Re:Exposure and retraumatization

I think I am with you. That said...

I wasn't worried about exposure being less safe. I should have come back earlier and made this point. My concern is compliance. Is it easier for client and clinician to comply with the EMDR protocol than with an exposure protocol?

With medications (Rx) compliance has a lot to do with prescribing. Sometimes this is taken to ridiculous extents (weekly prozac, in my mind) but once vs four times daily dosing of antibiotics for small children is a good example of making it "easy to comply", for everyone's benefit. Pt stays away from dr, takes less time, pt complete course of (drug) therapy and gets better.

Now as for what I meant by trauma, I think I meant (and I am sorry to not then or now be entirely clear in my own mind as to my meaning) the "felt sense" of one's life being in danger. I use this broadly, to include a childlike sense of being in danger, which would go vastly beyond the DSM definition. For a child a loss of attachment is life threatening (or can be perceived as such).

My own experiences in therapy have indicated to me that my "felt sense" of the therapist's constancy and attachment to me is vastly decreased when I bring up "nasty details". I have had therapists abruptly interrupt an account of abuse. I have had therapists express disgust and discomfort.

I love, for the record, the idea of exposure therapy. Show me a therapist who will listen to every detail and allow me to work it all through sequentially... and you've got yourself a convert to exposure therapy. (In my own treatment, my "shame" has had to take a back burner to therapist aversion and horror.) So, my point was, in the typical office, (not in a research setting) how do therapists behave and what works best? What are clinicians more comfortable with, and what is best for clients? Which technique will preserve an attachment (rapport, if you will) between client and clinician, as is desirable for efficacious treatment?

For the record, I have heard of horribly administered EMDR as well... I know problems with compliance to protocol don't exist just with exposure therapy. I am just wondering, if "in the field" exposure or EMDR works better. That seems to be the larger point to me: how does they work in the day to day practice? If one is going to do either emdr or exposure IMPROPERLY which is better when done badly?

I know the question sounds ridiculous from the research point of view... but I am talking "real world".

Thanks for your responses.

PS I'm all for therapists keeping their mouths shut... and I do think the stance of EMDR of "noticing", non-disclosure and a "safe place" faciliate internal and external silence, as do the sets of bls.

Replies:

Re:Exposure in the real world, by Client, 02/07/03 Re:Exposure in the real world, by Cahill, 02/07/03 Re:Exposure in the real world, by Ulrich Lanius, Ph.D., 02/07/03

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