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Sunday, February 15, 2015

Psychotherapy Blog: How EMDR Works - Part 2: Overcoming Trauma

In my prior article, How EMDR Works: EMDR and the Brain, I gave an overview of the basics of EMDR, including how emotional trauma affects the brain and how EMDR therapy helps to process trauma.

How EMDR Works:  Overcoming Trauma

In this article, which is a continuation of this topic, I'll give a composite scenario to demonstrate how EMDR therapy works.

I'll delve into some of the aspects of EMDR that are uniquely helpful to healing emotional trauma (for an overview of EMDR, see my article:  What is EMDR?)

As always, this composite is a combination of many different cases to protect confidentiality.

Alice
Alice came to therapy because she knew she was overreacting in her relationship with her boyfriend, Ed.

A day or so after she got angry with him, in hindsight, Alice could see that she had overacted, and she felt ashamed and guilty about it.  She would apologize and tell Ed that she would try not to be so reactive, but then a week or so later, she would find herself overreacting again, and this became an ongoing pattern in their relationship.

Alice loved Ed very much and she knew that Ed loved her.  When she was calm, she knew she could trust him, but when she was in the throes of an overreaction, she forgot all of this and she reacted as if he didn't love her and he wasn't trustworthy.

She would often feel rejected and abandoned by things that he said--only to realize afterwards that she overreacted once again.

This happened to Alice so frequently that she was beginning to feel like she was losing her mind.  After she calmed down, she couldn't understand how she could have felt so sure that he was rejecting and abandoning her when she was upset.

She asked herself:  Why couldn't she remember that he loved her?

Even though Ed was patient, Alice knew that her reactions would erode their relationship after a while. She knew she couldn't keep accusing him of being unloving and then apologize afterwards.  She knew she had to do something.

Having been in talk therapy in the past to deal with a traumatic childhood, Alice felt she needed to try a different type of psychotherapy, so when a friend told her how much EMDR helped her, Alice decided to give it a try.

How EMDR Works:  Overcoming Trauma

As we discussed Alice's family history, it became apparent that she was uprooted quite a bit from infancy to adolescence, due to her single mother's substance abuse problems.

During that time she was moved from her mother's home to her maternal grandmother's home and then to an aunt's house.

Finally, when she was a teenager, she moved back with her mother.  By then, her mother was sober, but her mother was still emotionally neglectful.

As an only child, Alice remembered feeling lonely and unloved.  Even though her grandmother and aunt took care of Alice's basic needs, they remained emotionally distant from her.  Alice would pray to have a loving adult come into her life, but she remained without emotional support.

Emotional Neglect:  The Past Affects the Present

As an adult, during her first therapy, which was talk therapy, Alice learned to make intellectual connections between the childhood emotional neglect and her feelings of being unlovable but, even though she had an intellectual understanding, talk therapy didn't help her to actually overcome these feelings.  So, she experienced herself as carrying around this heavy emotional burden throughout her life.

She usually managed to make only one or two close friends because she had a hard time trusting people.

While in college, even though she wanted to be in a loving romantic relationship, she had an even more difficult time trusting men because she felt too emotionally vulnerable to open up (see my article:  An Emotional Dilemma: Wanting But Dreading Love).

After college, having been in talk therapy, Alice knew that her feelings of being unlovable as an adult were connected to her early childhood neglect, but she didn't know how to change this.

She often wondered if she would ever feel emotionally safe enough to enter into a serious romantic relationship (see my article:  Adults Who Were Emotionally Neglected as Children Often Have a Hard Time Trusting).

When she met Ed, she knew he was one of the kindest, gentlest, loving men she ever met.

At first, they got along well.  But as they continued to see each other and got closer, after several months, Alice began to feel emotionally vulnerable and unsafe.

She knew these feelings weren't related to anything that Ed was doing or not doing, but she couldn't stop herself from seeing even the most innocuous remarks that he made as rejecting and abandoning.

During their last argument before Alice started therapy, Alice exploded when Ed said he had to work late and he couldn't see her.  She accused him of lying, not loving her, abandoning her and not caring about her feelings.

Overcoming Emotional Trauma With EMDR

Afterwards, Alice realized that she had overreacted, and she knew that Ed wasn't lying and that he genuinely cared for her.

As Alice recounted this argument and other similar arguments, she broke down in tears.  She said she was sick and tired of feeling this way, tired of accusing Ed of not loving her, and tired of the arguments that she started with him.  She also feared that she would bring about the very thing that she feared most--that Ed would get tired of her and leave her.

Developing Coping Skills as Part of Resourcing Before EMDR Processing
Since Alice came to do EMDR, I began by helping her to develop better coping skills so she could cope with her feelings both in our therapy sessions as we processed her traumatic background as well as in her everyday life.

We focused on helping her to respond instead of react (see my article:  Responding Instead of Reacting).

This phase of EMDR is called resourcing (for more details about resourcing, see  a prior article that I wrote).

As someone who was emotionally neglected as a child, Alice primarily knew only two maladaptive ways of attempting to cope:  overacting or emotionally shutting down.  She knew intellectually that neither way worked for her, but she didn't know what else to do.

