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Advanced Techniques in the Use of EMDR to Treat Complex Trauma Barrylittmft.com Barry Litt, MFT Concord, NH.

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Presentation on theme: "Advanced Techniques in the Use of EMDR to Treat Complex Trauma Barrylittmft.com Barry Litt, MFT Concord, NH."— Presentation transcript:

1 Advanced Techniques in the Use of EMDR to Treat Complex Trauma Barrylittmft.com Barry Litt, MFT Concord, NH

2 Trauma memory Consciousness Neocortex Narrative (semantic) Memory EMDR Episodic Memory Stored in Limbic System and Brain Stem Re-lived vs. Remembered Dissociated from Narrative Memory Aspects of Trauma Dissociated from each other (B.A.S.K.)

3 Trauma memory Consciousness Fear/avoidance Negative Transference Distraction Emotional Numbing Blocking Beliefs EMDR Affect Phobia Amnesia Interpersonal Defenses Why Ego States Matter…

4 Object Relations Theory: Fairbairns Structural Model of the Self Central Ego Self as Object Seeking Antilibidinal Ego Libidinal Ego Splitting of the Self: 6 – 18 mos.

5 Object Relations Theory: Fairbairns Structural Model of the Self Antilibidinal Ego Libidinal Ego Central Ego Borderline Personality Disorder (Kernberg)

6 Object Relations Theory: General Model of Introjected Family Members and Their Relationships Superego Ego ID Introjects serve as template for relating to others

7 Object Relations Theory: General Model of Introjected Family Members and Their Relationships Introjected Relational Configurations Yield Yield Relational Attitudes

8 Ego State Theory of Watkins & Watkins All manner of introjects, including ego cathected roles

9 Pathogenic Family Dynamics Co-Dependency; Collusive DenialCo-Dependency; Collusive Denial Undifferentiated family ego mass (Bowen) Undifferentiated family ego mass (Bowen) Pseudomutuality (Wynne, 1965) Bilateral transference Bilateral transference (Warkentin & Whitaker,1966) Trading of Dissociations (Wynne, 1965)

10 Summary Pathogenic family dynamics (relational configurations) are internalized as ego state conflictsPathogenic family dynamics (relational configurations) are internalized as ego state conflicts The resulting ego state system is a structured The resulting ego state system is a structured complementation of the loyalty system complementation of the loyalty system The subjective sense of Self (and corresponding The subjective sense of Self (and corresponding relational attitude) is adaptive to the original, relational attitude) is adaptive to the original, formative context formative context

11 Phase 2: Preparation 1.Safety Assessment Self-Harm vs. Stability Self-Harm vs. Stability (Intrusive Experiences, Dissociation)

12 Phase 2: Preparation 1.Safety Assessment Self-Harm: risk factors Self-Harm: risk factors a)History of Suicidal Ideation b)History of Suicidal Gestures c)History of Suicidal Attempts d)History of Psychiatric Hospitalizations e)History or Current Reliance of Self-Harm Behaviors

13 a)Safety Contract b)Psycho education c)DBT Group? d)RDI, Affect Management Skills Training (AMST) e)Safe Place Phase 2: Preparation 1.Safety Assessment Self-Harm Interventions Self-Harm Interventions

14 Phase 2: Preparation 2. Stability Assessment Intrusive experiences, including: Intrusive experiences, including: a)Fugue, lost time b)Regression c)Amnesia d)Acting-out (e.g., cutting, substance abuse, risk-taking behavior) e)Panic Attacks; freeze responses f)Insomnia

15 Phase 2: Preparation 2. Stability Assessment a)Grounding exercises b)Mindfulness practice c)Journaling d)Present-time orientation e)Safe-Place work f)Medication g)Constructive Avoidance (Forgash) h)Ego State Work: Daily living team (Twombly) Interventions: Interventions:

16 The Overall Structure of Therapy Three Intertwining Tracks: 1.Cognitive Scaffolding Insight/Psychoeducation 2. Affective Transformation (EMDR) 3.Relational Repair ; Rejunctive Action ; Earning Entitlement Cognitive Affective Transformation Relational Repair

17 Kitchurs Strategic Developmental Model: Genogram-Based Target Selection and Sequence Parents RelationshipParents Relationship Mother Mother Father Father Sibling Dynamics Sibling Dynamics Nodal Events Nodal Events Target Selection

