When the Shoe Doesn’t Fit

August 9th, 2010
By Sarah Jenkins, MC, LPC, EMDR Topic Expert Contributor

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

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He called me, as most new clients would, needing to know the usual questions about me, my practice, and my approach to helping. Of course he would; he is supposed to. The catch is that on this call, I found myself having to educate him about EMDR, not because he didn’t know, but because what he had “heard about it” from his current therapist, was inaccurate. Unfortunately, and with therapy especially, this happens a lot.

As I tell many folks, finding your therapist is like finding the right pair shoes. Some look good, but don’t fit. Some don’t look like you would expect, but are. Literally, as you will see on many Good Therapy posts, being an educated therapy consumer is a necessary part of your healing journey.

At the same time, and as most therapists will attest, when you call, we are also wondering if we are the right therapist for you. If our type of therapy would be in your best interests, let alone if we have the expertise that you seek.

With this in mind, I found myself in a bind. On the one hand I wanted to be respectful of he and his current therapist’s relationship. On the other hand, as he searched for a new counselor, what he had been told about EMDR was not accurate. He was a consumer with information that could possibly hurt him, if he was not in the know.

Not a Quick Fix

The truth was that EMDR was not necessarily a “fast” way to heal as he had been told. Certainly, it can be, but it is no guaranteed quick fix. In fact, when I first meet with a client, and we talk about EMDR, this is one of the first misunderstandings that comes up. We are a culture that often looks for a quick fix. Certainly, EMDR’s way of processing traumatic material can be rapid, intense, and highly effective. Nevertheless, it is like a specialized surgery procedure, a laser beam of sorts that hones in on the material that is “stuck” in the nervous system causing the distressing symptoms. I wouldn’t ask my surgeon to rush, nor would you. In fact, if you do rush you may even miss going through the eight phases.

More Than Just Eye Movements

The second misunderstanding he had was that “it’s all about doing eye movements.” Yes, with the name EMDR (Eye Movement Desensitizing Reprocessing), that would seem like a logical conclusion. Unfortunately, the name has enabled folks to miss the larger picture of the eight phases.

For the sake of brevity, it is for this reason that I am writing the following more “user summary” of the phases for you. I hope that you find them helpful. If you are in EMDR therapy, you may already know where you are in the process. If not, if may take some of the mystery away from EMDR.

Though the phases are to be completed in an order, it does not mean that we don’t go back and forth between them, in a circular fashion. We can go back to a phase at any time. Nevertheless, if your EMDR therapist is only talking about eye movements and nothing else, it’s not EMDR.

It’s Not Just The Processing Phase; We’re Doing EMDR The Whole Time

History Taking (Phase One): In this stage, your therapist is learning about you, your history, and even conducting any of the standard assessments that he or she uses. You may feel this as the time when you are sharing your story, getting to know your therapist’s style, and setting up some initial treatment goals. From the EMDR therapist’s perspective, he or she should also be creating a “Target Sequence Plan.” This is essentially an overview of what affects you from the past, triggers you in the present, and your future template. In this phase you are likely to discuss “Touchstone Events,” earlier experiences that contribute to your symptoms now. Even if you think they do not, you may be surprised to know that how you think and feel in this moment has its roots in “old stuff.” You may also be asked how disturbing things are to you on a scale of 0-10, as well as your “negative cognition.”

Preparation Phase (Phase Two): I share with clients and consultees that the next three phases are like a traffic light. We are in the “Red” stage if you will. You are learning more about EMDR, as well as identifying and ensuring your readiness to move further through the phases. You may be learning additional grounding skills, stress reduction skills, or “state change” skills. You will also be asked to complete a brief assessment to identify if you experience dissociation. (If you want to learn more about that topic, read my article “Life Through A Lens” also found on this site). In this second stage your therapist is also creating a “Safe Place” image for you, and educating you about “bilateral stimulation” (BLS). This is what you would experience as the “back and forth” sounds, tactile sensations, or eye-movements. BLS asks the right and left hemispheres to process the traumatic material, therefore activating the brain’s Adaptive Information Processing system that I discussed in last month’s blog. In this phase, you may also hear your therapist talk about “resourcing,” and using the BLS to help you access more positive experiences, thoughts, images before moving on through the remaining EMDR phases.

Assessment (Phase Three): This phase is what I call the “Yellow” stage. In the assessment phase, we are taking essentially a base line for what we will be addressing or “targeting” when moving onto the processing phase. You will hear your therapist ask you for an image, a negative cognition, positive cognition, as well as use a 1-7 scale for how true your positive cognition feels, how you feel, a 0-10 scale for how disturbing the “target” is, and finally what you experience in your body.

Processing Phase (Phase Four): This phase is the “Green” in our traffic light analogy. This is the “Go” part of the EMDR process and where the BLS really comes into play. This is, as many of you who have done EMDR know, is when what you are working on “comes up.” All of your senses can become involved as you process the disturbance you are “targeting.” Unlike talk therapy, you are not talking to your therapist as you do it. You give a brief check in, and then go back to hearing the tones, feeling the taps, or moving your eyes back and forth. This is where AIP comes into play and your brain is recycling the material for your nervous system to release it as it did not get to at the time. In between “sets” of BLS, your therapist may also throw some things in for you think about; we call these “cognitive interweaves.” We use that same 0-10 from the assessment phase, to help us assess your level of disturbance again. When it gets to a 0, and it truly feels like a 0, which is not distressing or neutral, we move on to phase five.

Installation (Phase Five): We are now “installing” the positive cognition that you chose with the BLS. But, before we do, we recheck to see if the positive cognition has changed at all. It often does because you have moved further on in your healing. We also check to see how true that positive cognition feels to you, using that same 1-7 scale from Phase Three. We then keep the BLS to see if anything is getting in the way. When you get to a 7, completely true, we move to Phase Six.

Body Scan (Phase Six): Just as sounds, you are asked to mentally scan you body to find any body sensations, tensions, etc. that signal that something is still left over or “stuck” there still regarding what we targeted. We continue with the BLS if there is.

Closure (Phase Seven): This will look and sound differently depending on if your session was complete or incomplete. Essentially, you are closing down the material, and doing a final check in. You are also using various methods, including imagery, to “contain” what material is still not processed, which can include returning to your “safe place” or creating a “container” to hold anything that may become to distressing in between sessions.

Reevaluation (Phase Eight): The reevaluation phase, though it “looks” like the end of the steps of eight, also spirals back as if it were the beginning. Your EMDR therapist will, at the beginning of your next session do a check in, including reevaluating your disturbance level regarding what you were targeting last time. This way, we know if your disturbance is still a 0 that “positive cognition” still rings true at a 7, if you had a complete session last time. If we still have processes the material, we get right back to starting the reprocessing phase again.

In the case of the man calling me about EMDR, I took the time to educate him and tell him the truth about it, even though it was different what he had heard from his provider. That was a tough call to make. But, I’m glad that I did, for he was able to identify better what he needed from a counselor, especially if he chose to pursue EMDR later on. For, while the shoe didn’t fit, at least he knew how it might in the future.

 

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©Copyright 2010 by Sarah Jenkins, MC, LPC, therapist in Tempe, AZ. All Rights Reserved.

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