1. 1 HAP UK & Ireland Volunteer EMDR Consultant’s Workshop Birmingham Midland Institute Friday 30 th November 2012 Cast in order of appearance… Sian Morgan, David Blore and Candy Bamford 1

2. 2 agenda for the day Introduction – David & Sian Orientation to HAP expectations – Sian On being a volunteer EMDR supervisor – David Libyan amputees presentation – Candy IT exercise – David Conclusions, what have I learnt? – David What next? – Sian and David 2

3. 3 aims and objectives To prepare volunteer EMDR Consultants for a supervision role that has considerable differences to (and some similarities to) ‘normal’ (i.e.) EMDR supervision By knowing the requirements of the role and gaining an awareness of HAP’s requirements By investigating a range of contextual issues By having the opportunity to discuss facets of those contexts By having the opportunity to try out the modus operandi of supervision and learning from other’s experiences By having the opportunity to ask questions on any of the above

4. 4 questions to bear in mind during the day What does being a volunteer supervisor mean for me personally? How will being a volunteer EMDR supervisor differ from my ordinary supervision? What things may I need to bear in mind? What information will I need to know beforehand? Have I any previous experience of being a volunteer supervisor? What special skills do I have that I could use? What are your objectives for the day? (Write them down) 4

5. 5 Sian’s slides 5

6. 6 On becoming a volunteer EMDR supervisor 6

7. 7 the 7 ‘contexts’ 1. Personal 2. Welfare 3. Cultural 4. Political 5. Geographical 6. Communications 7. Special contexts 7 Motives 4 ‘S’ Culture Politics Distance and time Communications & IT ‘One off’s’

8. 8 the 7 ‘contexts’ 1. Personal context 2. Welfare context 3. Cultural context 4. Political context 5. Geographical context 6. IT context 7. Special contexts 8 Some of these ‘contexts’ may be more relevant than others in certain situations e.g. in areas of civil/ military unrest then welfare and political contexts will be particularly important …whilst areas where Internet connection is poor, it is thousands of miles from the UK and a very different culture, then those contexts will need attention

9. 9 1.Personal Context This involves some soul searching and may be very personal (NB you do not have to share any of this material with the group) 9

10. 10 1. Personal Context Suggested questions to ask yourself: Why am I here today? What personal agendas do I have? What priorities do I have? What do I hope to achieve? What can I commit to realistically? 10

11. 11 2.Welfare context Safety Security Support Supervision 11

12. 12 2. Welfare context The key issues… 1.Safety and security of the clinician you are supervising? 2.Giving advice and guidance? 3.What methods of supporting the clinician might there be? 4.Looking after your own welfare? 12

13. 13 2. Welfare context Focus on safety first, and compliance to EMDR second Is your clinician practising EMDR in a safe environment? If no, what is unsafe about it and what advice do you need to give? Can the environment be made safer?(If no then what?) Is the EMDR being provided safe? (you will tend to focus on this most, so is unlikely to be an issue for an experienced supervisor - if in doubt stress components of Phase 2) Most likely issue is safety of modifications to EMDR due to the unusual application of EMDR Is your clinician in a safe environment to discuss cases with you? (Check this out each time) Who else is about/ can hear? This is not just about confidentiality (Check this out each time)

14. 14 Are you prepared to delay/alter/stop sessions if welfare issues indicate this is the safest course of action? On the other hand, how convenient/inconvenient is it to you to prolong a given session to make sure you have covered safety issues? How might you change your supervision to make sure both clinician and practice are both safe? How would you tell if the supervisee was showing signs of: Vicarious traumatisation (don’t under-estimate this one!)? Exhaustion? (too many clients) Ethical dilemmas in practising EMDR? (struggling to reconcile application of the EMDR model with practical need) is under pressure in some way from an undisclosed source (e.g. political pressure) 2. Welfare context Focus on safety first, and compliance to EMDR second

15. 15 What online resources are there that might help your client – why may this be an advantage? (Internet, ease of access, prior filtering by you) What effects may hearing material in supervision have on you? How will you look after yourself? Supervision for the supervisor. Any other welfare issues? 2. Welfare context Focus on safety first, and compliance to EMDR second

