BILATERAL STIMULATION CONSIDERATIONS
As an EMDRIA Approved Consultant, I try to keep up with the EMDR Listservey moderated for many years by Roy Kiessling, LISW, now by Katy Murray, MSW, finding it usually a rich source of clarification, new information and case consultation. Occasionally I have posted my own or consultees' questions and get excellent responses from the best in the EMDR world which always amazes me. I read the Listserve and learn a great deal, keeping up on the wisdom and sometimes debate in the EMDR world, sharing what's relevant with consultees and occasionally summarizing on this blog. This time my 'gleanings' relate to differing views on the varieties and types of BLS to use.
Bilateral Stimulation—Finger Eye Movements or Technology
There has been a lengthy thread of discussion about the differing types of Bilateral Stimulation (BLS) with lots of variation in therapist opinion and usage. We know that eye movements following the therapist's fingers is the most often researched, though I believe there's some research comparing all types. Therapist experiences would support that all types work for processing but preferences vary. For example, several therapists expressed their dislike of the BLS technology (for example, www.neurotekcorp.com) that many others, myself included, use routinely.
Many adult clients who prefer to close their eyes while processing may go deeper into their processing using tactile or auditory stimulation. Many of us also use 'tapping in' of resources, taken from Laurel Parnell's 2008 book by the same name, Tapping In. It's nice to think of 'tapping in' a positive, pleasand or peaceful state. We use a 'magic wand', a collapsible antenna or music wand, puppets, squeeze balls, drums and many other ways of bilateral stimulation or dual attention in our preparation and processing phases of EMDR work.
Roy Kiessling, Director of EMDR Consulting, prefers not to use use technology. He believes it interferes with or becomes a barrier to the therapeutic relationship and the therapist's attunment with the client. This is an opinion shared by others who posted on this topic. He used it in the past, but changed back to using his fingers for eye movements, hands for tapping, or snapping his fingers for auditory. That one is impossible for those of us who can't snap that efficiently or in a sustained rhythm but it works for some. One of my consultees, however, has used the large magnetized clips for posting material on metal areas, for clicking until she could purchase the technology. I've also recommended use of stress balls in alternating hands, drumming, stomping, and other adaptations to meet the needs of clients who cannot connect or get comfortable with other options.
I have been pondering this, as I have used Neurotek's Advanced Audio Scan with the large removable tactile stimulators and audio capacity for many years. Part of the reason is ongoing shoulder and neck issues , but another is that it works and clients seem to like it. I am a strong relational therapist, so I didn't feel the technology was a barrier to the therapeutic relationship. In fact, my clients' favorite BLS form is tactile, such that I have replaced the tactile attachment most frequently through the years. That's why I switched to the larger paddles and wire, which light up as well. These are more sturdy, offer the eye movements as well and with plug in ends, I can replace one side at a time if only one of the paddles quits working.
Since I having been teaching EMDR Basic Training , I continue to teach and emphasize eye movements as the first, most researched, and probably most activating form of BLS. The latest research continues to support the use of EM's (Eye movements) to reduce the vividness and emotionality of distressing images. I have learned the hard way that if I don't teach eye movements first, trainees will not really learn how to use EM's, switching to tapping because it's easier. There's real benefit in learning to use EM's so that therapists can demonstrate different forms of BLS to most effectively assist the client in both resourcing and processing. We also have need of switching modalities when clients get stuck in processing. I've also used one form of BLS for resourcing, typically tactile or tapping, and another for processing with clients who seem to benefit from separating the BLS styles based on state or trait change work. In Roy's Basic that I teach, we use tapping or walking through for resourcing as it makes intuitive sense to 'tap in' (Laurel Parnell) the positive to deepen it. We certainly don't want to reduce the positive images and emotions that we are developing or enhancing in our Phase 2 EMDR work.
I know that many of us use one or more of Neurotek's products and find the equipment very useful including the equipment that offers eye movements, tactile and auditory altogether, such as the Lapscan or Eye Scan. There are now many apps for I-Pad and other electronic devices that offer the variety of BLS, with my vote going for EMDR Elite, an app developed by an EMDR therapist for IPadat $24.99.
The 'buzzies," as kids may call them, can work well with children because you can put the paddles in their socks or under wrist bands while the little ones are playing or processing. I've had adults sit on them, which works well if you make sure the intensity is strong. Adolescents may respond to the Advanced Audio-Tactile equipment that allows for external audio to be plugged in. They can listen to their own musci or play lists in a bilateral form. A few of my clients appreciated the choice in style of tones that this equipment can offer.
