The EMDR Podcast

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.

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.

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

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.