16. 16 3. Cultural context …a huge subject! 16

17. 17 3. Cultural context Cultures transcend national borders… People living in individualistic cultures (typical of the West) tend to express their emotions, even negative ones…. In Western culture, emotions are largely seen as belonging within the individual rather than stemming from the environment around them. (Uchida, et al. 2009) Although expression of emotions can differ: e.g. Southern versus Northern Europeans… An ‘open and largely expressive’ stance on emotions is completely opposite to a collectivistic culture (Japan being a particular example)… (Niedenthal, et al. pg 306) 17

18. 18 3. Cultural context Cultural issues in expressing emotion… …emotions are a universal phenomena, but they are always influenced by culture (Richeson & Boyd 2005) “Is the client indicating a reluctance to disclose material, particularly detailed information? Is there an explanation for the reluctance? It is particularly necessary to make a distinction between ‘reluctance to disclose’,dissociation and avoidance because of anxiety or lack of preparation.” (Blore et al paper in review) 6 basic emotions: happiness, sadness, anger, fear, disgust, and surprise (8 if using the ‘Plutchik wheel’) 18

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20. 20 3. Cultural context Historical context to culture e.g. wikipedia provides an excellent history of Bosnia Religious context of culture e.g. Minorities such as the Russian orthodox church in Libya Cultural aspects of trauma, particularly how cultures react in-situ to trauma e.g. Turkish proverb: ‘Dead is death: Those left behind are ours’ 20

21. 21 4. Political context Don’t underestimate this context! 21

22. 22 4. Political context Politics of country of trauma Politicisation of humanitarian response ‘Turkish Probe’ Blore 2001 Secondary political agendas Israel involvement in Turkish earthquakes 1999 22

23. 23 4. Political context Remaining neutral and ‘humanitarian’ Non-interventionist awareness of supervisor role The seven fundamental principles of the International Red Cross and Red Crescent Movement are: Humanity Impartiality Neutrality Independence Voluntary service Unity Universality The British Red Cross also has four values: Compassionate, Inclusive, Dynamic, Courageous 23

24. 24 5. Geographical context 24

25. 25 5. Geographical context Know your country! Bosnia the first and ongoing project for HAP UK & Ireland Turkey overspill from the Syrian civil war Libya post Gadaffi ‘scores’ being settled Jordan foiling Al Qaeda 25

26. 26 Quick quiz 1.What is the time difference between Bosnia and the UK? 2.Do they put the clocks back in Autumn in Jordan? 3.What is the time difference between Libya and Iraq? 4.What is the difference between Israel Standard Time and Palestinian territories Standard Time? 5.Why was the answer to Q4 so important in 1999? 26

27. 27 Quick quiz answers 1.What is the time difference between Bosnia and the UK? Bosnia is 1 hour ahead of the UK 2.Do they put the clocks back in Autumn in Jordan? No 3.What is the time difference between Libya and Iraq? Iraq is 2 hours ahead of Libya 4.What is the difference between Israel Standard Time and Palestinian territories Standard Time? PST is one hour ahead of IST 5.Why was the answer to Q4 so important in 1999? Two Palestininians carrying a bomb set to go off at 17.30 IST was actually set for 17.30 PST and blew up in transit. The terrorists were awarded the 1999 ‘Darwin’ award 27

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31. 31 Candy’s slides 31

32. 32 6. Communications context 32

33. 33 6. Communications context Communicating with others from different cultures IT skills and requirements

34. 34 6a. Communicating with others from different cultures Group exercise to identify all types of communication problems that may be encountered:  Consider communications (ignore all IT issues at this stage): Imagine a face-to-face situation: you are in your supervisee’s country doing face to face supervision. 1.List all communication problems you might encounter 2.List any practical solutions you can think of

