EMDR _ EP – Michael Galvin_ PhD DECELERATING AND ACCELERATING by maclaren1


									                                                        EMDR & EP – Michael Galvin, PhD


                                     TRIGGER Modality
             FOR DECELERATING                                  FOR ACCELERATING:
    A clinician may treat an agoraphobic             Some clients need to be taken to the
person in his or her house at first, thereby     site of their triggers, such as a theater in the
delaying the additional stimulation, or the      case of an actor with stage fright. This in
more powerful triggers, involved with            situ or in vivo strategy will usually produce
having to leave home to go to the                emotions that do not appear readily in the
therapist’s office for the initial sessions.     therapist’s office.
    A person afraid to face the triggering           A person with symptoms that are not
power of a specific memory can be helped         associated with specific memories can be
to approach it metaphorically, or in             encouraged to float back into early times to
segments. One can also begin to work on          search for a time when s/he felt the same
relatively less troubling memories in the        symptoms that is being reported today.
beginning of treatment.                          That earlier memory is then processed.
   Ask about a client’s “resistance” before         Sometimes the client’s “resistance” can
judging it as inappropriate. Some clients        be located in the body, connected with
should not begin therapy until issues of         trigger words, or tied to a past experience,
secondary gain are resolved.                     and processed with EMDR.
   Sometimes it is necessary to work                A parent can be invited to a session to
individually rather than with a spouse or        talk about a child’s problem while the
other family member present who may              therapist treats the child with EMDR. The
provoke too intense a reaction in the client.    parent’s narration will trigger emotions in
The question of whether or not to involve        the child that can be processed. (This is a
others in a person’s session is complex.         complex strategy that requires training. See
(See Glang, 1996 for more information).          Lovett, 1999) for specifics.
   Check out secondary gain as in the case          For vague complaints, ask the Miracle
of phobia that allows a client to be excused     Question (O’Hanlon & Weiner-Davis,
from having to learn to become assertive         1989): “How would you know if overnight
and to learn to say “no.”                        you had miraculously made these
                                                 changes?” Then use EMDR to install a
                                                 future template, and desensitize any
                                                 negative emotions, sensations, and images
                                                 that arise.

                              Idea for using the trigger hierarchy
   process with      then process        then process      use future         test out in situ
an agoraphobic       in the therapy      in a mall or      template for       and reprocess
client at home       office               other “agora” other events          as necessary
   with a “reluctant”           interweave with questions       see if resistance wanes, and
adolescent, begin with an       about the adolescent’s          propose working on original
issue of personal interest      reluctance to be in therapy presenting problem
                                                   EMDR & EP – Michael Galvin, PhD 2

                                     IMAGE Modality
            FOR DECELERATING                                FOR ACCELERATING
    Use EMDR on a single aspect of the             Return to original incident and look for
traumatic image of a particularly disturbing    other aspects in the image which may have
memory (“fractionated” work).                   gone unnoticed but which are disturbing.
     Consider developing and installing            Some clients will feel more if they use a
positive images as resources for the client     photo or other visual stimulus instead of
prior to desensitization.                       relying on imaginal pictures.
     Offer the client a device for simulation      Be aware that your placing your fingers
if the very sight of the therapist is too       in front of the client may be visually
disturbing.                                     stimulating in and of itself

                           Ideas for using the imaginal hierarchy
  Ask the client to imagine the                    Ask the client to imagine a perpetrator
  perpetrator sitting quietly                      in progressively more action
  Use an imaginary glass protection                Slowly, “systematically,” begin to
  between the client and the image of              remove the imaginary glass protector
  the perpetrator in a traumatic memory            and process each new image
  Put the image in black and white                 Slowly add colors to the image as the
  or in colors not disturbing to the client         client guides you and process
  Have the client imagine being distant            Slowly the client imagines watching
  from the perpetrator, perhaps                    the perpetrator approach, or watching
   watching through binoculars                     the traumatic picture come closer
  For children especially: use drawing,            Gradually introduce visual prompts
  pictures, or other visual cues to                stimulate more emotion, all within the
  create a sense of safety to develop               client’s ability to tolerate

