The Process of Therapy · Trauma Therapy

EMDR in your Therapy Session, Part 2

Ever wondered what EMDR looks like in a counselling session? EMDR – which stands for eye movement desensitization and processing, is a therapeutic approach with a wide range of applications. Research has demonstrated that EMDR is effective for working with experiences of trauma (and post-traumatic stress), anxiety, phobias, addictions, to name just a few. To learn more about the components of EMDR, please read Part 1 by clicking here.

There are eight stages to the process of EMDR therapy. It begins as many therapies do: building rapport, gathering intake information (your backstory, so to speak). Knowing your story helps your counsellor understand your needs in counselling, any troubling symptoms that need immediate attention, and also helps you both collaboratively create a treatment plan.

The next stage shifts into preparation, or resourcing. “Resourcing” is the common name for developing those emotional coping skills. It involves helping folks develop the tools they need to self-regulate. This phase involves learning to notice and move through strong, over-whelming emotions as they arise. It’s the part of therapy that works with the treating the symptoms (the pounding heart sensation of anxiety, excessive worry cycles based on past experiences, sleep disturbance, etc.). In EMDR, we work with a rating scale called the Subjective Units of Distress Scale (SUDS for short). It’s a rating scale from 1 to 10, where 10 is the most distressed you’ve ever felt and 1 is no distress at all. The scale is a helpful way for therapists to attune to their clients, and also for client’s to notice their own progress in a session.

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Developing and strengthening emotional coping skills is important, because moving into processing trauma too soon could cause a person to feel unsafe and emotionally flooded. Our job as your counsellor, is to help you be present with emotion without being over-powered by it; learning to turn down the volume on some emotions as you need to, and ultimately helping you feel safe with the counselling process.

Many folks who have experienced trauma have an overall feeling of being unsafe, so cultivating a sense of safety has to be a primary focus.  You need to feel comfortable with your therapist before you disclose all the tough stuff. And, it is super important that you build the emotional coping skills to be okay after and between sessions. EMDR respects these important features of trauma work. 

With the ability to regulate emotion and connect with a degree of internal safety developed, we can begin the next stages of EMDR: Desensitization.  I know you remember what that means from Part 1! This is where trauma processing begins. For those of you wondering what on earth this part of therapy looks like, let me demystify it for you. 

During this trauma processing stage of EMDR, a session starts out with resourcing, then moves into target selection (which just means you choose what the session focus will be). Because I work with trauma, that often means we want to start out with the first traumatic memory or the worst traumatic memory. Wait! Please don’t slam your laptop shut and storm off – I know that can sound frightening, but you will be ready for this stage because of all your hard developing and practicing emotion coping skills during the preparation stage! 

Once we’ve got that memory selected, we connect the negative belief that goes with it, the emotion it evokes, and where you feel it in your body (the sensation of the emotion). 

Side Note: Why do we Need to Cultivate Awareness of the Felt Sense of Emotion?

Cultivating awareness of how we feel emotion in our body is super important. Trauma can often leave folks feeling disconnected from their body. They can get caught up in staying in their head (thoughts), because perhaps it feels safer. However, our body still carries all that tension. Maybe it gets experienced in the form of stomach aches or digestive problems, holding the breath/shallow breathing, muscle tension, or a clenched jaw. This disconnection from the felt sense can become so habitual, that many folks stop noticing it. But all that tension and unrecognized dis-ease can cause all kinds of health problems. 

So, with the pairing of the trauma memory, with the negative belief, the emotion it evokes and how distressing it feels, and how you sense it in the body, we add BLS and start processing that old memory. Whatever your distress level was at the beginning of the session, your therapists goal is to guide you through the processing to get that number down so that you are anchored in a sense of internal safety when the session ends. 

And here is the amazing part: as the BLS is repeated, the brain is processing the trauma to reconcile it as a past event. When your brain and your body can reconcile trauma as a past event, it means you can anchor into the present moment. You shift out of survival mode and can more accurate attest that you truly are safe now. 

