PART 4: EMDR WITH CHILDREN AND ADOLESCENTS - 13 to 18 year olds

Here's the last of four posts from the presenters for a previous Iowa Regional Network workshop on EMDR with children and adolescents. Each of four Des Moines area EMDR therapists with expertise in child and adolescent treatment responded to the question: “What would you have liked to know when first trained in EMDR about working with children?” This series of posts are written by those presenters to provide basic guidelines for implementing EMDR with children 0-18. The authors each present tips, techniques and resources to use EMDR therapy in working with children and adolescents.

Elyse Harper, LMFT, is in private practice at Waukee Iowa, providing EMDR psychotherapy with all ages. She is also an Approved Consultant, EMDR Basic Training Coach as well as an EMDR Specialty workshop presenter. Elyse shared creative and impactful ways to engage and treat 13-18 year old adolescents with EMDR psychotherapy. Here is a summary of what she had to say, her responses to several questions raised by the participants, and many resources/links that she uses:

"What would I have wanted to know?

The mechanics of the EMDR processing phase are the same as when working with an adult, unless the adolescent you are working with is developmentally delayed.

If your adolescent lives in a less than ideal home environment, they can still significantly benefit from EMDR. therapy. This is because adolescents have often formed meaningful relationships outside of the immediate family, and are also able to think abstractly and challenge family belief systems.

Some adolescents are very open to and intrigued by EMDR, and some are very skeptical and hesitant. Therefore, I discovered early on that I would need to find ways to get adolescent clients to “buy in” to therapy and the EMDR approach.

Below you will find some considerations and activities to help assess, collect history/information, and create “buy in” with your adolescent clients!

What do teens want?

-To be cool/popular

-To be attractive/confident

-Relationships!-friendships and romantic relationships

-To create/find their identity

Activities

-Don’t be afraid to bribe with food! Teens are nearly always hungry and a blood sugar boost can do wonders for their mood and level of cooperation.

-Sometimes it is easier to identify adolescents' negative cognitions by asking them what they imagine OTHERS think/feel about them.

-Have them do formal or informal “personality quizzes,” many of which can be found online for free. This gives them a chance to learn something about themselves and is also a non-threatening way to share things about themselves with you. Discuss the results, noting that oftentimes the teen wishes they were different in some way. Here is an opening to explain the AIP model and how past events impact current behaviors and emotions. Now you’ve got yourself an adolescent ready to dive into EMDR! Here's one option:  The Cube Test, among others, is a fun projective test. All of my adolescents love this and it can be used to assess subconscious beliefs! Here’s one site for the Cube test and other options: Owlcation.com

-Have them design their dream persona (wardrobe, piercings, hair color etc.) and have them explain what that persona would show or say about them. How is that different from what they show the world now? What aspects of themselves are hidden? Why are they hidden? Then, you can explain how EMDR can help them “come out of hiding” and be closer to their “best self”.

-Have them design their own tattoo. You can gain a wealth of information from this activity!

-Have them create the soundtrack of their life/situation-what is their preferred soundtrack?

-Sometimes, if an adolescent powerfully relates to a song, you can add bilateral stimulation while they are listening to the song.

-Allow them to share their favorite movies and TV shows-who they admire, which characters remind them of people in their lives, who they relate to etc.

-Don’t be afraid to look at their Instagram, Twitter, Snapchat, or other social media profiles if they offer. There are often a lot of quotes that they relate to, and you can see how they are representing themselves to their peers.

-Many adolescents have their own YouTube channel where they post their own videos and subscribe to others’ videos that they relate to or are interested in. This is great rapport building and can often provide a doorway into talking about their trauma in a non-threatening or more detached way.

-Video games- Is that their social outlet? What does their avatar look like? How are the other gamers treating them? Do they use the game as an escape? What kind of escape are they looking for?

-Let the adolescent read their case note- if you are wrong they will tell you!

-Have them write a letter to a past or future self. This provides a good opportunity to let them know that old perceptions aren’t always reality and EMDR can help provide a clearer picture of the past and a brighter picture for the future.

Responses to Participant Questions:

  1. Emotion regulation ideas for teens who get very distressed, depressed, self-hate, cutting.

-Prayer and/or Meditation

-Holding an ice cube (simulates the sensation of cutting)

– Give them craft foam to tear (helps release tension)

-Playing catch in session if you see them start to space out/dissociate

-Have them suck on ice/chew gum if you see them start to space out/dissociate

-Other grounding techniques—many sources. Here’s one: Top 21 Anxiety Grounding Techniques

-Listen to POSTIVE/upbeat music

-Watch a silly video

-Teach them how to do Safe Place at home

-Teach them how to do Light Stream/Spiral technique at home (found in Francine Shapiro's Getting Past Your Past, 2012)

-Teach them how to do “Butterfly Hug” at home

-Give them a list of alternatives/coping skills to utilize instead of cutting such as Alternatives to Self Harm

-Teach them The Butterfly Project”. Here are the directions: “Draw or have someone draw a butterfly on the place you usually self harm and name it. This has to be the name of someone special to you that wants you to stop cutting. However, if you cut, you kill the butterfly. To keep the butterfly alive you have to let it fade on its own. No scrubbing!”

2. What to teach parents of above teens, if relationship permits?

-Do not allow teens to isolate themselves!

-Allow teens to share feelings/emotions without parental judgment or giving unsolicited advice

-Have a safety plan in place

-Teach parents what to watch for (child wearing long sleeves, increased secrecy/time in bathroom etc.)

-Teach parents how to SUPPORT child, not just CONTROL environment

-Teach parents that this isn’t bad behavior, but a misguided attempt to regulate emotions/self soothe.”

 Recently Elyse expanded on working with adolescents in her presentation for one of our EMDR Brunch & Learns: STUCK? Now What? Working with Resistant Adolescents and Adults. This was packed with more ideas, tips, and an additional trauma processing resource developed by Elyse called The Hallway. Her presentation received rave reviews and we hope to develop this in future as an online course

Thank you Elyse for these ideas in your resource-rich post!You can contact Elyse at elyselmft@gmail.com

Bonnie Mikelson LISW
Director, EMDR & Beyond