Is EMDR Helpful?

EMDR 1

Last year, I attended a trauma training and the trainer touched on eye movement desensitization and reprocessing (EMDR). He stated something like, “It’s very simple, the client moves his eyes back and forth several times and then the feelings associated with the trauma are no longer triggered! For the deeper traumas, they may have to have the process repeated. It’s a very effective and very interesting therapy!” This tends to be how many mental health therapists view EMDR. It is an intriguing enigma because, after years of working to evolve therapy into something that is always helpful, there is finally a method that is shown to be consistently effective.

Francine Shapiro, “discoverer” of EMDR, has stated that EMDR is effective in all traumas, but that “it takes longer when you have multiple traumatic experiences because there are more memories that need to be processed.” Studies upon studies have shown the effectiveness of EMDR because it uses the brain’s natural abilities to heal itself. It is effective, but is it always beneficial?

As I’ve written previously (About PTSD), EMDR pulls the traumas that are stored in the limbic system and brings them into conscious memory, in order to be stored correctly in the cortex. This tends to be a fairly straightforward process for those who have experienced a one-time trauma in adulthood. However, because the childhood brain is so malleable, when children experience a significant trauma, their brains are forced to veer from normal development in order to process the trauma and protect the brain.

One of the very common ways children manage trauma is through dissociation. It is common for these previously dissociated memories to surface in adulthood, mostly because the brain is finally fully developed around age 25 (the topic of recalled memories is quite debated, but it is indeed common). This is a normal process as the brain attempts to bring the memories into consciousness in order to be stored correctly. Some memories become conscious, and some do not; it depends on what the brain feels it can manage at a conscious level. EMDR fast tracks this process and does not allow the brain to pick and choose which memories it is ready for. Therefore, those who have experienced complex trauma (continual trauma during childhood) may become flooded with very intense memories. The complex trauma survivors’ brains have spent years adapting to the trauma and building up walls of protection so the person can survive. EMDR reverses these protections and breaks down the very protective walls they have spent years building.

Many complex trauma survivors who have attempted EMDR have reported that it makes them feel worse and that they are unable to manage the overwhelming feelings. Recalled memories return at such a quick rate that leaves the survivors flooded. The brain is not prepared for an onslaught of memories because naturally, it unfolds trauma at a far slower process. This seems to be what the non-EMDR trained therapist does not understand; I have found myself considering referring clients with complex trauma for EMDR in the past, simply because it is known as an effective therapy for trauma survivors. Now, I realize that in the case of complex trauma, it may be more beneficial to allow the survivors’ brains to unfold the memories at the rate their brains can manage (however slow and exhausting the process may be).

While many mental health therapists are intrigued by EMDR, and rightly so, not every trauma survivor is well-suited for EMDR. Because EMDR fast tracks processing, the processing could take less time, but the process could leave the client in a heap. EMDR therapists understand this and are able to filter their clients accordingly. However, even the smallest safety-building EMDR session may send their complex trauma survivors into a spiral of the past that their minds have worked so hard to forget (I therefore recommend great caution in reading Francine Shapiro’s book, Getting Past Your Past, because it immediately teaches the basic concept of bilateral stimulation to improve safe place).

If you are interested in reading more about a personal account, I invite you to click on the EMDR tag at the bottom of this post.

Re-parenting The Inner Child

inner child dressesDraw your inner child connecting with you

In the mental health world, we often consider those with complex trauma as “stuck.” This means that at the point where their trauma began, a portion of their brains stopped developing, and even as adults they exhibit some of the same emotional development they did at the age where they became stuck. Clients who are “stuck” may over-attach to those who exhibit desired parental qualities or are older. This can easily lead to unhealthy attachment. It is typically healthier to transfer these feelings onto a therapist, who is better able to manage these needs with proper boundaries. Talk of re-parenting usually occurs in these therapeutic situations.

I heard a beautiful story once of a family who re-parented a teenager with complex trauma, including reading children’s stories and tucking her into bed. Through this endeavor, the family changed the course of the teenager’s life and improved her attachment style. Though this is the deepest desire of all inner children, the time and effort this requires makes this kind of story quite rare. However, the concept is very common, especially in therapy.

Some therapists help clients re-write their stories as if they were their own parents, each chapter of the story being a different age bracket. Other interventions include encouraging the clients to listen to and meet the needs of the inner child. This may include offering her something as simple as a juice box, time on the bed with her favorite blanket, or a coloring book when she is having a tantrum. Through meeting these needs, it is theorized that the inner child will feel her needs are met and will calm down. I personally do not believe the child will ever become completely “un-stuck,” but the inner child can certainly be made to feel safe. With care, the child will not feel she needs to wreak havoc in her adult’s life.

When people hear talk of re-parenting, it is common to feel uncomfortable. After all, connecting with the inner child may remind us of how popular culture has turned diagnoses like Dissociative Identity Disorder (DID) into something to fear or make jokes over. According to a study, DID occurs in approximately 1.1% of the population and ought to be better understood than a few movies. Dissociative Disorder NOS (DDNOS) is a far more prevalent diagnosis for survivors of complex trauma. Those with this diagnosis may have successful careers, and when their brains are engaged professionally, they exhibit no symptoms (this relates to their ability to easily separate from other parts of themselves). However, they have frequent and lengthy periods of partial or complete dissociation or feeling they are walking in a fog. Those with DDNOS often have a very strong sense of an inner child, who is developmentally the age of the adult when the trauma began (re: being “stuck”). It is the inner child who recalls and relives the trauma. However, they differ from DID in that the child does not have her own identity or take over completely. The adult is typically always in ultimate control of the mind and body, though they may feel the constant struggle of the inner child.