My clients seem to prefer the tactile first, then auditory (some using both), then eye movements last. After getting the Mega Pulsars, more clients were willing to do the EM's along with their tactile. I have hadone or two clients who want me to use my hands to tap them on the knees or top of hands and I do think it is connected to their tactile deprivation by history or in present.
This is not meant, however, to be an ad fo Neurotek, though they have served me well. Instead, I would like to provoke thought as to what you use, how you decide to use it and your experiences with what works with your client population.
Client feedback as well as observation tell me that clients access internal material more easily with eyes closed, unless the eye movements are their strong initial preference. With dissociative clients I will avoid EM's if possible or watch their process with eyes closed to ensure they can sustain dual attention. I also will avoid EM's with anyone who has eye problems, a history of seizure disorder, brain tumer, or other eye/head injury that may impact their use.
Asking clients to keep the eyes open is a way to anchor them or slow down flooding when processing. It also does sustain attunment and may be more important as clinicians learn to read signs that they are accessing and processing the targeted memories.
BLS CD’s for RDI & Relaxation
Some wrote to support the use of auditory stimulation and, in particular, commercial CD's, for resourcing to develop or enhance stabilization, affect regulation, , relaxation, and stress management. I currently have a number of clients who are benefitting from Mark Grant's relaxation CD Calm and Confident (on his website www.overcomingpain.com and Amazon.com) as well as David Grand's Biolateral Sound Recordings (www.biolateral.com ). (See separate post on Bilateral CD's for more information). Some prefer BLS sounds without music, some with music but no words, and some don't like these resources at all.
I keep them in my office and try them out in session so we can see what works, their preferences, and that they can sustain the BLS experience in their positive neuronetworks. A reminder–slow short sets for resourcing is to keep them from accessing the dysfunctional neuronetworks. Longer, faster sets are more activating so that is for reprocessing. Changing type, speed, or direction is one of the steps in addressing stalled or stuck processing.
Client or Therapist Decision?
A final area of disagreement, if not controversy, is whether clients are given the choice of BLS or clinicians retain this responsibility. I have introduced all forms and allowed clients to choose, per the excellent consultation I received, but there were EMDR therapists who felt this is part of clinician expertise to assess and decide for the client, barring any discomfort or inability (i.e., cannot track fingers with eyes without dizziness). I don't have capacity to offer eye movements along with tactile and auditory, but I do agree best practice is to demonstrate all three, eliminating the least acceptable by client preference. This is based on the more BLS, the better–and I do have clients who use both auditory and tactile. I have a colleague who uses the Lap scan Neurotek equipment so is able to offer all three. Others have held back from the Lap Scan eye movement or computer-based BLS because they felt the span of the eye movements was not sufficiently broad, limited by the screen width. My colleagues who use these have not found this to be a concern. A final curiosity I have routinely noticed using BLS with clients who have recovered from addictions: They prefer their BLS as fast and as strong (if tactile) as possible. Anyone else run into this or have ideas about the recovering brain needing more and stronger stimulation to reprocess?
So, what to do re BLS? Many ways of BLS can work, and it is the clinician's job to have solid reasoning, tested by experiential feedback, for what you offer, decide, or use with clients.
Further Clarification from Roy Kiessling, Listserve Moderator
Following is further clarification from Roy Kiessling LISW in a later Listserve post, explaining his BLS preferences and how they evolved. With his permission, I am adding his comments to my post as they are worth considering and give a clearer picture of his position. Roy states:
" . .personally – I prefer my involvement (when culturally appropriate – previous posts).I am very, very attuned to the client when producing and pacing the self-produced [vs. machines] BLS in sync with the client's non-verbals. . .non-verbal attunement—is this not what infants attune to, and parents respond to?. . .and – with more complex clients, is that the attachment, attunement (non-verbal) that is perhaps missing and causing the deep seeded abandonment? Perhaps the very process in the session is doing attachment repair.
Has the mutual BLS activated my own stuff – of course. a) at times – part of the client's healing ( and times needing cognitive interweaves) b) and when it did in a manner not in the best interest of the client —– – off to an EMDR clinician to 'heal myself."
Personally – I prefer using only my own activated BLS (EM's tapping on – or having the client watch and copy my BLS ( if touching is not ok). As an aside – – at times it seems the motivation to use machines is driven by the clinicians agenda more them the client's. If so – please ask – "my stuff, or in the best interest of the client?" when considering the use of machines vs self-produced BLS. Just thoughts to consider… Roy"
More to consider as we make our own decisions about how we do BLS.
Bonnie the Blogger