When an event or experience in one’s life becomes so painful that it is unendurable, it is called traumatic. Sometimes a single event can be traumatising and sometimes trauma is the result of a group of difficult experiences. The symptoms of trauma can begin immediately following a traumatic experience or arise much later. Causes of psychological and emotional trauma include experiencing violence, childhood abuse, living through catastrophic events (like war or natural disasters), and accidents. The death (or loss) of a person can be traumatic for some people. Life transitions like moving home or leaving one’s culture can have a traumatic impact on some people’s lives. Throughout life, there are many experiences that some people find traumatic. PTSD is a special type of trauma that requires specialised treatment. The types of treatment I provide are called Narrative Exposure Therapy (NET) and Eye Movement Desensitisation Therapy (EMDR).
IN THE REGION OF TRAUMA, ALL DURATION OR STRETCHING ALONG COLLAPSES; PAST BECOMES PRESENT, AND FUTURE LOSES ALL MEANING OTHER THAN ENDLESS REPETITION.
[ROBERT STOLOROW, PHD.]
Intensive Therapy for PTSD, Multiple, and Complex Trauma
Eye Movement Desensitisation and Reprocessing Therapy (EMDR)
Eye Movement Desensitisation and Reprocessing (EMDR) therapy (Shapiro, 2001) was initially developed in 1987 for the treatment of post-traumatic stress disorder (PTSD) and is guided by the Adaptive Information Processing model (Shapiro 2007). EMDR is an individual therapy typically delivered one to two times per week for up to 12 sessions. I find that EMDR typically takes approximately 10 sessions; however some people benefit from fewer sessions. Sessions can be conducted on consecutive or non-consecutive days.
The Adaptive Information Processing model considers symptoms of PTSD and other disorders to result from past disturbing experiences that continue to cause distress because the memory was not adequately processed. These unprocessed memories are understood to contain the emotions, thoughts, beliefs and physical sensations that occurred at the time of the event. When the memories are triggered these stored disturbing elements are experienced and cause the symptoms of PTSD and/or other disorders.
Unlike other treatments that focus on directly altering the emotions, thoughts and responses resulting from traumatic experiences, EMDR therapy focuses directly on the memory, and is intended to change the way that the memory is stored in the brain, thus reducing and eliminating the problematic symptoms.
During EMDR therapy, clinical observations suggest that an accelerated learning process is stimulated by EMDR’s standardised procedures, which incorporate the use of eye movements and other forms of rhythmic left-right (bilateral) stimulation (e.g., tones or taps). While clients briefly focus on the trauma memory and simultaneously experience bilateral stimulation (BLS), the vividness and emotion of the memory are reduced.
The treatment is conditionally recommended for the treatment of PTSD.
Using EMDR to Treat PTSD
The Following is adapted from the APA website:
EMDR therapy uses a structured eight-phase approach that includes:
- Phase 1: History-taking
- Phase 2: Preparing the client
- Phase 3: Assessing the target memory
- Phases 4-7: Processing the memory to adaptive resolution
- Phase 8: Evaluating treatment results
Processing of a specific memory is generally completed within one to three sessions. EMDR therapy differs from other trauma-focused treatments in that it does not include extended exposure to the distressing memory, detailed descriptions of the trauma, challenging of dysfunctional beliefs or homework assignments.
The Phases of EMDR
History-taking and Treatment Planning
In addition to getting a full history and conducting appropriate assessment, the therapist and client work together to identify targets for treatment. Targets include past memories, current triggers and future goals.
The therapist offers an explanation for the treatment, and introduces the client to the procedures, practicing the eye movement and/or other BLS components. The therapist ensures that the client has adequate resources for affect management, leading the client through the Safe/Calm Place exercise.
The third phase of EMDR, assessment, activates the memory that is being targeted in the session, by identifying and assessing each of the memory components: image, cognition, affect and body sensation.Two measures are used during EMDR therapy sessions to evaluate changes in emotion and cognition: the Subjective Units of Disturbance (SUD) scale and the Validity of Cognition (VOC) scale. Both measures are used again during the treatment process, in accordance with the standardized procedures:
Validity of Cognition (VOC) scale
|The clinician asks, “When you think of the incident, how true do those words (repeat the positive cognition) feel to you now on a scale of 1-7, where 1 feels completely false and 7 feels totally true?”|
|Completely false||1||2||3||4||5||6||7||Completely true|
Subjective Units of Disturbance (SUD) scale
|After the client has named the emotion he or she is feeling, the clinician asks, “On a scale of 0-10, where 0 is no disturbance or neutral and 10 is the highest disturbance you can imagine, how disturbing does it feel now?”|
|No disturbance||0||1||2||3||4||5||6||7||8||9||10||Worst possible|
During this phase, the client focuses on the memory, while engaging in eye movements or other BLS. Then the client reports whatever new thoughts have emerged. The therapist determines the focus of each set of BLS using standardised procedures. Usually the associated material becomes the focus of the next set of brief BLS. This process continues until the client reports that the memory is no longer distressing.
The fifth phase of EMDR is installation, which strengthens the preferred positive cognition.
The sixth phase of EMDR is the body scan, in which clients are asked to observe their physical response while thinking of the incident and the positive cognition, and identify any residual somatic distress. If the client reports any disturbance, standardised procedures involving the BLS are used to process it.
Closure is used to end the session. If the targeted memory was not fully processed in the session, specific instructions and techniques are used to provide containment and ensure safety until the next session.
The next session starts with phase eight, re-evaluation, during which the therapist evaluates the client’s current psychological state, whether treatment effects have maintained, what memories may have emerged since the last session, and works with the client to identify targets for the current session.
Treatment typically lasts for approximately 10 sessions for EMDR with each session lasting 90 minutes. However, this can vary depending on each’s patient’s experiences. For best results, sessions should be scheduled once to twice weekly. A course of ten sessions, or individual 90-minute sessions, may be scheduled directly through my website, and paid for by bank transfer. If paying by private insurance, please ask your insurance company for pre-authorisation for EMDR or NET. Please feel free to email me with questions.