EMDR Resolutions with CISM and Brief Treatment

• EMDR in practice by Greg Patrick, LCSW, 7/28/97
  
  

I am interested in recent postings and I want to offer a description of my use of Eye Movement Desensitization and Reprocessing (EMDR) and comment on what I experience, possibly as the most important aspect of the method. I have considerable appreciation for Dr. Roger Solomon’s experience and teaching regarding this topic (see his posting, this section). My comments here are not new to those who use EMDR, however they emphasize an aspect that is so important that I hope discussion of it is still useful.

EMDR has been a major part of my work in community mental health since 1989. Because I do primarily critical incident management and crisis intervention, the number of sessions I spend with a client is limited to no more than a few. Therefore, I generally use EMDR with clients who have experienced a recent (or relatively discrete) trauma. When I encounter dissociative disorders, multiple unresolved traumas of childhood, or histories of a very severe nature, I refer to other EMDR practitioners in my community who are able to see the client over a greater number of sessions and use the method combined with a wider variety of strategies.

Targeting clients who have experienced recent trauma, I often use EMDR together with CISM interventions including, but not limited to, defusing, debriefing, 1:1, and several educational and supportive strategies. Clients have benefited from EMDR together with a variety of CISM interventions (always including information about psychological and physiological impact of trauma) to prepare them for a group debriefing when they want to participate but are too traumatized to do so without additional assistance. Also, clients who have not fully resolved their symptoms following other CISM interventions frequently are able to move forward after participating in brief EMDR treatment.

Persons who, in my experience, have benefited from EMDR include emergency personnel dealing with a wide variety of critical incidents (often line of duty death of close associates), people dealing with suicide or other traumatic deaths of family members, parents dealing with loss of children, victims of crime, etc. EMDR work with the citizens and emergency providers of Oklahoma City following the bombing of the Murrah Building is among the most encouraging work I have been privileged to be part of during my career. The reason it was so inspiring is that gains made were frequently both rapid and profound, and methods of resolution were particularly uplifting to those involved.

Aside from the rapid and thorough treatment of signs and symptoms of trauma, I have been most struck by the recurrently unique, individualized resolutions clients come to as a result of the use of EMDR. Presumably this is because EMDR work is done largely by the client, with assistance, but not usually direction from the clinician. Certainly our professional understanding of trauma is increasing rapidly and competent practitioners must be familiar with the patterns of likely resolution for a variety of traumatic experiences, however clients in my practice seem to move to more original resolutions with less guidance from me since the introduction of EMDR.

The work, though brief, now takes many more invigorating, surprising and transformational turns than with many other approaches, and the level of resolution and individual variation is much greater now. Previous outcomes, especially in very brief treatment, seemed more homogeneous, often helping traumatized people live more creatively and comfortably with a considerable level of pain or dysfunction. Now I see more clients freeing themselves from the pain and/or transforming it to illuminating and often liberating resolution. It is certainly this dynamic, in part, that Dr. Shapiro identified when she added "reprocessing" to the constellation of words describing EMDR.

In my clinical experience, dramatically individual variations of resolution are a common outcome of EMDR and outcomes appropriate to the client’s unique needs seem far more hopeful and exciting than before. When I began using EMDR, I was looking for effective workable reduction of the pain clients endured and often adjusted to following their traumatic experiences. What I observe now, however, is somehow far more unique and individualized, evidencing more complete resolution of symptoms and a more affirming view of self, others, and the world. Thus EMDR shows itself to be highly respectful of the client’s own strength and resiliency and greatly encouraging both to me and to them.

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