Home EMDR

[Daniel]

I've just experienced EMDR for the first time, and I was very impressed with the immediate, positive results it seemed to have for both my memory and my sense of trauma about it.

But now, I'm curious about the advisability of occasional "home therapy," that is, making the eye movements without my therapist nearby, using similar intervals/lengths of time.

Might I do myself damage by trying this when I have a disturbing thought outside my therapist's office? Is it something only more experienced EMDR clients should attempt?

[Sandra Paulsen]

You may know that we only make general comments here, so the following may not apply, but....I wouldn't begin to recommend self administered emdr for quite a while. For people with considerable trauma histories, they could tap into a reservoir of deep pain and not have a great way to move through it.

EMDR consists of a number of elements, only one of which is the eye movement/bilateral stimulation. Other elements include: formulating the case, selecting appropriate targets, articulating negative and positive cognitions. Additionally, for clients with complex trauma histories it includes resourcing, containment, stabilization, and in particular fractionating the target appropriately to match the strength of the self system of the client.

Remember also that if processing gets stuck, the clinician gets it unstuck. The clinician also provides strength and an observing witness to the process. These are not small things. In short, self administered EMDR is a bad plan for the longest time.

I've tried it myself, and find it to be a problem that there is no observing witness to debug it if and when it gets stuck. I'm a terrific EMDR practitioner and I still can't do it for myself.

Having said all that, once one's major closets have been cleaned, there may be a place for self administered bilateral stim (see also "butterfly hug") to calm oneself.

[MercyMe]

Hmmm, I kind of have the opposite problem...

I am in a public assistance program which is paying for my treatment of complex PTSD. I am verly limited in the mental health providers that I can use; they only have one who does EMDR. This same program pays for my meds, which are saving my life. (I should mention now that I can't be seen to be "uncooperative" by these nice folks or I lose my meds.)

I have been in this therapy once a week now for about five months, and the first month of that was just begging her to try EMDR; I had a strong gut feeling that it would work for me. But I also got the impression that, while she had it on her shingle, so to speak, she did not actually use it frequently. I also noted that she is not listed on any of the trained EMDR practitioner lists found on the official sites, but I assumed that because she offered the treatment she had to know what she was doing.

We did try EMDR, and it was *amazingly* effective at rooting out some deeply seated stuff. I have been so disconnected with my body, my person, that I had no idea these things were lingering in there. EMDR not only allowed the memories to come up, but almost compelled their processing in an easy, natural way I never expected.

But fast forward a few months, and we have a problem. As time has gone on, she has dispensed with everything but the eye movement part itself; I even have to bring myself out of it as I drive home because she doesn't do anything but say, "Time's up." I miss a lot of depth that I could have if only I were taken through all the steps, reminded to pay attention to my body, not worry or try to make things happen, etc. but with her that is not available to me.

There have been several times (I'm in one now) where I am stuck, I know I'm stuck, but when I ask her for help or tools to help me I am told, "That's up to you. You need to find the tools that will bring you out of this. You need to find what will work for you." To me, this is completely unacceptable, but she's on the public paycheck... what can I do? It's like I have EMDR without a therapist. If it were up to her I would talk the *whole* time, but as I explained when I first walked into her office, talk doesn't do diddly-squat for me; I'm talked out and yet symptomatically still the same.

As a last resort, I took to doing it at home in the garage where no one will intrude on my "sessions", and find that while I am still impaired in that there are places where I just have no clue, I am actually getting into deeper places more easily *without* her; it's like I don't have to carry her AND try to heal myself. It's much harder to focus, but I can freely go with whatever presents itself, and end it if it gets nowhere. I do find that even if I get nowhere in the EMDR itself, processing does continue in flashbacks, dreams, released memories, etc. I also find that what I accomplish on my own is, while minor compared to what I processed with her assistance at first, is just as real and long-lasting as anything else.

I guess I should also note that I am no stranger to dealing with traumatic memories, and no matter how bad it gets, well, I've been there before and I can talk myself into the safety of the present without a lot of fear or terror about what I'm feeling. Thank God, because that's the only way I'm getting my EMDR treatment. After the last two weeks or so, with me *begging* her for therapeutic tools to help me get past my "trappedness" only to hear that I'm on my own... I'm actually kind of grateful, because my healing really IS up to me and she did me a favor by letting me know, as useless as it was at the time. Also, if I'm on my own then I need not feel compelled to help her understand or allow her oversight of my process: this alone has held me back a great deal.