Emotional Activation (Feeling Triggered):

Have you ever noticed that when something in the present moment reminds you of a trauma you experienced, the emotion that arises feels completely raw and overly-excessive to the present situation you are in? That is what unprocessed trauma can feel like. There is an amazing little brain system we all have, called the limbic system. Its sole job is to keep us alive. Experiencing trauma can keep us popping into that limbic system survival mode way too frequently. Constant survival mode living can leave people feeling emotionally reactive (as though we are constantly in fight, flight, for freeze), and emotionally exhausted. The brain just doesn’t recognize that the trauma is over, that you are safe now. That is why counselling is so important for your overall health and functioning.

During processing with BLS, emotion becomes less intense. One of the session goals is to keep reducing activation – getting your SUDS number going down, so that you are shifting more and more out of distress. 

EMDR_Congition_ListAs a result of all that emotion process, you are able to connect with a positive belief, and we install it with BLS (the next stage in our 8 stage model). Instead of the negative belief a person started the session with, such as perhaps “I am not enough”, folks now get to decide what positive belief is more preferable, (such as “I am worthwhile”, or “I did the best I could”). We link the positive belief in with BLS so that when the client thinks about the past experience, he or she is no longer washed over with thoughts of being not enough – and in fact, that old negative belief feels distant. The past event really does feel over and anchored in the past, and linked with the positive belief. It may still evoke a degree of emotion (after all, we can not erase the past from having happened), but the sadness or fear that arises going forward when the memory is recalled, will be less intense, and will fit the situation you are in.

Containment metaphors amight be used at the end of a session, as well as a body scan. The body scan is a super useful tool to strengthen the positive sensations associated with the positive belief, and also for identifying any distress still present. The final stage of the session (but not yet the 8th stage of EMDR), is a debriefing of sorts, where we can review strategies for anchoring in the present moment, handling emotion as it comes up, and discussion what to expect after the session in terms of emotions percolating and taking care of self between sessions. 

The subsequent session starts out with an exploration of anything that came up between sessions, and a re-evaluation of thoughts, beliefs, emotions, and sensations connected with the work from the previous session That’s the eight stage of EMDR, and then the process continues until folks feel as though they have worked through the pieces they entered into counselling to address. 

I hope this summary of what EMDR in a therapy session looks like has been helpful. Remember,  while we can not erase traumatic experiences from your memory, with EMDR the brain can reconcile it as a past event. We can lessen the intensity of the emotion the memory evokes, as well as the meaning attached to it. We learn to notice when we are shifting into the limbic system and either act to maintain safety or anchor back into the present moment acknowledging the memory as well as our present moment safety.  

If you want to learn more about EMDR, please check out the EMDR International Association website, or EMDR Canada. Both of those websites also list EMDR therapists by location, so you can even tap into those resources to find a practitioner close to you. 

Be well.

The Process of Therapy · Trauma Therapy

EMDR in your Therapy Session

Part 1

There are many therapeutic approaches Counsellors can use when working with clients on their goals. This article is about EMDR therapy, which is an approach for treating trauma, but has tons of other applications. The letters stand for Eye Movement Desensitization and Reprocessing – which I am going to describe in more detail in this article. The second article will explain what a typical EMDR session might look like

Disclaimer: please know that no therapy is one size fits all. There are many layers to therapy, and to the complex issues people bring forth into their counselling experience. My intention in this article is to provide a simple overview of EMDR. Think of it as a brief summary, and know that there is much more to it. Kind of like the sign at the local gas station that reads ‘Car Wash’.  When you go through the carwash, your car will receive the wash, along with the added bonus of an under flush, foaming polish, clear coat sealant, and air dry. There is so much more to the car wash that that sign mentions! Similarly, there is so much more to EMDR than this summary will include. My aim is to make this informative and brief, leaving you with a solid understanding of what EMDR is, so that you can feel you understand the process prior to starting therapy.

EMDR was developed by clinician Francine Shapiro. The approach has been researched and modified for many diverse applications. In this article, I am going to be describing the variation attachment-focused EMDR, which was developed by Laurel Parnell. 

