Here is Rich’s AIP-informed military specialty case presentation.Unknown Object I have added a picture of Rich (left) with Francine and another fine military EMDRHAP trainer in training, Danny Henry, representing the US Army.Danny and Rich are doing wonderful work in training as well as treatment and we were most blessed to have been with them in California.
Military Specialty Case prepared by Richard Smith, reviewed by Francine:
a. SM came in with this presenting issue: “My Anger”.
b. Key Initial Questions
i. What are the unprocessed maladaptively stored memories that are contributing to his anger
ii. What are his present triggers?
iii. How does he want to see himself functioning in the future?
2. Examples of Anger (Demonstrations)
a. Arguments with his wife (couple’s therapy was not a goal for tx for him as both he and—by his report—his wife had determined that their conflict was by in large a byproduct of the PTSD).
b. Yelling at his kids
c. LOUD verbal confrontations with his neighbors for parking too close to his spot and allowing trash to blow into his yard.
d. SM is clear that “I’m too angry about this small crap and that’s why I’m here”.
e. So, I know a little about his present triggers and a little bit about his desired functioning for the future—that he doesn’t want to overreact or “go off on people”. However, I don’t yet know about the specific unprocessed memories.
3. SM reported the following:
a. “I’m an E-8 and been in for 19 years. I’ve done six tours in Iraq, and was awarded the bronze star”. SM went on to report that going after “the deck of cards” was his job (the initial boots on the ground in Iraq were issued decks of cards with the faces of Iraqi leadership). SM reported that finding them “was my job—and I was very good at it”. SM added that “Some of what I did I’m not too proud of” (interrogations). SM noted that he was imbedded with special ops and grew close to them such that his departure was difficult for all involved. SM added, “Anyway, I’ve been dxd with PTSD and that’s why I’m here.”.
b. So, what do I know at this point? Some memories from his time down range—however vague—are unprocessed (i.e., things he’s “not real proud of”). However, is he also able to engage in positive accessing (i.e, does this soldier have strengths, skills, abilities, talents, achievements, and resources that are apparent to him)? Yes.
c. Taken together, he summarized by stating that he had been dxd with PTSD and he was trying to make to sense of it.
4. My explanation: “Maybe I can help”.
a. “First, the past is present”. He said, “ok”.
b. “Next—sometimes when he go through difficult experiences [some military personnel may be defended against the word “trauma”—so, basically, I don’t want to penetrate or even challenge any emotional armor that may be “up” during this first session], painful information from these past incidents can become stuck” [He said, ‘ok’]. So, what kind of information are we talking about? It’s about sight, sound, smell, taste, and/or touch-related aspects, painful emotions, unsettling physical sensations, and negative beliefs—those darker conclusions we can come to about ourselves and others in a given context. So, those painful aspects become stuck—painful then/painful now—stuck then/stuck now—affecting the quality of our daily life”.
c. “So, what we want to do is get that information unstuck. We want to jump start that information processing system, and the way we do that is by engaging [I purposely use the word “engage” as sometimes we hear that term in the military community—e.g., engaging the enemy, the conflict–or mission in which we are engaged, etc) in a series of eye movement drills—eye movement exercises [drills and exercises are common military terms having to do with preparing/practicing for the mission]. And we find that when we do that, the pain we were talking about that has been stuck is released. Another way to think about it is that it was stuck but becomes digested”.
d. “This is not memory erasure stuff. You’ll still be able to remember that it happened, but that memory without the painful sensory parts, emotions, physical sensations, and negative beliefs (those darker conclusions), is simply a memory that gets re-routed to its appropriate place in the filing cabinet [pointing to the back of the head] rather than hovering close to the surface and sticking you in the eye at inappropriate times”.
e. He had no questions, so I explained to him the following:
i. We’re going to complete a hx of events to see which incidents are contributing to current distress.
ii. However, I’m not going to ask for any details except for type of incident, age at the time it occurred, and SUD (level of intensity or distress) for each incident.
iii. Also, I want to know more about your strengths, skills, abilities, talents, achievements, and resources because we’re not simply the sum total of all of our traumas.
f. From that, we developed a list of targets that are explained as unprocessed memories—“those weeds that need to be pulled up from the garden—those viruses that need to be removed from the hard drive to allow for more efficient functioning” (from my experience, keeping the verbiage more technical and less emotional seems to be useful for this population) :
i. Multiple childhood incidents (molested by clergy, “100 incidents of physical abuse by dad”—about 5 or 6 came to mind readily).
ii. Six tours in Iraq, 9 incidents.
iii. SM advised that “I don’t want to work on that childhood crap”, so I explained to him that earlier painful experiences can lay the foundation for current reactions. This seemed to resonate well with him, so we agreed to reprocess the incidents of the six tours in chronological order . I noted that we could certainly do so but suggested that he be aware that these earlier incidents might come to mind as the brain associates and connections can be made. “So, you have an opportunity to observe and report [this is a common military phrase which we emphasize in the military trainings], and I’ll just serve as the guide in the process”.
iv. I forgot to mention at Sea Ranch that I also showed him a couple of different anger as a secondary emotion models early on in treatment just so he would be aware that other emotions (e.g., disappointment, sadness, hurt, shame, guilty, betrayal, fear, etc.) might surface [I did this so he wouldn’t be caught off guard and to help normalize that process].
v. We reprocessed the incidents from all six tours. There were two that were particularly difficult for him. One was a Iraqi MP station they visited. It was there that they discovered a small family in a closet to include a mother and her two young children. Through a translator who was reportedly “very good with women and children”, he found out that the police there had been gang raping her daily for six months in front of her children. The next day those 10 cops were summarily executed. The SUD resolved to zero with a VOC of 7 and CBS. This was also the case during Phase VIII.
vi. Another incident involved a Navy Seal. SM was originally furious that the Seal had opened fire on his position with a new machine gun that can fire several thousand rounds at a moment’s notice. SUDS was originally a 9 or 10. It resolved to zero with a VOC of 7 and CBS. During re-evaluation, SM stated that “I watched it on youtube”. I was surprised at this given the classified nature of his work, but there it was. He said, “When I did it, it was like watching a movie. And, I started to think about it differently. It occurred to me that this guy was a 19 y.o. kid who got shot at and he got scared, so he made a mistake in the fog of war. Actually, I kinda feel sorry for him because he has to live with that for the rest of his life”. There was no distress.
vii. After the memories from his time downrange were reprocessed, SM had a conflict at work for which he experienced considerable distress. Remember that he was quite defended against addressing childhood issues. So, we targeted that incident. Part-way through the session, he said, “Hmmm. Some of this is reminding me of my dad”. SM went on to report that “I’m afraid” of reprocessing those childhood memories. This is someone who had successfully completed six tours and was a decorated hero. I reminded him of the great success he had had thus far and suggested to him that we could also target these other experiences chronologically. He agreed. After two sessions, there was a generalized effect such that the remaining SUDS for the other memories changed to “zero”.
viii. As for the future template, SM had originally wanted to be able to react calmly at home with his wife and children (and was able to do so). At work, he wanted to see himself reacting more assertively and was indeed successful.
ix. In sum, this is a person who fought for us repeatedly–facing terrible adversity along the way. Then, he came home and once again in heroic fashion opted to take a look inside and slay the dragon. I am very proud of him!"
Each of the case presentations of successful EMDR healing were very moving to all of us. I hope to share more as we catch up with
Rich and get ours written. Meanwhile, this couldn't wait. It is not only educational regarding treatment of war trauma but also an
excellent EMDR case outline. Thanks again, Rich, for sharing.
Bonnie the Blogger