1 50 15 https://d1y502jg6fpugt.cloudfront.net/13023/archive/files/81a3d64d37c75595a22288d6c711730e.pdf?Expires=1790208000&Signature=R09GIcteU3WvpVw8Q4BvmoIUh468anPA%7E5mSd9CLPkKLdqCPrzPvsYoh4y03Vo-yo1mL9Y1EgoH2VmJ0k6Xgbgjr5cEzT5VVEX4QozwnQzkSe-ST5KtiuBZh05ksdmy1ilLrAVD1dYc2PX70IRQhKH6YV19e4lzBZ2687h1wJgCQ4MmQ2r7EzpFFaEAGx2nXteUHACy77kPpZ9hGQjk8XByycW9h1jp2TnvqbE1xufbJVuw1WxxEmQZp6KwWJAOrFBzw87XTDutEj21EdBl-DOdiGB0eNG-TCzQUqh01Hl0avFej03JjJFF7UG0hnt8WoNIvu-1yQTMTYE3ZxEeXLw__&Key-Pair-Id=K6UGZS9ZTDSZM 1db0c11060baac19af337492d3a010df PDF Text Text SPECIAL Network Newsletter EYE MOVEMENT DESENSITIZATION AND REPROCESSING P.O. Box 51010, Pacific Grove, CA 93950-6010 (408) 372-3900 STRAY THOUGHTS - Cautions and Metaphors . ............... Francine Shapiro, Ph.D .................................... 1 PROJECT CAPACITOR........................................................... Pat Cane ............................................................ 2 REVIEW OF "Cognitive Action Theory of PTSD"............... Andrew Sweet, Psy.D ........................................ 3 EMDR: A Cautionary Note ...................................................... Francine Shapiro, Ph.D ............................... ..... 3 INTERNATIONAL UPDATE ................................................... Francine Shapiro, Ph.D .................................... 3 EPIC: EMDR Professional Issues Committee. .................... Virginia Lewis, Ph.D .................................... ..... 3 INNOVATIVE USES ................................................................. Ron Martinez, Ph.D .......................... ................ 5 REVIEW of"The Meaning of Dreams" by Jonathan Winson . .................... Andrew Sweet, Psy.D ............... 6 STRAY THOUGHTS .................... .............................................. Francine Shapiro, Ph.D . ................................. .. 1 - Process issues, Recent Trauma, OCD, Fingertaps RELAPSE THERAPY. .............................................................. Robert H. Kitchen, MA, CRPS . ...... ................... 3 AUTONOMIC CORRELATES OF EMDR. ............................. David Wilson, Ph.D. & William Covi, Ph .D...... 5 EMDR: Innovative Uses .......................................................... Ron Martinez, Ph.D.. ........................................ 6 EMDR USED AS A TREATMENT IN CHRONIC PAIN. .... Carol Blanford, CFNP & Ray Blanford, MSW .. 6 THE MEANING OF DREAMS.. ............................................... Andrew A Sweet, Psy.D . ......................... ......... 7 TREATING THE UNKNOWN.. ................................................ Cliff Levin, Ph.D............................................... 8 INTERNATIONAL UPDATE ................................................... Francine Shapiro, Ph.D. ................................... 8 CREATING POSITIVE COGNITIONS. .................................. Landry Wildwind, LCSW........... ...................... 10 STRAY THOUGHTS . ................................................................. Francine Shapiro, Ph.D .................................... 1 - Forensic Issues, Fallacy of Memory, Cancer FROM WORTHLESS TO WORKING. ..................................... Edith Ankersmith , LCSW ................................. 2 1WO BOOK REVIEWS ............................................................. Andrew Leeds, Ph.D .................................... ...... 3 Memory in Mind and Brain: What Dream Imagery Reveals Mindworks; Time and Conscious Experience VARIATION IN DIRECTION OF EYE MOVEMENTS . ....... Ruth Grainger, Ph.D ......................................... 5 DIFFICULT CASES . ................................................................. Andrew Leeds, Ph .D .......................................... 5 INTERNATIONAL UPDATE.................................................. Francine Shapiro, Ph .D ....... ............................. 6 LESSONS FROM GEESE. ..................................................................................................................................... 7 PERPETRATOR-EARLY CHILDHOOD ABUSE SURVIVOR. .................... Landry Wildwind, LCSW ......... 8 CASE STUDY. ............................................................................ Liz Mendoza-Weitman, LCSW .......................... 9 EMDR: Innovative Uses ........................................................... Ron Martinez, Ph .D.......................................... 9 �STRAY THOUGHTS .................................................................. Francine Shapiro, Ph.D ..... ............................... 1 - Trauma and the Child Perspective, BioElectrical ANOREXIA, BODY IMAGE, AND SELF ACCEPTANCE .... Emmett Miller, MD ..................................... .. .... 2 INTERNATIONAL UP.DATE................................................... Francine Shapiro, Ph.D ................. .... .. ............. 