STAYING IN THE WINDOW OF TOLERANCE: UNDERACCESSING
Bessel Van Der Kolk (The Body Keeps the Score, reviewed in another post, here) says the most difficult clients are those that numb into hypo arousal. You can use several of the opposite of what you’d do for over accessing, such as bringing the image closer or adding/asking about color.
Many of Spierings’ techniques use drama to act out, often with props, as a way to experience challenges to blocks from dysfunctional (in the present) beliefs. Validate that they have a good and important reason for numbing or blocking and ask them to share what it is. This is similar to Blocking Beliefs (Knipe, 2015) or ‘going with the resistance.’
Relearn how to cry “Where and how do you block your tears?” If 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; if fear is that crying means the abuser won, remind that not crying was important then, but healing is more important now.
Work with the physical sensation. One way is to use a taskbar (see Shirley Jean Schmidt or 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. 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.
I have used this with a client with exercise equipment that requires bilateral movement, such as rowing. I had a client who worked for several years to process her extremely traumatic childhood. She finally cleared out the past targets from a severely abusive and narcissistic mother who also abandoned her to her sexually abusive maternal grandfather, only to discover a great deal of anger and grief over her lost childhood. She already had an image of this, which was looking over barren fields.
At my suggestion, she continued to access this image of the barren field and where she felt her emotions in her body while she used the rowing machine at her gym. . She was able to clear out much more in between sessions by using this method of accessing and reducing the emotional intensity that she felt she was stuck’ with. She was a long term client very experienced in trauma processing and we both knew she was able to do this. I would not use this technique with a new EMDR client or one inexperienced in recognizing their own responses to trauma. We all know how surprised clients (and some of us) are surprised with the intensity of responses from past traumatic events that we thought no longer bothered us.
Target breathing or use mindfulness to identify emotions and body sensations. “What is the underlying fear?” (useful for clinicians to consider as well and possibly do personal work to address). This includes asking ‘what is the worst that can happen when we process this?’ Katie O’Shea (2015 workshop) uses ‘what is your biggest fear in doing EMDR therapy?’” Some of us jokingly call this doing EMDR about doing EMDR!
Explore the underlying fear and/or blocking beliefs (Jim Knipe). Clients always have a good reason for their fears and stuck places. Learn to ask!
Common fears:
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 did not get to say?” assuring you will keep them grounded. They can do this internally or say it out loud, which can be most powerful.
Being disloyal to caregivers—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?” Often we can give to others what we can’t let ourselves have, so third person, ‘what would you say to others’ interweaves can be very useful.
One of my clients had been severely beaten at age 2 for disobeying her parents’ order not to go outside. She got stuck in processing, still believing it was her fault because she “didn’t listen and disobeyed her parents.’ I asked if she would blame or beat her own children when they were 2 years old and didn’t listen. She was horrified and said “No!”, at which point I said, “Go with that!” You are accessing the adaptive through through another way when they cannot give it to themselves.
Breaking vow of silence/fear of punishment or revenge. If they say they can’t tell _____, what would you say if you could?” Or, make visible what was done to them, like tying a shawl or towel over their mouth, externalizing their problem.
Guilty/to blame for part/all—use adult perspective; educate about fight/flight/freeze to submission; “what would you say to your child?” Act out or script accusing another victim, like a neighbor or friend, and have client be the victim’s defense.
Not being believed—reassurance that you believe them or believe their pain; good reasons why others may not believe like denying to protect themselves, loyalty, their own fears, refusal to believe this depth of evil/harm happens as challenge to their world view; if you have information to the contrary (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.
Not possible to heal. This is the NC “I am permanently damaged”—use metaphor of body naturally healing from a cut (Shapiro), or abscess needing to be cleaned out. I have had to titrate the positive belief: “I can begin to learn to heal” and/or I’ve held the “hope” for healing for the client until they are able to hope for themselves.
Being even more damaged than you thought—who owns the ‘dirt’ that damaged you—give it back to them; psychoeducation to strengthen 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 how to set a boundary by saying no. She acted this out with the client by walking up to her and asking the client to say no when she got too close. Eventually the client was able to say no with an appropriate physical boundary between her and Dr. Spierings. They went back to processing and this client delighted in yelling NO to the imagined perpetrator (a repairman) as she recalled him following her up the stairs in her group home. Remember, if it is not in the adaptive neuronetwork, it cannot link up with the dysfunctional neuronetwork to heal. We need to assist our clients in developing missed adaptive experiences that
The trauma is beyond the clinician’s strength to bear or fear of losing the therapist.
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?” I’ve also bluntly asked a survivor of sexual abuse with this fear because she had a sexual response and ‘enjoyed it’, “do you enjoy having sex with little kids?”
From Shirley Jean Schmidt www.dnmsinstitute.org), ask if them to see if there is light in themselves and in the abuser. Victims see light in themselves even if tiny and darkness in the abuser.
Teach setting boundaries such as saying no by using a rope “It is everyone’s right to decide where their boundary is.”
Guilt that has a purpose will not resolve with interweaves; address the reasons for maintaining guilt—i.e., better to be a bad kid with good parents than a good kid 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. Another case example is a client of mine who had been alcoholic and abusive, and was responsible for abusing her children. They were now grown and remained alienated from her despite efforts through AA to make amends. Though she had been sober for a number of years, she was responsible for that pain. She could only accept “that was then, this is now” as an intervention to begin to heal.
Joany Spierings has much more to teach us and her presentation was funny, free and dramatic. I found her style a bit more daunting to do with my clients, but it did challenge me to be more active more often in my clinical interventions and, clearly, to think outside the box. I have used many of these interventions, as you see in the client examples I have added.
Under accessing is just another way the person learned to cope, sometimes from families who ‘don’t do feelings.’ We need all the ways we can find to assist these clients in healing through EMDR therapy. I remain grateful to Ms.Spierings for stimulating this growth and the multitude of ideas she shared in this workshop, a few of them shared here. I highly recommend learning more from her through her materials and recordings and watch for when she might again present in the States.
Bonnie Mikelson LISW
Director, EMDR & Beyond