Originally developed for use with post-traumatic stress, EMDR therapy is also an effective approach for working with fears and phobias, addiction, and anxiety, It also works to strengthen feelings of calm and confidence.

The Body Holds Emotion

EMDR is a somatic approach to therapy, which means that while we do look at thoughts and emotions, we also look at how the body is holding emotion (that’s “the felt sense of emotion”). 

When a traumatic event happens, we humans tend to become flooded with emotion and our brain doesn’t process and store the memory properly. What happens is that parts of the event (thoughts, emotions, body sensations, images, and smells) stay unprocessed in the brain. What this means in daily life for folks, is that reminders in day-to-day life can activate those unprocessed memories. When this happens, it can feel as though the trauma is happening all over again. You know in your rational brain that it isn’t – but the felt sense of emotion that spikes up so fast that makes it feel as though danger is very real and present.

Using EMDR, we work with the memories that are causing the present-day distress and we “reprocess” them. This means we are working with all the elements of the present, past, and even future. 

Let’s look now at what the name EMDR stands for in more detail, and then I’ll explain what you can expect when you start up EMDR therapy. 

EMDR-2
It’s All in the Name:

As you have already learned, “EMDR” stands for Eye Movement Desensitization and Reprocessing. It’s a bit of a long and complicated name, so let’s deconstruct it. 

EMDR incorporates eye movements, which is a type of bilateral stimulation (BLS). This is a core feature of EMDR. The term ‘bilateral’ refers to two sides: eyes moving back and forth in a rhythmic side-to-side pattern. Thanks to research and new technologies, we now know that the bilateral stimulation used during EMDR can be visual (the eye movements), auditory (sound), or tactile stimulation (touch). The bilateral stimulation ensures both hemispheres of the brain have an active role in memory processing. 

Visual bilateral stimulation can be created by the therapist moving their hand back and forth, or with a light bar. A light bar looks exactly as it sounds: it is a sleek bar of lights, and a light flashes on one end of the bar and then the other, and back and forth it goes. The client follows the lights with their eyes, side to side in a rhythmic pattern, thus the term “bilateral”.  

Auditory BLS is facilitated with earbuds, with a sound being played alternating from one side to the other.  Mark Grant has developed a powerful app that utilizes EMDR with auditory BLS, called Anxiety Release.

Tactile BLS can be facilitated with tapping rhythmically from side-to-side.  I use a little hand held device with 2 parts that a client holds, one in each hand, and it facilitates bilateral stimulation (BLS) with a brief pulse, or vibration back and forth. It kind of feels the way your smart phone does with the silent mode vibration.

More about Bilateral Stimulation (BLS)

You may be wondering, why is this strange BLS thing so important in therapy??

Bilateral stimulation is a core feature because through repeatedly activating the opposite sides of the brain, it harnesses the power of the accelerated information processing model and aids in releasing emotional experiences that feel ‘stuck’. It can be said that this process mimics REM sleep. You may have heard of this before: when we are sleeping and in the REM stage of sleep, our brains have a chance to process the events of the day. In trauma, we know that memories get stuck – they don’t get processed and worked through. So by using BLS as part of the trauma processing, we help our brains to finish processing those distressing events. As the troubling images and emotions associated with the disturbing/scary/upsetting event are processed while paired with repeated alternating activation (BLS) the memory consolidates, the distressing bits feel resolved, and a more peaceful emotional state is achieved.

There is a lot of emotion packed into the trauma memories.  As you read this, you might be feeling worried that if you start working with a past trauma, the level of emotion it evokes might be too much to handle. In EMDR therapy, therapists are trained to help folks through the process. So while working through distressing memories does evoke emotion – we go slowly, and keep our focus narrow. This way emotion can feel more manageable, and the body can start to regulate.

