Interweaves and Other Techniques for Under Accessing

         As EMDR clinicians it is important to know how to keep our clients in their window of tolerance. This post focuses on those clients who are hypoaroused, underaccessing the material we are trying to activate in Phase three of our work for processing through the distress.   This material is adapted from Dr. Joany Spierings’ EMDRIA Conference 2011 presentation, (Non) Cognitive Interweaves for EMDR, She gave a day’s worth of specific ideas and techniques, fully developed and applied to client examples.  These are summary samples, with a few additions from my own practice.

Bessel Van Der Kolk says the most difficult clients are those that numb into hypo arousal. The very skill that allowed them to survive can be one of the most powerful blocks to reprocessing traumatic material. You can use several of the ‘opposites’ of what you do for over accessing, such as bringing the image closer or adding/asking about color. Many of Spierings’ techniques act out, often with props, to dramatize challenges to blocks from dysfunctional (in the present) beliefs. Repeatedly she reminds therapists to “Ask the client!”

Common Fears and Blocking Beliefs

Spierings suggests that we validate that they have a very good reason for numbing or blocking and ask them to share what it is. This is similar to ‘going with the resistance’ in systems therapy. They may have a long held blocking belief (as in Jim Knipe, Ph.D.s work, cited below) that needs to be addressed first.  Some of her techniques to explore the underlying fear and/or blocking beliefs are listed below. (Dr. Jim Knipe’s Blocking Beliefs Questionnaire is available online at: http://www.emdrinaction.com/article/blocking-beliefs-questionaire-jim-knipe-phd

Loss of control–if client’s style is more mental, ask them to imagine letting go of anger/sadness; if physical, provide safe ways to act it out or speak it out “what did you need/want to say that you couldn’t say then?”

Being disloyal—“would you want your child to ‘owe this’ to you?”

Betraying parents—reinforce confidentiality; use third person examples “what would you say to… about this being a betrayal?”

Breaking vow of silence/fear of punishment or revenge. If they say they can’t "what would you say if you could?” Or you make visible what was done to them by externalizing their problem through ‘props’ or acting out.

Guilty/to blame for part/all—use adult perspective; educate about fight/flight/freeze to submission; ask “what would you say to your child?”              Act out or script accusing ‘another’ victim and have the client be the victim’s defense.

Not being believed—reassurance that you believe them or their pain; reminder that we are working on their perception of experiences; reasons why others may not believe like protecting themselves, loyalty, their own fears, won’t believe this depth of evil/harm happens as a challenge to their world view; if you have information that they would have been believed by loved ones, ask “what would ____ do if you did tell?” to access positive nurturing and support they received in the past. I had a client whose mother died in her teens, without the client telling her that she was being molested. She was able to process through to realizing that her mother would have protected her and they would have left the situation where it was occurring. This was a very powerful shift in her healing.

Not possible to heal—use metaphor of body naturally healing from a cut (Shapiro), or abscess nee

Not possible to heal—use metaphor of body naturally healing from a cut (Shapiro), or abscess needing to be cleaned out. It’s their own brain that does the healing, that’s always working to integrate such as in REM sleep, so I suggest we won’t know until we try.

Memories are ‘made up’, not real—“to accomplish what?” Distress can be addressed without ‘proof;’ it’s their perceptions of trauma that are in need of healing.

Being even more damaged than they thought—“who owns the ‘dirt’ that damaged you? Give it back to them”; psycho education to strengthen their adaptive information network, as you cannot access what isn’t there; stop EMDR and teach skills that are missing; Spierings gives an example of a retarded woman who was raped who did not heal until she was taught, by practicing, to say no. Many of my childhood trauma survivors

Losing your old self or identity—“what do you need to keep? How is that useful to you now?”

New responsibilities—explore underlying fear or blocking belief; connect to strengths and resources, development of RDI

Others that respond to reassurance and strengthening the therapeutic relationship:  trauma is beyond the clinician’s strength to bear; being judged; losing the therapist; trust; and, abandonment.

When the fear is of being like the abuser— use a ‘staccato of challenging questions like “who thought it up, who worked it out, who took the initiative, who wanted this, who enjoyed it, who insisted on it?” Use sunglasses to deal with the “I am bad” NC—have client describe the room with/without sunglasses, then ask “Did the room change?”  From Shirley Jean Schmidt www.dnmsinstitute.org), ask if them to see if there is light in themselves and in the abuser.  Victims typically see light in themselves, even if tiny, and darkness in the abuser.

To assist in relearning how to cry, ask “Where and how do you block your tears?” If there is a specific fear of being unable to stop crying, you will “help them through”; 

 “we will stop in time”; have client set a time frame, reminding them they have demonstrated experience in not crying, another ‘going with the resistance’ technique. If the fear is that crying means the abuser won, remind them that not crying was important then, but healing is more important now. Ask “What is the underlying fear?” which is also useful for clinicians to consider as well and possibly do personal work to address.

Non Cognitive Interweaves

Teach setting boundaries such as saying no by using a rope “It is everyone’s right to decide where their boundary is.” Script out their fear with detailed scenarios to challenge distortion or unrealistic predictions “fear is not a prophecy.” Externalize their actions and emotions through pictures; have them draw a picture of the abuser and then destroy it any way they choose.

With bad parents, survival is more important than anything else. Guilt may be an illusion of control, easier to maintain than fear. If guilt is realistic, assist with resolution such as seeking forgiveness or making amends.

. “No therapy can take away realistic guilt.” Guilt may be due to secrets, such as having received presents or special privileges.

Work with the physical sensation. One way is to use a taskbar (see Shirley Jean Schmidt MA (www.dnmsinstitute.org ) or a stretch band to unblock and clear strong emotions.  Have them locate the emotion in the body and pull hard with the taskbar or stretch band under the feet as strongly as possible, then release. I have found clients can do this on their own with exercise equipment such as rowing, once you know they can manage the affect. The key is for the client to focus on the body location of the strong emotion while doing the exercise.  For those who have health issues that limit use of legs, you can also have them put the stretch band over their back and pull or stand in a doorway pushing on either side and then release. You can also target breathing or use mindfulness to identify emotions and body sensations.

Dr. Spierings is known for her standup comic routines on EMDR (which I haven’t had the pleasure of seeing), so she is not only funny but clearly uses her drama skills to good effect in her psychotherapy and presentations. Not surprisingly, she uses humor as an interweave as well. It is truly worth hearing her present if you get an opportunity. 

She challenges us to become more active, to get beyond the cognitive interweave, to creatively add movement, drama, props, and other activities. A final message she left with us and a useful ‘push’ for me is “Make your client DO things.”

Bonnie the Blogger