Welcome to one of four posts from the presenters for the Iowa Regional Network's recent workshop on EMDR with Children and Adolescents in 2013.  Each of four Des Moines area EMDR therapists with expertise in child and adolescent treatment were asked to respond to the question of what they would have liked to know when first trained in EMDR.  Each discussed techniques and resources utilized in order to implement the 8 Phases of the standard protocol in working with children and adolescents.  I am delighted that they all agreed to post a summary of their presentation on this blog to benefit EMDR IOWA and the broader EMDR community.

Kenya Randall Rocha, MS, LMHC, is Director of Mosaic Family Counseling Inc., providing a variety of bilingual treatment services including EMDR psychotherapy with all ages. She is also an Approved Consultant and EMDR Basic Training coach.  Here is a summary of what she shared with the group and the many resources she used in working effectively with children, and a powerful case example:Unknown Object

“What I wish I had known when I began working with children using EMDR:

Children process much faster than adults or an older teen.
It is harder to gauge affect tolerance, because they don’t always show emotions the way an adult does.
Children don’t always show congruent affect
Children dissociate as well as adults, though it may look like boredom or sleepiness. It is important to keep them in their body and in the room. Movement will help them to stay engaged enough to process, such as using a ball to bounce back and forth using one hand at a time. This will provide BLS and guide the story telling from the child, assisting the child to move through unprocessed memories. I have a balloon in my office that has stickers and words on it, they get to choose the stickers to put on it and this can help with positive installations.
I have the children choose clip art (preselected) to identify their negative emotional states and coping skills (behaviors reframed) as well as their NC's. You can put that on one sheet, and on the next sheet, we put clip art examples that shows how they want to be for their PC. Use BLS, then have them identify from the positive states sheet how they feel. The children are engaged in the use of the computer to do this and they feel good about the ‘project’ we are doing.
Movement when they are bored is also important. Being bored can be a way for them to communicate to you their disengagement from the process.
The place I start with preparation is to teach children how to label their emotions. – I use this for kids up to 10 years old depending on their developmental level.
Makes it important for kids to be able to label their emotions and have a better understanding of them. Use Sesame Street Emotions from YouTube. This is fun and helps the child to label their own emotions.
http://www.youtube.com/watch?v=EAqGGpj0Ans Kermit and Cookie Monster (happy, mad, sad) http://www.youtube.com/watch?v=vS0y47wlP1U – Elmo Emotion Ocean (love, mad, hungry, joy) Not human faces – Good for kids on spectrum – may tolerate them better

http://www.youtube.com/watch?v=hO3M60RO7rk Richard Pryor (happy, sad, scared) Human face http://www.youtube.com/watch?v=sTziMz8ukSg&list=PLpYp7q0TWMPnWiTY3Wfi7q0i2j25KWNQK Big Bird and Margaret Cho – human face

Can help kids recognize the reasons people experience these emotions. – better for older children

http://www.youtube.com/watch?v=Lqwq5ijLv-M emotion commotion – older kids

http://www.youtube.com/watch?v=UsISd1AMNYU – emotions song 3 minutes –

normalizes emotions – lets kids know that emotions change all the time.

There are many more to use:

Use a ball with feelings and open ended questions written on them and bounce the ball back and forth having them answer the question their Left thumb lands on or closest to… This helps to process content and put things in your mind for target sequencing – tying it all up together – creating a better picture for yourself – assessment phase, preparation phase

Play banana grams with feelings words and they have to tell a story about the word they use, you have to as well – give examples.

Drawing:                                                                                                                                                                           You draw a line and ask them to draw more lines and make a scene, then tell the story of what they drew. I keep a big sticky note pad on my wall and we often sit next to it and draw our scenes that have a direct connection to traumatic incidents. You can use this activity to draw out things in their timeline in order to create their targeting sequence plan.
Draw a body and ask them to draw, mark or color in the area of their body they feel the emotions we have                   learned.

Ask the child to tell you a story about someone who feels this emotion in that place in their body.

9. I wish I had understood dissociation better for children, particularly how to keep them present in the room. I use Ana Gomez’s (see EMDR Resources) idea of asking the child to gauge for me how ‘in’ or ‘out’ they are. She uses a dial – a clock adapted for all the way in, half way in or out. Body movement, any dual awareness activities such as listening to music or moving with the music helps children stay present.

In order to help kids to practice 'all the way in' and understand this concept, I use the Mouse Cookie book. It is called Mouse Cookies and More book (If You Give a Mouse a Cookie…a Moose a Muffin… a Pig a Pancake;  If You Take a Mouse to School… (see EMDR Resources).

