al, 2004, p. 13).

Even in cases that do not fit the criteria for complicated grief as described above, the events surrounding the death may be sufficiently traumatic to interfere with daily functioning or result in unrelenting distress. As a psychotherapist specializing in grief and loss, I have found EMDR (Eye Movement Desensitization and Reprocessing) to be an effective tool for alleviating trauma in grief. As in grief, trauma affects the whole person — body, mind and spirit, and on a hierarchy of needs, trauma must be dealt with in order for the healing process of grief to proceed in a healthy, and healing, fashion.

What is EMDR?

In brief, EMDR was developed by psychologist Francine Shapiro after making a chance discovery that the lateral movement of her eyes reduced the intensity of disturbing material she was dealing with in her life (Shapiro, 1995, p. 2). Dr. Shapiro spent several years scientifically studying this phenomenon, and found that bilateral stimulation, i.e., stimulation on both sides of the body — whether in the form of eye movements, tapping, sound or other forms — released traumatic material from the brain in a way that made the material workable. Trauma that is locked in the brain leads to the “fight, flight or freeze” response, and EMDR helps transform traumatic images into memories that no longer have a deleterious hold on the individual.

In addition to this physiological response to trauma, the traumatized individual often develops negative beliefs about him or herself (such as “I do not deserve love, “I was at fault” etc). The beauty of EMDR is that it works on a cognitive level as well as the physiological level, not only facilitating the transformation of traumatic images in the brain, but also allowing the individual to replace negative cognitions about him or herself with positive ones (such as “I deserve love”, “I did the best I could”, etc.). EMDR also works on a somatic level, with the therapist guiding the client to feel the traumatic images and negative beliefs in the body, thus further facilitating the transformation of the images into non-intrusive memories, and also transforming the negative beliefs into positive, useful ones. Therapists need to be trained to practice EMDR, and follow a standardized protocol in EMDR work with clients.

Case Studies

Two cases in my practice are illustrative of the effectiveness of EMDR in resolving traumatic grief. “Carol”, the mother of two small children, came to see me complaining of ongoing distress after the death of her husband nine months before. “Bill” was in a motorcycle accident, sustaining a broken leg. After being admitted to the hospital, Bill suffered a stroke and brain swelling, and died after being taken off life support two days later. Carol was concerned about her irritability, particularly toward her children, and her anger toward Bill for dying and leaving her with two small children to raise alone. She also expressed guilt regarding her anger toward Bill, which I spent time validating and normalizing, since anger is often exhibited as a normal grief response. Carol spent much time telling her story — a useful healing tool for making meaning of a seemingly senseless situation (White, 1995). She did not exhibit signs of trauma for the first few months that we worked together. However, as the anniversary of Bill’s death approached, Carol found it difficult to sleep, being awakened by intrusive images of Bill lying in the hospital bed and her shock when she learned of his condition. We explored Carol’s negative cognitions around these images and Bill’s sudden death. The negative belief that that most impacted Carol was her belief that Bill’s death was her fault because she had a premonition that he would be in an accident, and she did nothing to prevent it. In describing the images of Bill lying in the ICU and her belief that it was her fault, Carol felt tightness in her chest and had difficulty breathing. After two 90-minute EMDR sessions, Carol was able to replace her negative belief “I was at fault” with the positive belief “I did the best I could.” She reported that she still, of course, experienced memories of Bill’s death, and reported she was very pleased that that she could feel sadness without guilt. Carol was thus finally able to process her grief and loss in a healthy way.

My work with “Mary” was deeply profound and moving. Mary’s husband “Don” suffered with Lou Gehrig’s disease (ALS) for three years, and Mary witnessed the horrible, inexorable ravaging of Don’s body while his mind stayed strong. Mary’s expressed purpose for coming to see me was that she was unable to feel Don’s presence in her life. Mary described Don as her soul mate, and I assured her that because of the strength of their bond, she would find a place for Don in her heart and feel his presence as a support in order to move forward. However, it was clear that she would first have to deal with the traumatic images that prevented her from fulfilling this step in her grief process. The most disturbing image, and target for our EMDR work, was finding Don lying in a pool of blood on the bathroom floor after falling out of his wheelchair. I taught Mary the “butterfly” technique, in which the client crosses his or her arms across the chest in a hug and taps alternately below each shoulder, simulating the bilateral stimulation used in formal EMDR sessions. I instructed Mary to use this technique at home as a resource when traumatic images arose. After two sessions, with Mary working at home with the butterfly hug when disturbing images and emotions arose, Mary reported that those images had receded as mere memories that were no longer unduly disturbing.

Mary came into our next session glowing, and reported that she had felt a tug at the back of her shirt while sitting quietly one day and “knew it was Don, back in my life.” She reported that she subsequently felt Don’s presence coming to her every night before she fell asleep. Our trauma work was done, and Mary was well on the way to healing her grief.

Conclusion

Dr. Roger Solomon has observed that: EMDR often results in the emergence of positive memories of the deceased with associated affect….It is the emergence of memories of the deceased that let us know and acknowledge the meaning of the relationship, the person’s role in our lives and identity, and enable us to carry the basic security of having loved and been loved into the future.

My work with both Carol and Mary, as well as many others, has enhanced my confidence in my therapeutic skills in identifying and working with traumatic grief, and has increased my trust and faith in the effectiveness of EMDR as a healing tool in grief.

References

A. Mitchell, Y. Kim, H.G. Prigerson, M.K. Mortimer-Stephens. (2004). Complicated Grief in Survivors of Suicide. Crisis 25(1), 12-18.