                                  COGNITION Modality
            FOR DECELERATING                                FOR ACCELERATING
    Tell the client that “It’s old stuff; you    Use the Socratic method, asking, for
survived it; you’re safe here in my office;   example, “What do you think about …?” or
it’s over,” or use other truthful and         “Whose fault was it?” or “What if?” to
comforting words.                             stimulate further processing.
    Role-play having the client comfort and      Role-play: “What if this had happened to
assure and advise a child or their own        your son or your daughter?” to encourage
Child ego state.                              looking at the problem differently.
    Role-play having the client advise           To stimulate a stuck point, ask the client
another person regarding a problem similar to give a voice to it: “What would that
the client’s.                                 feeling say about you if it could speak?”
   When a client makes progress, say: “Do        To stimulate a negative cognition, ask:
you see that you can heal?,” or: “What does “What does that (awful experience) say
it say about you that you can heal?”          about you?”
    Ask client to “Please repeat those           Ask client to “Please repeat those strong
  positive words you just said.”              negative words you just said.”
    If client doesn’t believe original PC,       Ask, “What would you have to learn or
modify it down to a more “believable”         believe about yourself for the VoC to go
form, e.g., “I would like to believe …”       higher?”
     To link both columns when a client seems to be stuck on an old memory, encourage
                                                      EMDR & EP – Michael Galvin, PhD 3
the client to “Keep one foot in the past, one in the present.” Another way to say might be:
“It is the child part of you that is feeling that old memory; the adult part of you knows
that it is in the past. Notice that the child could not have done anything else then, and that
the adult can now see it in better perspective.”
     Tell the client, “I’m confused. Are you saying that a 6-yr-old child could have been
responsible for what happened?” to help the client see the problem from the vantage point
of a mature adult, even as s/he feels it from the point of view of an abused child.

                       Some ideas for using the cognitive hierarchy
  Ask clients to think of the words they     then say      then say those words more
  would have said had they been allowed      the words     loudly … more loudly …
  as children and process with EMDR          softly (and until they can be shouted,
  (this is the “unspoken words” technique) process)        processing each change

                                    EMOTION Modality
             FOR DECELERATING                                FOR ACCELERATING
    When the client uses a word suggesting           When you hear the client mention a
strength or calm (e.g., “hope” or “wish”),       strong emotion (e.g., “angry” or “scary”),
ask them to repeat and to feel the word in       consider asking the client to repeat while
their body, and do bilateral stimulation.        you do bilateral stimulation.
    Begin with a fractionated emotion. For           For clients who “lose” feelings, ask:
example, begin with one memory that              “What was that feeling you just had?” or
produces only moderate anxiety.                  “Where was it when you noticed it last?”
    Remind the client “It is only a feeling          Ask the client to pretend having a
you are having about the past,” “It’s only       feeling such as anger over memories of
an emotional memory,”or “It’s over.”             abuse, and role-play a reaction to the
    Ask, “What might you feel if you had             Ask, “What might another person feel in
already resolved this problem?”                  circumstances such as this?”
    Ask: “How would you like to feel?” Then process with EMDR after client answers.
    Sometimes a client, for example, a teen sent by a parent, will be willing to work with
you, without admitting to harboring any residue from past trauma. Consider providing
continuous background bilateral stimulation, e.g., tones, while the client recounts his or
her history and notes any incident that still elicits a disturbance.

                            Ideas for using the emotional hierarchy
   Some clients can tolerate            process with EMDR           process, then see if they
hearing only the therapist             then see if they will        say something like,
mention a feeling word, such            say the word by             “I am allowed to feel
“anger,” or “fear”                      themselves                  anger, fear,” and so on
    Consider asking client to use increasingly more stimulating words, processing with
EMDR after the client speaks each new word, according to a hierarchy meaningful
to the client, such as in the following example:
“I’m irked”       “bothered”       “aggravated”       “irritated”   “angry, enraged,” etc.
                                                   EMDR & EP – Michael Galvin, PhD 4