Some ideas on meeting the needs of the inner child

Cut your food into small pieces

Have a blanket to use for comfort

Have crayons and a sketch book or coloring book handy

Listen to kids music

Keep juice boxes in the fridge for her

Write letters to her

Allow her to keep a journal (giving her a voice will calm her)

Visualize yourself holding her and tucking her in at night

Keep your favorite childhood toy, or buy a favorite toy for her

Paint fingernails and toenails

Finally, if you have children, play with them. Allow yourself to feel nurtured as you meet their needs.

For more ideas on healing the inner child, read Courage To Heal or click here 

inner childA bed prepared for my inner child’s favorite doll, which should arrive Saturday

Art Therapy

IMG_0135

An example of art therapy when the prefrontal cortex is functioning

When a person experiences trauma, the brain may shut down the prefrontal cortex, which is responsible for higher functioning such as language and reasoning. The brain then uses its basic brain, which is where the limbic system is located. The limbic system is responsible for, amongst many other things, the storing of memory and emotion. It stores memory in fragments, so anything from a smell or a sound can trigger memory of the trauma. Because the brain views the trigger of a traumatic memory as a threat, it shuts down higher functioning and once again, the brain is storing the trigger as trauma.

image

An example of art therapy during basic brain functioning (during a trauma response)

When I process trauma with clients, I find that the means of processing largely depends on where they are at in their own journey. For instance, if they can recall the trauma without their brain shutting down, we can process the trauma using language. If they are highly sensitive and begin shutting down when they are triggered, at times they can write, but it may come out in rudimentary words like “scared” and “help.” Their handwriting is often basic as well. However, if I provide the same clients with colored pencils and a blank paper, they can draw but in much the same form that a child would- with stick figures, and coloring very hard when very stressed. If they are willing, they can begin to process the memory through these drawings. If they are very creative people, however, they will attempt to shut this process down. This is because, I have noticed, when I hand creative people art supplies, they feel the need to perfect the art. While art therapy is useful for very artistic people, this is not usually what I use art therapy for in either my personal (I am not artistically inclined) or professional life. I use it as a means of communication and emotion regulation during a strong trauma response.

Ideas for art therapy:

Colors, how hard the colors are applied, objects, size of objects, objects in relation to one another, and placement of art onto the paper are all symbolic. The more a person is able to take these things into account, the greater they will be able to communicate through art. Keep in mind that conscious symbolism requires higher brain functioning. However, the unconscious brain often uses the same symbolism in art therapy; this is the means therapists use to interpret client art… particularly when treating a child.

About PTSD

At a training recently, I heard that trauma is so common that we must assume that everyone we come in contact with has experienced it in some degree- this is part of having a trauma informed perspective. We must have empathy for the negative attitudes or behavior a person may show towards us because we do not know whether these are symptoms of trauma. Normal, processed memories are stored in the cortex of the brain in language form. However, when a person experiences significant trauma, the brain may be altered. This alteration is more serious if the trauma occurs in childhood while the brain is still developing. A significant or unprocessed trauma is stored in the limbic system, or the part of the brain responsible for emotion (including fear). Therefore, each time the person experiences an overwhelming emotion, the brain is triggered and the person reacts with an emotional trauma response.

Because posttraumatic stress disorder (PTSD) involves measurable changes in the brain, PTSD infiltrates every aspect of a person’s life, regardless of how hard that person strives to keep it at bay. Faith, relationships, work, parenthood, marriage, and friendships may suffer, and everyday tasks can become difficult and overwhelming. Many people with PTSD do not sleep well, and may go through periods where they do not sleep at all. There are, of course, varying degrees of this disorder that may depend upon length of time since the trauma, the nature of the trauma itself, support system, environment, ability to cope with symptoms, and whether the trauma has begun to be processed.

There are several different types of trauma therapy, and one of the most common is trauma-focused cognitive behavioral therapy (TF-CBT). This type of therapy works to change a person’s thought process regarding the trauma, and often involves talking about the trauma in depth and coming to an acceptance. CBT in general is heavily present-focused, so a therapist will assist the client in making small, reachable goals regarding moving forward from the trauma. Dialectical behavior therapy (DBT) is also often used. DBT focuses on emotion regulation, especially accepting and controlling overwhelming emotions so that no damage ensues during strong trauma responses. Another common type of therapy is eye movement desensitization and reprocessing (EMDR). This involves the therapist assisting the client in processing the memory through various forms of bilateral stimulation, so the brain can re-store the memory in the cortex. EMDR does not require the client to talk about the trauma in depth, and is short-term because it only focuses on the brain’s ability to heal itself through bilateral stimulation. The best natural example of this is rapid eye movement during sleep, where the brain is able to process what has taken place throughout the day.