3 BEHAVIOR VALIDATION OF EMDR: 1WO PTSD CASES Robert Flint, Ph.D ... .......................................... 5 DIFFICULT CASES.................................................................. Andrew Leeds, Ph.D .................... ...................... 7 EMDR INNOVATIVE USES.. ................................................. Ron Martinez, Ph.D .......................................... 8 ERRATUM AND CLARIFICATION. ....................................... Robert Kitchen, MA ................................... ....... 8 SUBJECTIVE UNIT OF MOTIVATION................................. Linda Neider, MA, ATR .................................... 9 ...... PROTOCOL FOR-..DESENSITIZATION OF RECENT TRAUMATIC EVENTS ...................................................................................................... Roger Solomon,Ph.D ............. .'.......................... 10 BOOK REVIEW: ........................................................................ Ronald Kaufman, MS .......... ............................. 12 The Wetmind: The New Cognative Science by Stephen Kosslyn and Oliver Koenig PATIENTS WITH A HISTORY OF SADISTIC AND RITUAL ABUSE...... Walter Young, MD .. ................ 13 DO YOU HEAR FLORIDA CALLING? . .................................. Judy Albert, MA ............................................... 14 HURRICANE ANDREW DISASTER RESPONSE TEAM .... Ruth Knowles Grainger, Ph.D ....... .................. 14 BOOK REVIEW ........................................................................ Francine Shapiro, Ph.D ................................... 15 Give Sorrow Words: Working With A Dying Child by Dorthy Judd THE HEART OF EMDR ........................................................... Cliff Levin, Ph.D ....................................... ....... 16 MONITERING THERAPEUTIC CHANGE VIA DREAM CONTENT......... William Larsen, MFCC .. .... ..... 17 Ron Marteniz, Ph.D.-A Legacy . ................................................................................................. ................... .... ... 1 STRAY THOUGHTS-Memory Retrieval . ........................... Francine Shapiro, Ph.D .................................... 1 REFERENCES ........................................................................................................................................................ 2 INTENSITY OF VISUAL STIMULATION FROM THE ENVIRONMENT. .. ...... .. ...... ..................................... .. ........... ..... ..... .......................... Tom Mathews, Ph.D .......................................... 3 SMOKING CESSATION PROTOCOL.................................... A J. Popky, CHT ............................................... 4 Trauma/Abuse Memories with Multiple Personality Disorder (MPD) . .. Marilyn Luber, Ph.D ................ 6 REM Correlated with Emotional Intensity Not Scanning in Dreams. ... Tom Mathews, Ph.D ................. 8 EMDR Grief and Morning....................................................... Donald Weston, Ph.D ............................... ......... 9 EMDR in Patients with a History of Sadistic and Ritual Abuse .............. Walter Young, MD ................... 9 FRIENDS OF RON MARTINEZ . .............................................. ........................................................... ................. 11 UPDATE ON FLORIDA DISASTOR RESPONSE EFFORT. Judith Boore, MA .................................. .......... 11 Selection Criteria for Negative and Positive Cognitions in EMDR. ....... Andrew Leeds, Ph.D .... ............ 12 INTERNATIONAL UPDATE................................................... Francine Shapiro, Ph.D ................... .. .............. 15 STRAY THOUGHTS.................................................................. Francine Shapiro, Ph.D .................................... 1 - Keynote - The Boundaries of Quantum Psychology EMDR Client Safety Checklist............................................... Virginia Lewis, Ph.D ........................... :............. 5 CLOSING EMDR SESSIONS................................................... Laurel Parnell, Ph.D .......................................... 5 Behavioural Approach in the Treatment of Long Term Depression...... Zara Yellin, Ph.D ..................... 6 TREATING CHILDREN'S NIGHTMARES............................ Ricky Greenwald, MA ....................................... 7 QUESTIONING.......................... :........................................... :.-.. Darrel Dunkel, Ph.D ......................................... 9 EPIC Announcement............................................................................................................................................ 7 INTERNATIONAL UPDATE. .................................................. Francine Shapiro, Ph.D ............................. ...... . 9 FROM THE EDITOR. ............................................................... Lois Allen-Byrd, Ph.D ...................................... 