PART 2: EMDR WITH CHILDREN & ADOLESCENTS - 4 to 7 years old
Here's the second 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.
Dorothy Lifka, LISW, Ed.D is in private practice providing EMDR psychotherapy with all ages. Dorothy shared creative and impactful ways to engage and treat 4-8 year old children and their parents with EMDR psychotherapy. Here is a summary of what she had to say, her responses to several questions raised by the participants, and resources that she uses:
"Young children ages 4 to 8 years of age may not know what “therapy” is and/or may not know why they've been brought to see a therapist. One of the questions I ask children in the first session is why their parent brought them to see me. If they say they don't know, I ask the parent why. The adult may need help from me to keep the explanation general and non-traumatic. For example: “We've had some ‘touching problems’ in our family.” I say that children might come to see me because they are worried about something, because they are having trouble managing strong feelings, because of scary dreams or because something scary happened to them or to someone in their family (or other examples that fit the child's age and reason for being there).
I also give examples of some things we might do in therapy: talk about feelings, draw pictures, play games, use the play therapy room or use the sand tray. I give Joan Lovett's example of her own car accident, described in her book, Small Wonders Healing Trauma with EMDR (2010)-see Resources), to explain to the parent how traumatic experiences can have unexpected triggers. In Joan's case, her children eating snacks in crinkly bags or munching on crunchy foods triggered memories of her car accident. This can help parents understand the connection between their children's annoying and/or concerning behaviors and traumatic events.
For young children and for children with attachment issues, with complex trauma, or living in foster or adoptive situations, establishing therapy as safe and myself as a safe person is key. Children who use the playroom as their safe place may be telling me that there is no other place in the world that feels safe to them. Other children may need to use a safe state or a good feeling they get from a healthy activity such as riding a bicycle or swinging on a swing instead of a safe place.
The term “safe place” may mean different things to children than adults. For example, one five year old chose the basement as his safe place because that's where he was supposed to go if there was a tornado. I often use the term “happy place” instead. I have several dry erase boards of different sizes in my office and find that many children in this age group like to draw while we talk. This keeps their hands busy and they are better able to pay attention. Some of them like the dry erase board because it's easy to correct “mistakes” and because you can make what you drew disappear if it's too upsetting to look at it. Usually children will let me snap a picture of what they've drawn before they erase it.
Gregory, age 4, was brought for therapy because of a recurring nightmare of being in a car accident and being thrown through the windshield. Adoptive parents reported that this had actually happened to Gregory when he was 2 ½, but they hadn't thought that he would remember it. I introduced tapping to Gregory as a way to help with the scary dream and tapped on his shoulders as I told the story of his “dream”. Nightmares were resolved after one EMDR session.
What I wish I had known to do then is to use EMDR to help Gregory and his parents with the more complex story of how the car accident led to his removal from his mother and eventual adoption. However, I don't know if the parents would have wanted to go beyond addressing the presenting problem.
I use buzzies or tapping, especially when children are playing or making a sand tray. Eye movements, sometimes with positive or power figures such as a dinosaur or super hero held in my hand are used with the metaphor that ‘EMDR is more powerful than the bad thing that happened to the child.’ Head phones can be used alsowith children, if they can’t track eye movements, or don’t like to be touched. . Some children are also bothered by certain sounds,so I improvise by snapping my fingers or clicking pens at their ears or having them drum. Children may like using Patty Cake hand gestures for BLS with made up words, especially for resource installation. An example would be ‘Dorothy, Dorothy, she's so cool. She likes to read when she goes to school.’
Many children of this age can only tolerate trauma processing for a short period of time. Sometimes I use a timer to show them how long we will “work,” with work sandwiched between activities the child chooses. Parents can be used to help children (and even adolescents) feel safe during EMDR. The child can sit on the parent's lap or snuggle against him/her. The parent can tap on the child to provide BLS while the parent uses the buzzies or the therapist can provide BLS to the parent. It is important to be aware of any aspects of traumatic material that may be traumatizing to the parent. For example, during trauma processing with a child who knew something bad had been going on in the basement (it was a meth lab and the parent didn't think he knew about it), mother needed help with her own reaction to the trauma material.
I often teach parents the safe place strategies because they can then practice the strategies themselves and help and remind their children to use them: the butterfly, the dinosaur stomp (tapping your hands on your thighs) or tapping toes. I also help them create a ‘safe island’: use a roll of paper so that it can be as large as the child wants. Have the child or adolescent stand on it and draw a safe island around him/herself. The child can then draw or use collage materials to fill in the space with safe or protective things or figures. When we use EMDR with children, one of things we help them do is to build islands of safety.” Dorothy M. Lifka, LISW Ed.D.
Dorothy adds that she uses a website Living Words of Wisdom to print free mandalas. She uses mandalas are a 'fidget' for people to color if they think or process better when their hands are busy. Check out this website for other free resources to use for calming and self regulation.
Contact Dorothy at firstname.lastname@example.org. Thanks, Dorothy, for all the great ideas, encouraging case example and resources!
Bonnie Mikelson LISW
Director, EMDR & Beyond