                                 SENSATION Modality
Note: “Sensation” in EMDR refers only to kinesthetic cues: touch, smells, and taste. The
auditory sense is considered under “cognition,” and the visual sense is part of “image.”
            FOR DECELERATING                                FOR ACCELERATING
    Install a safe place with a soothing            Some clients will “feel” a memory if
aroma, such as pine needles.                    they smell a substance associated with it.
    Focus on only one sensation at a time.          Focus on all sensations the client feels.
    Tapping the hands of some clients will          Tapping the hands of some clients will
soothe, perhaps in the tradition of healing     provoke a reaction as they recall a trauma
touch.                                          of physical abuse.
    Ask the client to hold his or her hand          For a client whose SUD is high but is
over the body location of a sensation, and      looping, ask: “Where is that number in
process with EMDR only what is under the your body?” and resume processing after
client’s hand.                                  the response.
    Not infrequently, clients recall                When working with addicted clients, it
unpleasant smells, tastes and kinesthetic       may help to stimulate the urge to use a
stimuli; or feel that they are gagging, being substance by exposing the client to the very
smothered, swallowing poison, being             substance (tobacco, alcohol, food). Then
burned, etc. In such an instance, say: “It’s    process with EMDR as the client reports
only a memory,” “It’s in the past,” etc.        the urge to drink, smoke, overeat.…
When a client reports a positive sensation          When a client reports a negative
(calm, peace) process with EMDR in order sensation, ask, “What does that sensation
to install it further.                          say about you?” and process the response.
    Ask for details about the sensation: size, color, weight, shape, temperature, texture,
etc. While this may further stimulate processing for some clients, it also may serve to
contain the experience for others. The therapist decides how the technique is intended to
be used, and checks in with the client to determine the actual impact.

                         An idea for using the sensory hierarchy
   A couple with sexual problems, highly motivated, and with major traumatic memories
   resolved could be taught to use EMDR along with sensory focus, desensitizing one
   another to increasingly disturbing kinds of touch with EMDR.
                                              EMDR & EP – Michael Galvin, PhD 5
                          Which Method for Which Problem?

                                                          EP   EMDR

Preparatory considerations
1. Client choice                                          3      3
2. Client asks for empirically supported treatment        1      3
3. Client asks for method with face validity              2      3
4. Therapist choice                                       3      3
5. Preparation of the therapist for a session             3      2

Presenting problems
6. Anxiety                                                3      3
7. Phobia                                                 3      2
8. Depression                                             2      2
9. Trauma                                                 3      3
10. Emergencies, one-session-only contacts                3      0
11. Dissociation                                          3      1
12. Medical conditions affecting treatment                3      2
13. Dilemmas                                              2      3
14. Insomnia and other sleep disturbances                 1      2
15. Addictions                                            1      1
16. Physical pain                                         3      2
17. Blocks to optimal performance                         3      3

During treatment
18. Abreactions, elevated SUD, “looping”                  3      2
19. When images are not reported                          2      3
20. When self-referent beliefs are not reported           2      3
21. When little or no emotion is reported                 2      3
22. Running out of time, high SUD at end of session       3      1
23. Resistance and other forensic uses                    3      2

24. Children                                              3      3
25. Group use                                             3      1
26. Client self-care following a session                  3      2
27. Client self-care without formal therapy               3      0
28. Paraprofessional training                             3      1
29. Cross-cultural use                                    3      2

       0 = not recommended for this particular purpose;
       1 = limited usefulness;
       2 = useful;
       3 = very useful and a treatment of choice.
                                                   EMDR & EP – Michael Galvin, PhD 6

                                   BEHAVIOR Modality
             for decelerating:                             for accelerating:
   Client can role-play assertive behavior     Client can hit a pillow to provoke anger
   Client can practice smiling.                Client can role-play a depressed look.
   Some clients should not begin EMDR          Many panic victims don’t feel panic in
processing until they have first learned to the office, so consider having client spin or
manage the physiological responses of       hyperventilate, then process. (Note: Special
anxiety and other unpleasant affect.        care needs to be taken with this technique.)