Here are a few more neat facts about BLS:

  1. BLS can help the body relax (all those muscles that were tense without you even being aware they were tense suddenly relax a bit)
  2. It can help our unstick our thinking so that we feel a great sense of cognitive flexibility (thoughts flow and feel less stuck and rigid on the troubling topics)
  3. It can help improve our concentration 
  4. And, my favourite effect of BLS: it helps us ease into the awareness of the distance between the present moment and the upsetting event. This means that the issue or event worked on during the counselling session feels smaller and further away; more anchored in the past and not so volatily-active in the present

Desensitization means that we’re working with the intensity of emotion felt when recalling a disturbing/scary/upsetting event.  Desensitization refers to the process of becoming less and less distressed with the memory of an event that was disturbing/scary/upsetting but that is now over. In it’s most simple terms: a memory that was once a super sore sensitive spot becomes less and less sensitive during the course of EMDR. We can not undo the past or erase the memory of it, but we can learn to turn down the intensity of emotion felt when recalling it. 

Reprocessing means that some memories of the disturbing/scary/upsetting event weren’t processed at the time the event occurred. There are many brain systems that are involved during trauma, and many more that are shut down, or suppressed, during the event. This means that the traumatic moment isn’t stored in the brain the way a non-traumatic event gets stored. Through EMDR therapy, reprocessing means that we work on understanding the memory so that the memory of the disturbing/scary/upsetting event becomes useful instead of so disturbing. By reprocessing it, in a very titrated and strategic way, the memory comes to be stored as part of an integrated memory system.

Here are a couple of things to keep in mind, regardless of the therapy you choose to access in your counselling session. 

  • Going slowly is important. Building up emotional coping skills prior to working through trauma is a helpful way to ensure sessions feel more manageable 
  • Therapy is rarely one size fits all. Your therapist will work on getting to know you, your story, and your needs, in order to best help you work through your goals in counselling.

In the next article, I will go over what a typical EMDR therapy session may look like. Stay tuned for it!

–> Click here for Part 2: What EMDR Looks Like in a Therapy Session

Affect Regulation · The Process of Therapy · Trauma Therapy

Calm in the Storm – The New Book on Settling Strong Emotion!

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Before we can heal from trauma, we need to develop the ability to be with the strong emotions associated with trauma memories. These skills are taught in counselling, but what about all the folks that haven’t yet started up counselling? I have been working on that resource, and I am so pleased to tell you that it is now available!

Calm in the Storm is collection of simple emotion regulation strategies that can be used by anyone who experiences anxiety, panic, and symptoms of post-traumatic stress – to shift them out of intense emotion and back into a place of internal safety. The book is written in a way that can help folks develop a new relationship with emotion, one that lets them off that roller-coaster ride of emotional ups-and-downs, that enables them to feel more in control.  

When it comes to symptoms of anxiety and post-traumatic stress, we need to know how to regulate emotion – those are all those grounding and containment skills designed to bring us back to the present moment and enabling us to shift out of high motion. Healing the trauma or underlying reasons that spike us into anxiety is important, but folks need a starting point. This book is that starting point. It will ignite hope and spark a renewed belief in one’s inner potential. It isn’t meant to replace counselling, but the book is a great starting point for folks who need to develop some basic regulation skills before delving into trauma work with a therapist.

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“Once we discover the ability to settle strong emotion, the emotion itself becomes less frightening” – Susan Guttridge

Pick up your copy of Calm in the Storm today, and please check back and let me know which strategies worked best for you.

For sale now at the following locations:

 

 

Mindful Parenting · Trauma Therapy

Returning to the Present Moment in 5-4-3-2-1

The strategy I’d like to share with you here is helpful for shifting out of strong emotion. It is considered a “grounding strategy”. Being ‘grounded’ simply refers to the notion of being emotionally and mentally present in the here and now.

Known as 5-4-3-2-1, the underlying technique here originates from trauma therapy. It is used to help individuals be present in the moment: it can slow racing thoughts, stop flashbacks, minimize addictive cravings, ease ruminating, and lessen anxiety. And, it is incredibly easy to learn and apply. If you catch yourself and your child/teen arguing and the situation seems to only be escalating, excuse yourself for a few minutes (just say you need a few minutes to calm down), and use this technique to ground yourself so that you can return to the present situation. In your mind (or out loud if you are alone), focus on the following things in great detail:

  • 5 things you can see (such as different colours, or items in the room you are in)
  • 4 things you can touch (such as things you can physically feel with your hands, or feet, or the temperature),
  • 3 things you can hear (listen carefully!),
  • 2 things you can smell, and
  • 1 thing you can taste

This grounding strategy can help you to shift your focus away from internal, emotional experiencing, to external distraction (the trick is to get out of your head and into the present moment!). Focus on external details as you talk through the sequence. Notice your breathing will slow from when you first begin the strategy to the time you complete it. Allow the the full cycle (from 5 down to 1) to take a few minutes; take your time and truly allow yourself to be distracted from your inner chatter.

