Why EMDR basic training doesn’t answer every clinical question

Do you sometimes run into obstacles applying the EMDR Standard Protocol?

You’ve done your EMDR Basic Training and off you go to use it with your clients, excited and daunted by this powerful new tool in your kit. Some of your clients go so well with EMDR, but you realise you also have questions about the process of EMDR.

For instance:

• How do I know we’ve arrived at the right negative and positive cognitions?
• How do I decide whether to do resourcing, and how much resourcing is needed?
• How do I use cognitive interweaves?
• How fast should the BLS be?

With other clients, you run into problems, such as:

• A client gets overwhelmed and becomes phobic of EMDR
• Another client presents with trauma symptoms, but they have no conscious memories of trauma – so how could you treat this with EMDR?
• Another client becomes vague and non-responsive when you discuss working on memories (and you are not sure what to do)!

These questions and challenges are common in the phase after doing your Basic Training. Here are some tips that helped me get started applying EMDR in the complex trauma presentations that make up the bulk of my work.

EMDR for complex trauma practitioners: Understanding negative cognitions

Using survival responses to identify the right negative cognition

Do you wonder if you’ve got the right Negative Cognition, and how you would know if you did?

I found this so confusing until I had some consultation with Andrew Leeds. He taught me something really valuable: focus on their physiological symptoms, not the words they are using.

When you understand which action system of survival drives the symptoms, you can frame the intervention around that, and you’ll know it’s correct because when they say it to themselves, the action system comes online, and they feel their distress.

When you work this way, you only have to hold three things in mind, and you listen for these in the presentation and the history:

1. Fight or Flight symptoms of fear or anger, meaning: I am in Danger
2. Freeze symptoms of numbness and immobilisation, meaning: I am Helpless
3. Submit symptoms of shame and overwhelm, meaning: I am all Alone, I don’t Belong

Choosing the right resource for danger, helplessness and belonging

When you work this way – looking for signs of physiological over-activation of a survival response – it’s also clear whether and what you need to resource.

It’s not necessarily just about a Calm resource, which is the appropriate antidote to a Fight or Flight, or Danger-based trauma.
If, however, you are working with a Freeze, or Helplessness-based trauma, then the antidote you need is Empowerment: a mobilisation of their body with its capacities to cope and self-protect is the antidote.

If you are working with a Submit action system, an injury to the sense of Belonging and Connection, then the antidote you need is a felt sense of loving connection and belonging.

I have noticed over my years of working this way that it’s often easier to begin with Danger and Helplessness symptoms, rather than Belonging ones.

Why? Because Danger and Helplessness tend to be simpler to resource and resolve, and they often process in a straightforward way using the EMDR Standard Protocol.

Injuries that affect Belonging, however, are often developmental injuries, and they often run deeply into our attachment systems, our sense of self, and the EMDR Standard Protocol may need some adjustment to be effective.

How do I use cognitive interweaves more effectively?

I used to find this so confusing, tying myself in knots about which type of interweave to use and what exactly to say, and I would get stuck with my clients.

Then I realised what an interweave does: it builds a bridge (with as few words as possible) from where your client is stuck (the trauma meaning: Danger, Helplessness, Aloneness) to where they need to be to heal (Safe, Empowered, Connected).

Once you see it this way, things are so much simpler – just ask a question or make a statement that activates the healing, adaptive meaning in their body.

So simple! 😉

Finding the right bilateral stimulation speed

The guidance to keep in mind is: fast if you’re reprocessing trauma, including doing installation, and slow if you’re laying down a resource.

I see BLS speed as a matter of attunement with your client – as fast as they can tolerate and stay in their window of tolerance, slower if they are struggling with things that are emerging.

What to do when EMDR processing gets blocked

EMDR Standard Protocol has several suggestions, including cognitive interweaves, but sometimes these aren’t enough.

How come?

Because some of our clients have dissociative structures that complicate processing.

Can you use EMDR with clients who dissociate?

But wait! You can’t use EMDR with people who disassociate, right?

Wrong!

I, like many of you, learned that you should avoid applying EMDR with people who dissociate. The problem for me was that when I learned EMDR, I had a whole caseload of people who dissociated.

Working with dissociative structures in EMDR therapy

So, I learned to understand a person’s internal world, map it out to understand their symptoms, and foster internal collaboration, with the help of many dissociation theorists like Richard Kluft, Sarah Krakauer and Kathy Steele and colleagues.

I have a foundational course on this work: Complexity to Clarity

I also have a course teaching how to formulate this way: Parts Work Formulation – How to Make a Map

And I have a course looking at advanced topics in this area: Clarity is Complex Again –
Advanced Parts Work Skills for Trauma-Related Dissociation

Working this way gives you possibilities to break complex presentations down into manageable, bite-sized symptom clusters, and to apply EMDR therapy in a progressive way.

The Progressive Approach to EMDR Therapy for complex trauma

EMDR practitioners including Jim Knipe and Dolores Mosquera pioneered the Progressive Approach to EMDR Therapy.

It’s based on a profound insight from Jim Knipe that bilateral stimulation does basically two things:

1. It decreases dysfunctional positive affect
2. It spreads activation through meaning networks, recruiting healthy adaptive networks to resolve the traumatic meanings

Using bilateral stimulation in strategic doses

Knipe then realised that you can use it progressively; in small doses, to ‘loosen the system’ that blocks access to a network, or process a smaller blockage to prepare a client for the EMDR Standard Protocol.

Dolores Mosquera has contributed to this approach in various ways, showing us how useful it can be to use strategic doses of bilateral stimulation to resolve symptoms that are life-interfering in complex and disorganised clinical presentations.

If you conceptualise your interventions from this perspective, you can apply EMDR in small and strategic doses, and EMDR becomes a much more versatile tool in your hands.

Advanced EMDR training for complex trauma

If you work with complex trauma presentations and find yourself running into these challenges, you’re not alone.

These are common questions that emerge after EMDR Basic Training and are often the reason clinicians seek further professional development trauma training.

My upcoming two-day workshop explores these topics in depth and provides practical approaches for applying EMDR therapy to complex and dissociative presentations. For more information (and early-bird pricing) please visit EMDR for Complex Trauma.

If you are looking to strengthen your EMDR skills, deepen your understanding of complex trauma, or expand your therapeutic approaches for complex cases, my hope is that this training helps you use EMDR with greater confidence, flexibility and effectiveness.

With thanks to:

Gonzalez, A. & Mosquera, D. (2012) EMDR and Dissociation: The Progressive Approach. First Edition, Revised. Self Published. Info@itradis.com

Knipe, J. (2015) EMDR Toolbox. Theory and Treatment of Complex PTSD and Dissociation. New York: Springer.