After the resourcing phase of EMDR, we were ready to begin processing her traumatic childhood experiences which were triggering her emotional reactions in her current relationship.

Before we started, I reminded Alice that she was in complete control of the process in terms of stopping or pausing the EMDR processing if she felt too overwhelmed.

This is very important for people who have experienced early childhood trauma where they were overwhelmed, there was no one to soothe them, and they felt helpless to do anything about it.

Bridging Back in EMDR
Then, we used a recent memory of Alice being upset with Ed and used that to go back to her earliest memory of feeling this way as a child.

This concept in EMDR is derived from clinical hypnosis and it's known variously as the affect bridge, the float back technique or bridging (see my article:  Bridging Back to Heal).

How EMDR Works:  Bridging Back to Heal

Sensing her emotions and where she felt these emotions in her body, Alice was able to remember an early memory where she was being uprooted once again from her grandmother's house to her aunt's house and how scared and unloved she felt (see my article:  Overcoming the Emotional Pain of Feeling Unlovable).

This earlier memory turned out to be significant in terms of how she got triggered in her current relationship.

EMDR and Imaginal Interweaves
EMDR uses a concept called "imaginal interweaves" to help clients to process emotional trauma.  These imaginal interweaves are used to help clients to feel emotionally supported during the EMDR processing of the trauma memory (see Laurel Parnell's book, Attachment-Focused EMDR).

The goal of EMDR is not to analyze the memories.  After all, many people who come for EMDR therapy have already analyzed their memories in talk therapy and they have intellectual insight.  After talk therapy, what they often don't experience is emotional healing.

This is not to say that talk therapy doesn't work because I continue to do talk therapy.  But there are certain people with early trauma that aren't healed by talk therapy.

So, rather than analyzing the trauma, the goal of EMDR is to process the traumatic memories with some form of bilateral stimulation, BLS (see my prior article for an explanation of BLS) so that the client is no longer affected by the trauma.

To use imaginal interweaves, clients are asked to imagine protective and nurturing people who might have helped them during the trauma.

These protective and nurturing people can be actual people in the client's life who are either from now or back then.   They can also be people from movies, TV programs, books or people from history.

Imaginal interweaves can include anyone and EMDR clients are only limited by their imagination.

They can include an imagined "ideal mother," who is different from their actual mother.

EMDR and Imaginal Interweaves:  Imagining the Ideal Mother

The idea of using imaginal interweaves is not for the client to believe that anything other than what actually occurred is what happened.  The logical part of the brain knows that, in actuality, there was no one who helped.

But the emotional part of the brain can take in these imaginal interweaves and this is emotionally healing.  This is why imaginal interweaves they're used.  Al Pesso, who developed Psychomotor Therapy, refers to this as new symbolic memories (see my article:  Mind-Body Psychotherapy: Healing With New Symbolic Memories).

The Therapist's Empathic Attunement 
An EMDR therapist needs to know more than how to do EMDR.  She also needs to be exquisitely attuned to what's going on with the client and be able to track the client's emotional experience.

A skilled EMDR therapist needs to be in sync with the client.  This is often referred to as a "right brain to right brain" connection, which means that the therapist's right brain, the area of the brain for empathic attunement, senses what's going on emotionally with the client.

This also presupposes that the client and the EMDR therapist have already developed a good enough working alliance so that the client will allow this (see my articles:  The Creation of the Holding Environment in Psychotherapy and The Therapist's Empathic Attunement Can Be Emotionally Reparative to the Client).

The EMDR therapist must also be able to repair whatever ruptures might occur in therapy (see my article: Ruptures and Repairs in Therapy).

Whenever Alice became stuck in the EMDR processing, we used an imaginal interweave to help her to get unstuck so that the processing could continue.

Gradually, over time, Alice's level of emotional disturbance about this memory was significantly reduced.

EMDR and Generalizable Effects
At the same time, she was much less reactive in her relationship with Ed, so we could tell that the EMDR processing was have a generalizing effect.

Generalizable effects in EMDR means that the healing effects of EMDR are also carrying over to other memories and current interpersonal interactions.

How EMDR Works:  Overcoming Trauma 

Completing EMDR Therapy
By the time that Alice completed EMDR therapy, she was no longer overreacting.  She was also no longer feeling unlovable, rejected or abandoned in her relationship.  She was able to free herself emotionally from her traumatic history so that she could live her life unencumbered by these memories.  She was also able could to develop meaningful friendships.

Getting Help in Therapy:
Reacting negatively to the present based on the past is a common experience for people who have experienced emotional trauma, especially if they experienced early childhood trauma.

If you feel that unresolved trauma is keeping you stuck, rather than spending your life reacting based on your past, you owe it to yourself to seek help from a licensed mental health professional who is trained in a mind-body oriented experiential therapy, like EMDR (see my articles:  Experiential Therapy, Like EMDR, Helps to Achieve Emotional Breakthroughs) and Reacting to the Present Based on Your Traumatic Past).

About Me:
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

One of my specialities is helping clients to overcome emotional trauma.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (212) 726-1006 or email me.



































































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