Try this strategy if you find that you are feeling over-whelmed, emotionally flooded, or even just very spacey and not able to focus. Once you complete the cycle, check in with your inner processing and try again to resolve the situation with your child/teen.

This article was originally posted on October 20, 2010, to Happy Parents = Happy Kids (focusedonparenting.wordpress.com) by Susan Guttridge

Mindfulness · The Process of Therapy · Trauma Therapy · Uncategorized

Living Life: Even on the Tough Days

On the darkest of nights, when there seem to be no options – no solutions to the despair you feel, how will you find your way? When it seems like there is no hope left, will you hold out hope for your own fire?

I’d like to write about suicide, and the option that takes just the tiniest spark of hope: living.

Ask 10 people for their thoughts on suicide, and chances are you will receive 10 completely different responses. Suicide is a word packed with 100 times more emotion than syllables. And even in sitting down to write about it today, I had to wait for the whirl of emotions to slow before I could hear the one constant resounding  thought: I value life. 

I value life.

I didn’t always though. I was once an impulsive and shy kid with few friends, the target of ridicule by classmates – once or twice even by teachers. I knew rejection. I knew loneliness. I even knew the pain of grief when cancer claimed my mother . I knew feeling directionless. Feeling unsure of myself. Of having no one to turn to who would truly have my back.

One day, during my Masters degree training, I took a class on suicide risk and intervention. After learning crisis intervention and theory, we were required to demonstrate our suicide intervention abilities by role playing client and clinician. When it was my turn to play the role of the ‘client’, I  harnessed those many years past from my youth, when living another day felt unbearable. And while I could still acknowledge the pain of those days, I could barely get the words out in order to “act” suicidal in the moment. And that was when it dawned on me: I value life. I could not even pretend for one moment that I didn’t want to be alive.

I have bad days and sad days. I have lonely days and grumpy days. But I also have good days and joy-filled days. I have peacefully quiet days and blissfully calm days. I have days when I feel invisible but I have so many more days when I love and value myself. The thoughts and emotions that awaken thoughts of suicide are a signal that you are in pain. That you are hurting and feel powerless to create change yet that you desperately need to create that change in order to be ok. Sometimes it might feel as though that change is impossible. Sometimes it might feel as though the energy required to act on creating that change is just too much. So what can you do?

We need to get out of our own heads. The view one takes of the world when feeling depressed or anxiety-ridden can become a habit and can breed more thoughts that are characteristic of depression or anxiety. We need to really look at the people in our life and ask the tough questions. We need to turn towards the people who care and we need to let them care. We need to be kind – even to ourselves. We need to listen. We need to be present. And in doing so, we can ignite the tiniest spark of hope to keep going, to find your fire – because this life really can be good.

If you are feeling suicidal, please reach out for help. Call, text, email, talk. You have more worth than you know.

If there isn’t someone you can talk to, or a Crisis Line in your area, check out The LifeLine App in the App Store.

SG blog

 

Trauma Therapy

Healing Trauma and Post-Traumatic Stress

The experience of trauma can come from any event which stresses the nervous system or drains our emotional (psychological) resources. Being “traumatized” often refers to the symptoms a person might experience after the event. These can include:

  • anxiety and dysphoria (uneasiness, depression, restlessness)
  • emotionally-based problems (such as irritability and detachment from relationships)
  • intrusive re-experiencing (unwanted memories and reminders, “flashbacks”)
  • avoidance of the unwanted memories and reminders
  • hyperarousal (jumpiness, easy to startle)

Individuals experiencing a life-threatening (or perceived to be life-threatening) event sometimes experience post traumatic stress. Symptoms of post-traumatic stress include:

  • hypervigilance
  • flashbacks (reliving)
  • dissociation

Falling into the anxiety disorder category, post-traumatic stress is considered to be a psychological reaction to experiencing a life-threatening event. The traumatic event usually involves actual death or a sense of impending death/serious injury to one’s self or others.