10. Pacing with children is different than adults, . You have to have attunement with the child to read their emotions and be able to pace them. This includes interpretation of their play,. When they are over-accessing emotions it is often a behavioral expression. When they are overstimulated, showing anxiety, help them to resource and self calm. To learn learn resourcing, use stories to help them identify who or what in their lives represent nurturing, protection, wisdom, calm place – you can use books that address these kind of issues to help them form a concept of these places. Dream Weaver book (see EMDR Resources) is one example.

I would have liked ready resourcing for children to engage in. For children who don’t have ready resources, we create things like magic blanket or magic bubble, using parents as anchoring and containment . Parents hold the children to remind them of feeling safe (if appropriate), helping child to utilize positive memory networks, remember times they were happy and pairing them with positive self-statements for the child: “Remember when we went to the park and you helped push your sister on the swing, you were such a good big brother, you are really important to your sister” or “Remember how hard you tried at .. You are so important to us.” It is important to be specific in finding times that link with positive feelings and beliefs .                                                                                                                                                                                                       12. Often, the parent can’t be safely used as an anchor. You then have to install resources for the parent and use previously identified resources with the children. I have had kids want to use their teddy bears, sense of comfort, or bring in items from home.
CASE STUDY

7 year old Tommy's history of abuse included witnessing domestic violence, mother drunk and being beaten, brother being kicked, taking his brother and hiding him in a closet to not get beaten (2 yr difference in ages). Tommy came to therapy exhibiting extreme behaviors, had to be put in the time out room – with padded walls – unsafe, throwing chairs and calling names, rocking- dissociation from things around him, felt helpless to stop himself. He had many attachment disordered behaviors.

I worked with him to identify good feelings, when he had them, how to remember them and use them to redirect self, using butterfly hugs and self-tapping for calming BLS. I also helped him to understand and normalize his behaviors to himself.

Tommy used his adoptive father as his anchor. Father had worked very hard to help this child recognize positives about himself in the face of all the phone calls –several calls a day–about behaviors at school, etc.

This child’s negative beliefs were “I don’t belong, I am bad, I am not good enough, I have to make sure my family (stuffed animals) is ok” by controlled things with anorexic behaviors. He had a wall against peers, with additional NC's “I am not important or smart enough. My mother chose her boyfriend who beat her and abused us over us. She didn’t love me, I am unlovable.'

Preparation phase with Tommy started with identification of positive emotions and recognition of where they sit in the body. Then we moved to when he was having negative feelings and where they sit in the body. We identified times he was happy and confident, then identify incidents of trauma which were targets that caused him great fear and PTSD.

When Tommy went to live with his aunt and uncle, he would put all his stuffed animals at the table, have to make sure they ’ate’ before he did, he was displaying anorexic behaviors refusing to eat certain things, obsessive about what could and couldn’t touch on his plate, he felt completely out of control. His memories of being confident were of himself being able to be in charge of himself, not having to answer to his mother who ignored him and allowed him to be outside until he wanted to be This was also part of his difficulties when he went to a new home and had rules “HAVING to be a kid”. We used EMDR to help him change his mind set about this.

One day he came in and flopped on the sofa and said “ I need the buzzies! I am so angry I can’t control myself. I know that when I was with my birth mom, I was in charge, I could do what I wanted and now I can’t and I have to be a kid”. He used the buzzies and ‘let go’ of the need to be in control of everything. He knew he was better being a ‘kid’, but couldn’t rectify this with being in control of what he wanted to do, when he wanted to do it. Previously, he was in charge of protection of his younger brother only because he put himself in charge. His mother was more attached to his younger brother and his father who was no longer in the picture due to addictions and criminal behavior , so Tommy was his only advocate.

His resolution was that he is more important than he had believed; that being a kid, although not always getting his way, was the more fun way to be and probably better for him. He identified that his mother was incapable of making good choices and that he could make good choices.

He went from being inpatient and on the verge of being placed in a school that was ‘better equipped’ to handle his outbursts of anger and inappropriate behaviors to getting 98% green days last year to all ‘green days’ this year so far. He still has processing to do related to some past abuse, but he has done a wonderful job of becoming more in control of his own behaviors and emotions, so that he is the ‘good one’ now.”

Thanks Kenya for these great ideas and the encouragement from the case you shared! You can put comments or questions here or contact Kenya at Krandall@mosaicfamilyinc.com or leave a message at her website www.mosaicfamilyinc.com.  I have the privilege of working with Kenya in her EMDRIA Consultant in Training process. While in training, she is available for 15 of the 20 hours required for EMDR Certified Therapist EMDRIA Certification. She should complete her hours for certification consultant by July 2014. It is exciting to have her join Susan Arland and myself in the Des Moines area in offering EMDR clinical consultation to the growing EMDR IOWA community.

 

Bonnie the Blogger