So I'm not sure whether to "recommend" this to anyone else or not; it's a situation I have very little control over, but it's helping me some and not hurting me at all, as far as I can tell. I have also bought a couple EMDR sound CDs, and I will try those as well just to see if they make it any easier.

Thanks for letting me talk, and for having this board to read through...

[Sandra Paulsen]

You are quite right, that EMDR includes more than the bilateral stimulation. There is the target set up, the returning to target periodically, and when things get stuck, there are supposed to be cognitive (or other) interweaves.

Any therapist who isn't doing the entire standard protocol when indicated should seek consultation from a certified consultant to help them learn what they haven't yet mastered.

A parenthetical comment -- "complex PTSD" is sometimes complex PTSD and sometimes is a dissociative condition. There are special procedures for dissociative individuals. Those special procedures are outlined in the new book by Forgash and Copely "Healing the Heart of Trauma" and will be laid out also in my forthcoming book, "Looking Through the Eyes" is its provisional title.

I don't know if you are dissociative or not, and I am not saying you are dissociative. I simply don't know. But to complete the thought, bottom line, for dissociative individuals, the most potent interweave when processing is stuck is to glance into the "conference room" in the minds eye and ask whatever would come up next to be present. Voila, that usually reveals something that is hiding or pushed away as unacceptable. Often it is shame or rage, or a parent-in-the-mind's eye censoring the work. Sometimes the stuckness is because there is a piece of information (psycho-educational) missing, that the therapist should provide.

That procedure also works, usually, with non-dissociative individuals who really have complex PTSD. I would not expect a person to be able to do self administered emdr using these interweaves, though. It really is the responsibility of the therapist to know and offer appropriate help. Or get consultation.

[MercyMe]

Sandra, thank you so much for your thoughtful reply. After I wrote the above post, I came across Laurel Parnell's EMDR handbook for therapists on Amazon. It just so happens that the excerpt provided is most of the first chapter, a thorough but quick overview of the eight phases of EMDR, and so I was quickly able to narrow in more exactly on what has been missing (specifically, most of the assessment phase, some of the desensitization phase, the body scan, and the debriefing/closing phase).

Armed with that, I went back for my regular appointment today and brought up how, in looking for my own tools and finding my own way as she had challenged, I had reexamined EMDR and thought we could use it more effectively. I tried to be very generous about it, did a lot of soft-pedaling and acting ignorant, but DID manage to completely outline the various missing parts and how I really thought we could gain from them.

She didn't like it, especially at first, but since I was closing most phrases with a, "Would you be willing to help me with this?" or a "Would this be something you could add?" she pretty much had to either assent or refuse. She said she would be willing to incorporate my suggestions, and as the visit went on it seemed more genuine on her part. I think as time went on she got that I didn't look at it as a failure on her part, or a challenge to her professionalism, but that I really do just want her professional guidance and help. So we'll see how it goes.

I do not believe that getting a consultation is in her repertoire, if only because she does not believe she needs one at all. And after today, she may not need one: if this encourages her to brush up and adhere to the entire protocol, every time, then I think I have the best I am going to get in this particular situation. After I return to work and have an income again, I can go to any therapist I like, but this is what I have available now.

I appreciate your comment regarding being dissociative; it's a good point because both types of PTSD, complex and non-complex, are categorized as dissociative disorders. My PTSD comes from an abusive childhood environment -- which I had actually worked through and come to terms with in many ways 20 years ago -- which was revisited in an incredibly bad professional situation. Bullying, physically threatening, lying, false accusations, the whole thing. And it went on, non-stop, day after day, for months. I became like the proverbial deer in the headlights: I just froze.

I knew it was bad, really bad, but I had no clue about PTSD or even that it had affected me in any deep way. I only knew that after I left that job I was more or less crippled and couldn't seem to get myself off the couch to find more work, and figured I just needed to rest and "get over it." But then I started having the whole gamut of PTSD symptoms (horrible insomnia, flashbacks, instant rage, short term amnesia, depression, suicidality, etc.) and when I got help for what I thought was depression, *surprise!* it's PTSD.