18 EMDR Target Selection, continued Pathogenic family processes (from genogram)Pathogenic family processes (from genogram) Double binds Double binds Split loyalties Split loyalties Intersubjective fusion Intersubjective fusion Dissociated affect from others Dissociated affect from others All likely to surface covert ego states and ego state conflict Affect bridge (floatback) from recent event Affect bridge (floatback) from recent event

19 A. Working with Domains of the Self Being vs. Nothingness Merit Safety

20 Domains of the Self, continued Being vs. Nothingness Being vs. Nothing Self-Other Dialectic Depersonalization Merit Neurosis Safety Hypervigilance

21 Cognitive Correlates to Domains of the Self Being vs. Nothingness Being vs. Nothing I dont exist Im invisible I dont matter Merit Safety Im gonna die Im not safe Im trapped Merit Im not good enough I dont measure up Im a failure Im bad

22 1. Features of the Being Domain Behavior: Acting-outBehavior: Acting-out (Better to be bad than to not be at all) (Better to be bad than to not be at all) Relational conflict and ego state conflict may be trading up from not being Relational conflict and ego state conflict may be trading up from not being Cutting; substance abuse; O-C D; etc. Cutting; substance abuse; O-C D; etc. Affect: anxiety, panic, fear Sensation: numbing Knowledge (NC): Im alone, invisible…

23 Working Through the Being Domain I think, therefore I am -Descartes I notice that I feel, therefore I am -(Damasio/Litt) The Importance of Sensation:

24 Working Through the Being Domain Dynamic Targets: -Narcissistic partner -Partner avoids/withdraws -As-if relating Event Targets -Rejection -Abandonment, separation, loss -Associations

25 Working Through the Being Domain NC: I dont exist; Im invisible;NC: I dont exist; Im invisible; Im alone; I dont matter Im alone; I dont matter PC: I am; I have myself; I exist even if… PC: I am; I have myself; I exist even if…

26 Working Through the Being Domain Body awareness must be maintainedBody awareness must be maintained EMDR augmented with somatic techniques EMDR augmented with somatic techniques Sensory integrity necessary for processing Sensory integrity necessary for processing Successful processing may trade up from numbing to shame/guilt Successful processing may trade up from numbing to shame/guilt

27 3. Features of the Safety Domain Behavior: avoidance, hypervigilanceBehavior: avoidance, hypervigilance Affect: anxiety, panic, fear Affect: anxiety, panic, fear Sensation: autonomic hypoarousal Sensation: autonomic hypoarousal Knowledge (NC): Im gonna die, Im not safe… Knowledge (NC): Im gonna die, Im not safe…

28 Working through the Safety Domain Therapist and client work together to maintain some control over fight/flight responseTherapist and client work together to maintain some control over fight/flight response Controlled and organized activation of fight/flight motor behavior during desensitization phaseControlled and organized activation of fight/flight motor behavior during desensitization phase Client attention to present condition of body while remembering threat eventClient attention to present condition of body while remembering threat event

29 depersonalized Avoiding/relaxed abreaction panic presence absorption B. Zone of Optimal Arousal for Processing Parasympathetic Sympathetic

30 presence absorption depersonalized Avoiding/relaxed abreaction panic Techniques : Distraction Somatic Cueing Present-time Orientation Somatic interweaves Node isolation techniques Olfactory Cueing

31 Parasympathetic Sympathetic presence absorption depersonalized Avoiding/relaxed abreaction panic Techniques: Closed eyes Push the NC Node isolation techniques Choosing new target

32 Parasympathetic Sympathetic presence absorption depersonalized Avoiding/relaxed abreaction panic Techniques: Breath Control Shift visual perspective (3 rd person) Node isolation Distraction Self-soothing techniques Pushing arms interweave Present-time orientation Olfactory stimulation Safety Interweave

33 Parasympathetic Sympathetic presence absorption depersonalized Avoiding/relaxed abreaction panic Techniques: Self-soothing techniques or, increase absorption Node isolation Silent Breath control cueing

34 C. EMDR with Ego States Complications in phase Four (Desensitization): Looping Pseudoprocessing revolving door ego states Confusion, overwhelm, or undifferentiated experience Abreaction (Iatragenic) Blocking (amnesia; avoidance)

35 Phase Techniques for E.S. Conflict Demand Characteristic Efficiency Change of visual perspective Pushing the NC Targeted elicitation of ego state Intervention of the Adult Self Affect bridge (floatback) Open-ended elicitation of ego state system (e.g., conference room) Node isolation techniques Somatic Techniques Schiffer Glasses


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