Common coping method clients use to deal with emotions or adverse life events:

When someone experiences a stressful or scary life event, this can lead to the experience of intense emotions.  The normal mode of coping with those emotions is to “stuff them”, “block them out”, “put on a mask”, etc.  The only problem with these coping methods is that they do not work.  Just like the dirty sock that is stuffed under the bed, emotions and hurt doesn’t just disappear if we are not thinking about it.  

Why work through feelings instead of stuffing them or ignoring them?

Feelings and hurts that we experience in our lives are like cavities in the sense that the longer the feelings sit there without being treated, the worse they can get.  To properly care for your teeth you need to brush and floss, and have regular checkups to make sure any problems with your teeth can be cared for or prevented, such as cavities, since we know any problems with our teeth need to be worked on by a dentist or the problem will remain or get worse.  Just like cavities, feelings do not just magically heal on their own.  It takes both work for the individual doing what they can to feel better, and the work of mental health professionals (like mental health therapist and psychiatrists) to help people heal and recover from hurts or adverse life experiences.  

What if the client starts EMDR treatment and doesn’t want to finish?

When we don’t feel physically well, we go to the doctor.  If we are diagnosed with an infection, we are prescribed antibiotics.  The doctor writes directions for taking the medication, which includes “don’t stop taking the antibiotic until you have completed all of it.”  If anyone quit taking their antibiotic and found they did not feel better, that is what we would expect since the directions were not followed and the person quit the doctor’s recommended treatment early.   The same concept applies to mental health therapy.    If a person starts treatment and does not finish, mental health symptoms that are experienced (sadness, worry, difficulty concentrating, etc.) will not get better and typically do not heal all the way.   Bottom line, if you start treatment of any kind, you have to finish it to see if it works to solve the concern.

What happens when the client gets to a hard part in treatment?  

Sometimes it’s temping when treatment of any kind is hard to just quit or not do the treatment at all.  This happens to some people when they are told they need to have surgery.  If someone is recommended to have back surgery, it is obvious that the surgery is not going to be fun.  If fact, it is very likely it will be uncomfortable, bothersome, annoying, anxiety provoking, and just plain yuck.  Why do the surgery then?  An individual will only be willing to put themselves through such torture if they know they will be happier and healthier after they recover from surgery.  We all know no one says they feel better right after they get out of surgery.  On the contrary they may say they are in pain for several days, weeks, even months depending on the surgery.   It takes time for the body to heal, and sometimes extra steps are needed to get the body working as it had in the past (e.g.  physical therapy after knee surgery).    After all, we would not want our surgeon to stop working when part of the surgery gets hard.  That’s when we want the surgeon to keep on going to make sure our procedure is finished.  We would hope the surgeon would anticipate there may be difficulties and to prepare for them accordingly.    We want our surgeon to complete what they started so we can feel better, even if the surgeon would rather quit the surgery if it gets too complicated.  All of this applies to mental health treatment, including participation in EMDR to heal any current mental health symptoms.  If you start working on something that causes you emotional distress with EMDR, you need to complete the treatment for it to be effective.  Just as it would not be effective for a surgeon to cut your back open, look inside, NOT fix what is wrong and sew you back up, it is not effective to start therapy, think about doing the work or do a small part of it, and then quit treatment or stop working on the event that is causing the distress.  If you start it, finish it!      

As a therapist, how do you know how far to go with clients and EMDR treatment?  How much is too much?  

When clients present for mental health therapy and have consented to do EMDR, they may be asked by their therapist, “What target or negative cognition do you want to work on first?” or “Do you want to work on the whole memory/targeted sequence plan or just part of it?”  Sometimes our clients will ask our professional opinion as their therapist, “What do you think I should do?”  Hopefully our answer is given after gaining knowledge of their level of emotional stability.  After all, we do not want to bring up more than the client can handle, even if the client says they want to work on more than we know they are ready to handle.  Always when in doubt, my opinion is to start with restricted processing (EMD, or ATIP).  If the client appears to tolerate this without difficulty, you can move to EMDr (targeting a piece of the memory they are ready to work on, such as targeting the relationship only with a sibling and not targeting the whole family relationship because it would be too much).  Eventually the goal is to get the client to be able to tolerate their emotions/memories so that the full EMDR protocol can be utilized, but the problem with that is some clients take a lot of preparation and time to be ready for that.  So here is a way to explain to clients or to use yourself to help decide how much to work on/which protocol to use (ATIP, EMD-Restricted, EMDr-Contained, EMDR-unrestricted or standard  from Roy Kiessling's Processing Continuum) with the client.  

If you hire a physical trainer and tell the trainer your goal is be able to run 10 miles but you haven’t run in 10 years, your trainer (If they are a good one) will not start your training by having you run the full 10 miles.   Your trainer will recommend a workout that you are able to tolerate, and that pushes you just a little out of your comfort zone so that you make progress.  If you are able to only run a block, you may be asked to run a block and a half.  If instead you started with the physical trainer with the ability to run 5 miles already, you would not feel training was effective if you were still only asked to run a block and a half.  I imagine that client would tell their friends that paying for the physical trainer was not helping their fitness goal.   Just as with the personal trainer, to make therapy effective using EMDR strategies, we want to start our clients out at a pace they can tolerate and push them just outside of their comfort zone so they can make progress.  This way, therapy is not too overwhelming, and not so slow that our clients are not making noticeable progress.  

Maybe you’re wondering how do you know how much someone can tolerate?  

With running, you would look for physical signs such as tired facial expressions, heavy breathing, fainting, or for the person to say “I can’t do anymore today”.   With therapy, you want to watch for nonverbal cues as well to indicate the client may not be ready to work on the target you have selected.  This may be shown by the client’s face looking very scared, crying uncontrollably, breathing very heavily, zoning out (signs of dissociation), body tight, etc.).  You can also ask for or listen for verbal indications the client is not ready or it is too much to handle.  The client may tell you “I can’t do this/I don’t want to do this” or simply be verbalizing the intensity of what they are feeling emotionally or physically is too hard to handle (e.g. “I can’t breathe”, “I don’t like how much my body is shaking”).  When I am wondering if a client needs to stop EMDR because they look/sound/have stated it is too much, after I complete a set (e.g. 25 passes) of bilateral stimulation, I ask the client quickly, “Do you need to stop or can we keep going?”  

Clients have been willing to tell me if they were ready to keep going or needed to stop.  I do educate them about the benefit of continuing, and tell them “If we keep going, your body can work through the feeling/emotion/body sensation and let it go so it does not feel as distressful”.  Often when clients know they can feel better if they keep going, they really want to do that.  If I still want to reduce the intensity of the experience but want the client to be able to continue reprocessing the target, I have been successful with reducing the number of passes of Bilateral stimulation I use and that can decrease emotional flooding and allow the client to continue working (e.g. decrease passes from 25 to 12-15).  Other times clients have said, I do need to stop today and we conclude the session with grounding/calming excises such as a review of their calm place, their container, or other calming exercise such as the light stream technique, spiral technique, guided imagery or other mindfulness technique.     

Shanon Claussen LISW  

Thank you Shanon for another creative and useful contribution to the EMDR community.  To contact Shanon for EMDR consultation:

Bonnie the Blogger

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