                            Ideas for using the behavior hierarchy
    in-office treatment            process with EMDR. Then            client approaches
of insect-phobic client:           have client approach the          and closer, processing
bug in jar, set far away            bug, SUD rises, process          until phobia resolved
    in-vivo treatment: client       as above, process each           continue until client is
drives with therapist to            time client reports increase     able to feel as desired
phobic object (airport,             in anxiety, moving up the        and in a way that shows
bridge, theater. etc.)              hierarchy of phobic stimuli       processing is

                               INTERPERSONAL Modality
               for decelerating:                               for accelerating:
    Clients are to be encouraged to utilize         Sometimes the therapist’s face,
their social networks.                          behavior, or proximity will provoke a
    Supportive therapeutic relationship.        transference response in the client. Instead
    The butterfly hug is useful in the group of interpreting, process it with EMDR.
context.                                            Ask spouse or parent to join session to
    Clients can be encouraged to dialogue       provide treatment targets.
with their various ego states.                      For children, ask parent to narrate a
                                                traumatic event while child processes.
Remember that some children will use                Some symptoms involving parent and
EMDR more willingly if a comforting             child (e.g., school phobia) can involve
parent is present. Assess the child’s           treating both clients simultaneously, using
comfort level with you first.                   speakers with tones in the background.
   The adult of today can carry on a dialogue with the child from the client’s past … or
can advise the child.
    EMDR can be used as an adjunctive resource in group therapy. Two therapists are
necessary. As past issues are provoked, client leaves group with one therapist and
processes, using EMDR, then returns to group to debrief. If all members agree to this
system, the process of leaving for individual treatment is normalized and utilized

                         An idea for using the interpersonal hierarchy
   A social phobic man            but may react with anxiety        and finally
   might be successfully          at the prospect of talking        process the most
   treated for a fear of          to a boss, so may need to         fearsome task of all:
   speaking in class              process again with EMDR           asking for a date.
                                                  EMDR & EP – Michael Galvin, PhD 7

                                    DRUGS/DIET Modality
                  for decelerating:                        for accelerating:
    Some clients need sedative drugs so as       Some clients need stimulating drugs to
not to be overwhelmed by a traumatic         allow them to feel sufficient energy and
memory.                                      motivation to work therapeutically.
    Some clients need to reduce their            An intoxicated client will need to get
chemical stimulants, such as those who feel sober, as the alcohol acts as a depressant
anxious from drinking too many caffeine-     and lowers emotion, creating distance from
loaded beverages.                            the problem.
    It is a good idea to recommend aerobic       Certain foods or chemicals can trigger a
exercise so clients increase their serotonin memory, and can be used both to stimulate
and other catecholamines                     an abreaction and check effects

                        Some ideas for using the drug/diet hierarchy
   Clients who take psychotropic medications can use EMDR to process the feelings that
   are accessible. As feelings are resolved they can, with medical supervision, lower their
   dosage and process new feelings that arise, and so on.
    Some clients will be able to lower their dosage, others will be able to stop taking
   medications completely.
   A similar process has been reported by therapists who work with certain pain clients,
   where the pain is found to be psychogenic. If the pain is only partially psychogenic,
   clients may be able to lower their medication dosage without eliminating it entirely.
   In a similar way, persons who use EMDR to stop smoking may notice troublesome
   feelings arising as they taper off their smoking. Process these as they appear.
   Some therapists have reported working with active alcoholics, processing memories
   and other stimuli that trigger the urge to drink, and working with the urges in a
   hierarchical fashion. Consider all associated stimuli that enhance the power of alcohol,
   such as friends, places, stressful feelings, and so forth--all are potential targets for
   Consider doing something similar with food triggers, especially as these are associated
   with other stimuli such as friends, TV, stress, and so forth. Desensitize each associated
   stimulus and any anxiety related to it.

   Many of these assessment procedures and therapy techniques can also be used in an
   energy therapy session.

    The above is from
        Hartung, J., & Galvin, M. (2003). EMDR and energy psychology: Combining
forces to optimize treatment. New York: Norton.

Michael Galvin, Ph.D.
315 East San Rafael
Colorado Springs, CO

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