35. 35 Without communication there is no supervision! Language – do you speak anything other than English? How well does your supervisee speak English (or the language you are communicating in)? How much does face-to-face supervision improve communication (versus e.g. email)? What are your options for communicating? (email, telephone, Skype, in vivo etc. What about the transferability of EMDR from one culture to another? Recall the American English manuals of the ‘old days’ and how they didn’t ‘easily translate’ in to British English? 6a. Communicating with others from different cultures

36. 36 The importance of identifying a PC that fits a client’s culture: “Mary initially could not think of an appropriate PC. She also found the list of PC offered to her not suitable. She randomly thought of a PC “I can let go of my burden.” This PC seemingly did not fit her. The subsequent emerged statement “I just follow my destined path of life” may sound passive and somewhat resigning, but it turned out more suitable to her. To the Chinese people, accepting one’s fate and destiny is a kind of active taking of the bad situations. It is similar to a Chinese idiom “let nature take its course.” To Mary, this cognition also implies that she should not take sole responsibility for her brother’s death. Obviously, there is some PC which is universal and comprehensible to both Western and Chinese people (e.g., “I am safe,” “I am useful/worthwhile/valuable”). However, some cognition may mean negative to Western people but not to Chinese people. To Chinese, the statement “I just follow the fate” means receiving and accepting what is offered by the nature. It has a connotation of “I have done my best but nature has its way. Mary’s case illustrates that accurate matching of a PC appropriate to one’s cultural belief would allow the capturing of the core theme of traumas, and provides a better chance for successful treatment.” Wai-Ling Poon (2012 p4) 6a. Communicating with others from different cultures

37. 37 ‘Mary’ illustrates other communication points (although not highlighted in Wai-Ling’s paper): Be mindful that NCs and PCs are more generalisable when thought of in a ‘Mother’ tongue. Why? Check that instructions to supervisee’s are fully understood (if necessary in the supervisee’s own language). Anyone experience of translator’s in EMDR sessions The ‘Cologne boiler room’ story 6a. Communicating with others from different cultures

38. 38 Pena ajena (Mexican Spanish): The embarrassment you feel watching someone else’s humiliation Schadenfreude (German): the pleasure derived from someone else’s pain Taarradhin (Arabic): implies a happy solution for everyone, or “I win. You win.” It’s a way of reconciling without anyone losing face. Arabic has no word for “compromise,” in the sense of reaching an arrangement via struggle and disagreement Yoko meshi (Japanese): literally ‘a meal eaten sideways,’ referring to the peculiar stress induced by speaking a foreign language 6a. Communicating with others from different cultures …words that don’t exist in English

39. 39 Skype (originally Sky Peer-to-Peer) Designed in Sweden & Denmark in 2003 Currently Microsoft owned; based in Luxembourg with 44% workforce in Estonia (where software was originally designed) 663,000,000 users worldwide Freeware download from www.skype.com : current version 6.0.0.120www.skype.com David’s Skype ID: emdrdavid 39 6b. IT skills and requirements

40. 40 Because session timing may be tricky (time differences etc.): set an alarm on your mobile for 5 minutes prior to agreed time of session – this will remind you and give you time to load up Skype software Agree a backup strategy (usually email or text exchange) Set realistic expectations 2 x ½ hour sessions may work better than 1 x 1 hour especially if Internet connection not good Try not to have to many files open on your PC during a Skype call Be prepared to have voice only (i.e. no video if call quality poor) Be aware of the background to your own video !! Cultural sensitivity ! 40 6b. IT skills and requirements

41. 41 Skype roleplay exercise 41 …feedback?

42. 42 What happens next? Your filled in forms have some detail on for matching Consultant to supervisees Sian will co-ordinate this Your own backup – free supervision for HAP supervisors – can be by Skype but preferably initial contact by email to: david.blore@btinternet.comdavid.blore@btinternet.com 42

43. 43 What happens next? Proposal of a closed discussion group for UK HAP Consultants on www.linkedin.com ?www.linkedin.com Mutual ‘cross’ support Share experiences Learn from each other Acquire some stats along the way Poll for opinions and best practice Act as a focus for producing a paper for publishing/ research 43

44. 44 Thank you for listening David Blore