Traumatic events leave the mind and body in shock. In the aftermath of the experience, we start to make sense of what happened and we begin to process our emotions and reactions. Individuals with post-traumatic stress remain in psychological shock. In order to move on from the experience, we need to look at the experience, and face those memories and emotions. As the famous poet Robert Frost said, “The only way out, is through it”. However, the way in which we look at it needs to be gentle and moderated. Contemplating the entirety of an upsetting situation will only leave us raw and emotionally flooded. We need to look at it in bits are pieces, while taking care to resource ourselves.

Click here to read more about post-traumatic stress and complex post-traumatic stress on my website.

I choose to believe that post-traumatic stress is not a life sentence. I believe that by working with the thwarted energy in the nervous system and creating regulation, we can process the traumatic material and start creating healing. The therapeutic approach I am speaking of is Mind-Body Attunement Therapy (MBAT). Developed by psychologist Kevin Miller, MBAT is based on the self-regulation therapy of research and therapist Peter Levine.

Some great books by Peter Levine include:

Waking the Tiger: Healing Trauma, The innate Capacity to Transform Over-whelming Expereinces (1997), by Peter Levine and Ann Frederick

In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness (2010), by Peter Levine and Gabor Mate

Trauma-Proofing your Kids: A Parent’s Guide for Instilling Confidence, Joy, and Resilience (2008), by Peter Levine and Maggie Kline

Trauma Therapy

About Mind-Body Attunement Therapy

Mind-body attunement therapy (MBAT) is rooted in the science of neurobiology. This fundamental underpinning sets MBAT apart from other therapies, which tend to be rooted in theory. It is an attachment and trauma focused therapy. Mind-body attunement therapy addresses the essential role played by the body, and the experience of emotions in the body. Peter Levine, a pioneer in the field of trauma theory and self-regulation therapies, explains that an incredible imprint is left in the nervous system when a person experiences a traumatic event. When faced with life-threatening danger, our human tendency is to fight, flee, or freeze. Our bodies generate an amazing amount of life-preserving energy. If our physiological response to that danger is somehow thwarted, such as when the danger is over-whelming and we freeze, this energy remains “stuck” in the nervous system. 

Mind-body attunement therapy thus is a body therapy, which works with the experience of emotion in the body (the “stuck” energy in the nervous system). There are basically two “jobs” that we want to accomplish in therapy to create a healthy nervous system. The first is to resolve unprocessed emotional memories that remain locked in the nervous system. These tend to get activated frequently (you likely know they are activated because you react with a high level of emotion which doesn’t seem to fit the situation you are currently in). So these unprocessed emotional memories tend to negatively impact our emotions, behaviours, and thoughts. The second “job” we want to accomplish is to teach your nervous system to return to calm quickly once it has been activated. Research shows that when we are exposed to ordinary everyday stressors, it takes approximately 2 to 3 minutes to return to a sense of calm. Some individuals take significantly longer than that, with activated responses lasting from several hours to several days. Using mind-body attunement therapy, the focus is on resolving unprocessed emotions and teaching the nervous system to calm quickly. Thus, MBAT assists individuals to work through over-whelming experiences without causing them to be re-traumatized.

“Trauma is a fact of life. It does not, however, have to be a life sentence. Not only can trauma be healed, but with appropriate guidance and support, it can be transformative. Trauma has the potential to be one of the most significant forces for psychological, social, and spiritual awakening and evolution. How we handle trauma greatly influences the quality of our lives.”  — Peter Levine

Resources:
Levine, P. (1997). Waking the tiger: Healing trauma: The innate capacities to transform over-whelming experiences.

Miller, K. (2012). Mind-body attunement therapy: Clinical Strategies. Mind Body Attunement Training Centre.