I'm statisfied that the diagnosis of complex PTSD is correct, because while I did a great deal of emotional work 20 years ago, and what amounts to cognitive restructuring, I never dealt with the somatic memories, nor did I know that I even had them, nor dissociative ways of coping with profound stressors. So I have spent most of my life piling on the original traumas without even knowing it. The work I did years ago was great for helping me to avoid more obvious and self-destructive reenactments, but there's no question for me that, PTSD or no PTSD, I have been dissociating in some form or another my entire life.

It was telling for me, after being diagnosed, to remember how when these things were occurring at the job I would actually begin to lose my memory of them that same day, and have to work through a mental haze to clearly recall the details when I would think about them later in the same evening. When it came around to accepting the complex-PTSD diagnosis, having seen this memory loss *in action* in myself was one of the things that made me a believer: I knew it was happening at the time, but not why, and it seemed like the least of my problems at the time so I didn't pursue it. The PTSD diagnosis made sense of it, and alerted me to what I had forgotten I had forgotten.

So to tell you the truth, I have no idea whether I am dissociative in terms of the more extreme manifestations of it. I honestly don't believe I am, there are no indications of "others" or alters or whatever, to the best of my knowledge. But I do recall after one major session of EMDR where a specific memory network was unleashed and processed, I had the distinct feeling of having lived my life on the edge of a cliff in the fog: no, I don't have multiple personalities, but in the ways that I have hidden myself from myself, I missed it by only a hair. When I finally saw the depth of my dissociative coping skills, I was -- and still am -- pretty shocked. So if someone were to tell me tomorrow that I am dissociative, it would not be a surprise.

That said, I appreciate the clue on the interweaving technique you outlined. I think I understand what you're getting at; I have never *asked* (as I would another person) but I can certainly give it a shot. It's not very different, as you described it, from what takes place in EMDR anyway -- the openness to, and welcoming of, associated pictures, feelings, thoughts, memories -- so I am assuming it's a more direct invitation of the same. Since I obviously dissociate, it's definitely worth a try regardless of the specific diagnosis. Is that technique also covered in the Forgash and Copeley book you mentioned? If it is, and others like it, I could find a way to ensure my therapist knows about it. She did, after all, challenge me to find my own tools; this would be another one I just happened across in my journeys.

You know, in a way I am very grateful to this woman for "dropping the ball". It really IS up to me to find my way out of this, and her actions have lit a fire under me to do so. If part of that is having to "manage the manager" while I pursue my healing, being direct with her and asking for what I need -- *regardless* of whether I should have to, or whether she should already know and be doing these things in her professional capacity -- then that's simply what I have to do. This has already forced me to look into other things I'm missing (especially somatic memory work, which I think will end up being really beneficial to me) so I can only thank her... especially if she steps up to the plate after today's chat. That would be bonus.

I look forward to hearing your thoughts. Thank you again for your thoughtful response; any and all information is much appreciated.

[Sandra Paulsen]

Well, I must thank you for a post that many many others will benefit from. I'm interested that you recognize that PTSD itself is a dissociative disorder -- hardly anyone realizes that. It isn't listed as such in the DSM -- it's called an anxiety disorder. Some of us think it should be moved over to the dissociative disorders, and construe it as being on the continuum of dissociation.

I'm not suggesting you try your own parts work. If you aren't dissociative it wouldn't hurt, but if you are, well it probably wouldn't work anyway. But it's best done by a professional, rather like a root canal. I do hope you leave THAT to the professionals! (an attempt at humor, that).

I think you are demonstrating considerable skill with the therapist, but really, it isn't the client's job to supervise the therapist's use of a specialized procedure. The eight steps are what comprises EMDR. if the 8 steps aren't there it isn't EMDR. Bilateral stim alone does not EMDR make.

It is a complicated procedure, so lots of therapists need to brush up, read up and get more training and consultation. There are consultation groups in most large cities.

Thanks for your informative post. I'm going to go back and make sure it isn't too triggering. If I end up deleting a few words in order to not trigger others, my apologies. Lots of people with complex trauma histories read these pages, so I'm cautious.

I hope to leave it as is, because it is very informative as written.