What happens after successful EMDR? Post Traumatic Growth by 87qxFj6

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									     What happens after successful EMDR?

Post Traumatic Growth becomes ‘Network Growth’


                        David Blore
                              PhD student
                School of Health and Population Sciences
                College of Medical and Dental Sciences,

             University of Birmingham, England



               10th EMDR Europe Conference,
             Beurs van Berlage, Amsterdam 2009




                                                           1
                 Observation
• Because clients are discharged when ‘symptom
  free’, EMDR clinicians rarely get to see what
  actually happens in the weeks, months and even
  years following the installation of positive
  cognitions…

• …this is hardly surprising given the understandable
  objective of healthcare to reduce the suffering of
  negative symptomatology… but this has given rise
  to a ‘lop-sided’ view… recognised over 50 years
  ago…

                                                        2
                Maslow’s criticism
   of the ‘negative only’ view of mental health:

“The science of psychology has been far more
successful on the negative than on the positive
side. It has revealed to us much about man’s
shortcomings, his illness, his sins, but little about
his potentialities, his virtues, his achievable
aspirations, or his full psychological height. It is as
if psychology has voluntarily restricted itself to
only half its rightful jurisdiction, and that, the
darker, meaner half.”
                                            (Maslow 1954 p.354)


                                                                  3
           Research questions

• What is the lived experience of clients who have
  been in a traumatic experience, subsequently
  undergone a course of EMDR and experienced
  ‘positive’ outcomes?

• How did they get there?

• What can be learnt about the role of EMDR in
  that process?


                                                     4
                 Methodology

• Phenomenological investigation of Road Traffic Crash
  victims, who had reported ‘positive’ outcomes
  subsequent to receiving EMDR

• Snowball recruitment of participants via treating
  EMDR clinician resulted in n=12 interviews of
  “experiential experts”

• An Interpretative Phenomenological Analysis (IPA)
  framework for data analysis to facilitate the
  generation of hypotheses

                                                         5
66
                    Results

• 1589 Second hermeneutic ‘summary phrases’

• Generating 19 ‘Sub themes’

• Clustering into:
   – 2 ‘Super-ordinate’ themes and
   – 1 ‘Over-arching theme’




                                              7
                 Collated findings grouped by super-ordinate theme

                                                       Alison Christine   David   Fiona   Isabelle   John   Mike   Nicola   Olga   Pat   Robert   Tim   TOTAL

      NAVIGATIONAL STRUGGLE
ASSUMPTIVE WORLD pre RTA                                3        4         1       2         2        2     1        2       0     1       1      1       20
PERI-RTA STRUGGLE WITH ASSUMPTIVE WORLD                 11       5         12      14        5        3     4        6       4     18      6      7       95
SPIRITUALITY TO RESOLVE STRUGGLE                        9        10        2       0         2        0     3        1       0     3       0      5       35
HANKERING (struggle to maintain assumptive w orld)      4        12        4       2         4        3     8        0       0     3       1      8       49
SECONDARY TRAUMATIC EXPERIENCES & IATROGENESIS          13       15        16      19        5        6     6        5       9     15      4      19     132
STRUGGLE TO COPE WITH NEGATIVE OUTCOMES                 9        24        11      5         3        5     5        7       9     8       4      9       99
STRUGGLE FOR CONTROL OF READJUSTMENT                    18       20        7       7         2        4     11       6       5     10      2      6       98

     FIGURATIVE LANGUAGE USE                            64       95        25      24        9        18    22       7       9     15     14      18     320

           NETWORK GROWTH
                    INVISIBLE
HINDSIGHTING (retrospective w isdom)                    35       31        14      13       3         8      6       9       6     15     11      16     167
PROSPECTIVE WISDOM                                      26       59        21      23       12        8      8       6       11    13     5       23     215
PARADOXICAL WISDOM                                      7        6         2       2        4         3      0       0       2     3      1       3       33
                      VISIBLE
DEVELOPMENT OF SUCCESS HEURISTIC                        12       12        5       3         0        2      2       0       1     3      3        7         50
ENHANCEMENT OF SOCIAL DEVELOPMENT                       6        6         3       9         0        0      0       2       1     2      13       2         44
ENHANCEMENT OF PERSONAL DEVELOPMENT                     5        20        6       4         1        3      0       2       4     5      4        5         59
APPRECIATION OF LIFE                                    3        3         2       2         3        4      0       3       8     4      5        5         42
SPIRITUAL & PHILOSOPHICAL DEVELOPMENT                   4        22        0       4         0        0      0       2       0     5      1        9         47
EXPRESSION OF POSITIVE EMOTIONS                         12       9         0       3         3        0      1       6       2     3      4        6         49
GROWTH ASPIRATIONS                                      1        12        3       2         2        1      1       1       2     2      3        5         35

                                               TOTAL    242      365      134     138       60        70    78      65       73    128    82      154    1589




                                                                                                                                                        88
          Why ‘Navigational Struggle’ ?

   • Because the themes that make this category
     effectively describe the individual’s ‘battle’ to get
     from the traumatic event to some semblance of
     normality and the ‘route’ taken had to be
     ‘navigated’