F. Shapiro. (1995). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures. New York: Guilford Press.

R.M. Solomon, EMDR and Grief. www.emdr.org.il/dls/solomon.doc. Retrieved October 25, 2009.

M. White. (1995). Re-authoring lives. Adelaide: Dulwich Center Publications.

©Copyright 2009 by Beth S. Patterson, MA. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Beth and/or see her GoodTherapy.org Profile

Click here to contact Sarah and/or see her GoodTherapy.org Profile

Sit down, and let me tell you a story, a fable that tells of a wolf in sheep’s clothing. It is a fable, written by Aesop, that you may be curious to learn, and can tell us of addiction’s common deceptions. Perhaps you will find the lesson in the beginning, or even at the end, but you will be curious about what you will soon learn, as you read on.

“A wolf found great difficulty in getting at the sheep owing to the vigilance of the shepherd and his dogs. But one day it found the skin of a sheep that had been flayed and thrown aside, so the wolf put it on over its own pelt and strolled down among the sheep.

A lamb began to follow the wolf in the Sheep’s clothing. So, leading the lamb a little apart, he soon made a meal of her. For some time he succeeded in deceiving the sheep, and enjoying hearty meals.”

What’s Underneath: The Wolf

Appearances are deceptive. Aesop’s famous fable, as in many stories from our own lives, makes that quite clear. Certainly, we can “think” we know what is causing our struggles, and often the causes can be quite obvious. Nevertheless, for those in recovery, what is on the “outside,” what is “seen,” is not always reality. Many times, it is the wolf “underneath” that seeks to drive the addiction, maintain it, and feed its hunger.

Think about yourself, or someone you know, who may be in recovery. On the outside, the addiction can “look” like the primary focus, and paradoxically can be. Yet, what I often speak of with clients, is that something underneath, within them, is painful, and is consciously, or subconsciously covered, protected, and held at bay. Beneath outside appearances, there is an often-painful event, experience, or history that the outside behaviors, the “pelt,” addictions, seek to cover. It is the “wolf on the inside,” trauma, that seeks to be hidden from view. Certainly, the wolf is not kind, nor is it tame, but the stories, and experiences, can still haunt people without their awareness. They are hidden under the pelt of addictive behaviors, and can look like something different than what they really are.

Sexual and physical abuses are some of the strongest wolves “under the pelt.” For example, they are the very things that can first drive people to engage in addictive behaviors. Even if the conscious mind struggles to know exactly what the underlying cause is, the addictive behaviors often seek to cover the trauma underneath. Addictive behaviors are often ways to cope with pain, whether conscious, or not. Sometimes the painful memories are so great that they split off and are stored in ways that even the conscious mind is not aware of.

There is a part of you that wants to be healed and wants to express the painful stories. This is the part that wants to get help, feel better, and recover. Nevertheless, sometimes we seek to “push the trauma away” to prevent the wolf from rearing its ugly head and attacking. The mind often grabs onto drugs, alcohol, sex, relationships, even chaos, to keep the wolves at bay. We cover it with a pelt. Nevertheless, the wolves are unrelenting. They seek to have their stories told by giving people flashbacks, body memories, fear, anxiety, and nightmares. Ironically, by letting the wolves out, by sharing the trauma, and processing it, the wolves lose their power. The nervous system can eventually release the trauma, and the physical, emotional, and spiritual symptoms.

Shedding The Pelt

The wolf’s growl comes in the form of the feelings, emotions, body memories, and experiences that surface. It is loud. Yet, why would the wolf, the trauma, want to come out from under the surface in the first place? Why doesn’t it want to stay under the sheep’s pelt, stay hidden, and keep feeding the addictions? The answer to these questions lies in an “internal healing mechanism” that seeks for us to feel whole, safe, and protected.

Ironically, this internal healer may be the same part that thinks that addictive behaviors will quell the trauma. Yet, the wolf is so overpowering and strong, trauma often wins out over those addictive behaviors. The pain is still there, somewhere. The trauma story must be reprocessed through a more healthy perspective, and its hold on the nervous system, released. It is the trauma, the wolf, that needs to shed the pelt.

EMDR

Consider that our brain has two hemispheres; the left is more logical and the right, more emotional. Trauma causes the hemispheres to get out of sync. For example, you may know that what happened to you “is over” but it doesn’t feel true. Your logical left brain and subjective right brain are in conflict. As a result, the upsetting, scary, or traumatic experience stay “stuck” or “frozen” in the nervous system. In addition, negative beliefs such as “I’m not good enough,” “It’s my fault,” or “I deserved it,” feel true, even though logically, you know that they are not.

EMDR (Eye Movement Desensitization Reprocessing) is an evidence-based therapy that often gets to the wolf, the underlying trauma. EMDR unfreezes the trauma, and helps the nervous system “let go.” The nervous system learns that it doesn’t have to be in a state of alert. The brain shifts out of the “fight of flight” mode that causes symptoms such as anxiety, body memories, fear, and flashbacks.

EMDR combines elements of several different therapies with alternate right and left (bilateral) eye movements, tones, or tactile stimuli. In essence, the bilateral stimulation encourages the left and right sides of the brain to communicate effectively. The brain releases the fight or flight response, thus the wolf underneath of the pelt is exposed for what it is. As a result, clients find that they feel more in the present, less controlled by what lies underneath. They learn that they can release the wolf, and its hold, and move forward.

©Copyright 2008 Sarah Jenkins, MC, LPC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Sarah and/or see her GoodTherapy.org Profile