ASSUMPTIVE WORLD pre RTA                            The 'departure point'
PERI-RTA STRUGGLE WITH ASSUMPTIVE WORLD             'Losing sight' of 'familiar territory'
SPIRITUALITY TO RESOLVE STRUGGLE                    'Calling on higher resources' for help
HANKERING (struggle to maintain assumptive world)   Wishing he/she hadn't departed
SECONDARY TRAUMATIC EXPERIENCES & IATROGENESIS      Adverse 'road and weather conditions'
STRUGGLE TO COPE WITH NEGATIVE OUTCOMES             Dealing with 'mechanical failures'
STRUGGLE FOR CONTROL OF READJUSTMENT                'Wrestling with the steering'


                                                                                             9
             Why ‘Network Growth’ ?
• Because channels of associations (networks) are
  expanding, or as Maslow would put it: “his
  potentialities, his virtues, his achievable
  aspirations and his full psychological height” are
  being achieved

                    INVISIBLE               DEVELOPMENT 'BELOW GROUND'
  HINDSIGHTING (retrospective w isdom)    "The EMDR therapist planted the seed" an
  PROSPECTIVE WISDOM                        idea 'germinated', roots formed, and a
  PARADOXICAL WISDOM                                'shoot headed upwards'
                     VISIBLE                 DEVELOPMENT 'ABOVE GROUND'
  DEVELOPMENT OF SUCCESS HEURISTIC
                                           The 'seedling broke the surface of the soil'
  ENHANCEMENT OF SOCIAL DEVELOPMENT
                                             a sturdy new 'plant' grew, in due course
  ENHANCEMENT OF PERSONAL DEVELOPMENT
                                           'buds formed' and the 'plant flowered'. The
  APPRECIATION OF LIFE
                                          'plant' reached its full psychological height
  SPIRITUAL & PHILOSOPHICAL DEVELOPMENT
                                          before producing the aspirational 'seeds' of
  EXPRESSION OF POSITIVE EMOTIONS
                                                          future growth
  GROWTH ASPIRATIONS                                                                      10
   ‘Figurative Language Use (FLU)’

• “Metaphor depends largely on encyclopaedic knowledge”
  (Griffiths 2006)



• Encyclopaedic knowledge = myriads of networks

• The individual who has been traumatised finds their existing
  networks unable to cope with the reality of what has
  happened (see Solomon 2004)

• To comprehend what has happened, the individual generates
  new networks (about 20% of FLU related directly to the
  RTC/ driving/roads etc.…)
                                                                 11
      ‘Figurative Language Use (FLU)’
• But isn’t that exactly what EMDR does…
   – Every time a traumatic memory is linked into an adaptive
     network?
   – Every time a cognitive interweave works?
   – Every time the client describes an insight?
   – Every time the client uses a metaphor so as to understand the
     traumatic event and its aftermath?


• “Metaphor  is a neural phenomenon… neurons
  that fire together wire together” (Lakoff & Johnson 1980)

                                                                 12
                  Where to next?

• 8 Conceptual models of positive change (O’Leary et al 1998) were
  reviewed to see if they could describe the positive changes
  reported after EMDR – none fitted – most had helpful
  elements.

• A model is thus needed to adequately describe the lived
  experience of positive outcomes after EMDR for
  psychological trauma – preferably one that uses Adaptive
  Information Processing (AIP) as a foundation…

• The ‘Network Growth’ model ‘takes root’ here…


                                                                     13
The ‘Network Growth’ model to explain positive
outcomes following EMDR
(Blore 2009)



                                      RTA



                                  Figurative
                                   Language
                                      Use




                                                 14
               Conclusions and implications for EMDR practice


EMDR treatment outcomes are considerably more than merely a reduction in
    negative symptomatology or resolution of diagnostic entities

Assessment of positive assets should be included as routine in history-taking

Secondary traumas were frequently cited in the ‘navigational struggle’ after the road
     crash by those developing positive growth.

20% of metaphor use related to the trauma itself suggesting adaptive meaning-
      making as per AIP model and therefore growth started within treatment itself

PCs could be usefully viewed as ‘incremental’ in nature to facilitate further
      reassessment of the PC at the end of the first cycle of the installation phase.
      Installation should continue until this process is exhausted. This may result in
      the need for an ‘incomplete session’ protocol for Phase 5.

‘Post Traumatic Growth’ (PTG) is too restricting a label to fully describe the lived
       experienced of positive outcomes following EMDR…instead ‘Network Growth’
       is proposed to describes the ‘invisible’ (i.e. adaptive network expansion
       occurring during EMDR) and ‘visible’ (akin to the ‘visibility’ of PTG thereafter)
       processes involved in EMDR positive outcomes
                                                                                           15
 Thank you for listening



Past presentations relating to this research:
       www.davidblore.co.uk/news.php

       E: david.blore@btinternet.com
            T: +44 7976 933096                  16

								
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