10 A CASE STUDY: Paradox and EMDR with Paranoid Schizophrenia..... Edith Schultz, Ph .D ................ 11 Desensitizition and Reprocessing of Chronic Pain with EMDR ............. Bruce Eimer , Ph .D .................. 13 WHENCE EMDR? ...................................................................... St even Silver, Ph.D ............................. ... ......... 17 WHENCE EMDR? .................... Comnientary.......................... Francine Shapiro, Ph.D ................................... 18 A CASE STUDY......................................................................... Terry Smith, Ph.D ............................................ 19 EPIC: Work Complete to Date. ............................................................................................. .............................. 20 �STRAY THOUGHTS ... ... .... .................. .... .. ...... .. ...... .......... .. ... ... Francine Shapiro, Ph.D. ... .. ..... .. .. .. ...... .... ..... ... . 1 - Clinical Cautions EMDR: WARTS AND ALL. ............ ......... ..... ... ..................... ..... Elan Shapiro, MA .... ...... ..... .. ....... ..... .. ..... .......... 4 METAPHORS DES~IBING THE EMDR PROCESS ..... .... Errol D. Schubot, Ph.D. .. .......... .. ............ ... ..... .. 5 AWARDS .... ....... ..... ... .................. ........... .... .......... .... ....... ..... ....... ... .............. ...... ..... ................. ............... ....... ... ....... 7 EXPOSURE/EMDR: DIAGNOSTIC USE OF FEEDBACK. Frank J . Schlosser, MS .......... ... ....... .. .... ......... .. 7 A NEW TECHNIQUE FOR CLOSING OUT OF EMDR SESSIONS ......... Steven Lazrove, MD ........ ........... 10 INTERNATIONAL UPDATE . .. .... .... ............. .. ....... ............ ...... Francine Shapiro, Ph.D......... ...................... .... 11 NEWS FROM THE EMDR RESEARCHffRAINING CENTER. ...... ......... Clifford Levin, Ph.D ........... ...... .. 15 MAGICAL INSTALLA--TI~AN EMPOWER CLIENTS TO SLAY THEIR DRAGONS ............................. .... ..................... ............. .......... .. ... ........ ... ...... ... Ricky Greenwald, MA ............................ ........ .. 16 CASE HISTORY: A CLIENT UNABLE TO TRACK. ........... Judith Boore, MA .................................... ... ...... 17 INNOVATIVE USES: EMDR BODY CENTERED PROCESSING....... .... Keith Andreson, MA ................... 19 THE IMPORTANCE OF MATCHING POSITIVE COGNITION TO CLIENT VALUES ...................... .................. .. ........... .... .......... ..... ................ .. ......... ... Edith Ankersmit, LCSW ...... ..................... ...... . 20 STRAY THOUGHTS ... .... .. .................. ........ ........ ...... .... ... ..... .... . Francine Shapiro, Ph.D. .. .... .. ... ..................... ... 1 - Issues of Compliance in EMDR EMDR AND THE ATROCITIES IN BOSNIA..... .. ............... .. Geoffry White, Ph.D.......... ............................ .. .. 3 EMDR FOR CHRONIC PAIN... .............. .............. .... .......... ..... Bruce N. Eiiner, Ph.D... ... .. .......................... .... . 4 PREPARATION FOR CARDIAC CATHERIZATION.......... Dean Funabiki, MD .................... .. ...... ... .... ....... . 8 USING THE SUDs AND VoC TO MAP THE MEMORY NE1WORK. ...... Eirin Gould, LMFI' .... .. ............ .. . 10 NEWS FROM THE EMDR RESEARCHffRAINING CENTER ...... ........ .. Clifford Levin , Ph.D .. .. ...... .. ....... 11 DISSOCIATIVE DISORDERS AND THE 'SPATIAL MAP'. Curtis C. Rouanzoin , Ph.D . ......... .... .......... ....... 11 EMDR WITH CLIENTS IN RECOVERY FROM CHEMICAL DEPENDENCY .. .................. .... .......... .................. .................. ...... ...... ... ............. .... Silke Vogelmann-Sine, Ph.D. ...... ...... .... ............... .. ... .. ................................ ......................... ...... . and Larry Sine, Ph.D.. ................ ....... ..... .. ....... 12 EYE MOVEMENT 'GLITCHES' AND SLOWER PASSES ... Sheryll Stuart Thompson, MFCC .... .............. .. 16 EMDR: When Miracles Become Commonplace ............... ... Donald Weston, Ph.D. ...... .... ........ .. .................. 16 INTERNATIONAL UPDATE ................ ............ ......... ................... .. .............. . Francine Shapiro, Ph.D ....... .. ..... 17 EMDR WITH COMBAT VETERANS ....... ................. ..... ... ....... ..................... Jamie Zabukovec, Psy.D.... .... ..... 18 AUDIOTAPE ORDER FORM - 1994 CONFERENCE .............. ........... .... .......... ... ...... ..... ...... .... .... ...... .. .. .......... 31 STRAY THOUGHTS - Prevalent Theories Regarding the Effectiveness ofEMDR .............................................................................................. Francine Shapiro. Ph.D......... .. .................... 1 HOW DOES EMDR WORK, ANYWAY ............................ Steven L. Henry, Psy.D . ................... .. ......... 4 ENHANCED EMDR OUTCOME THROUGH ADDITIONAL SACCADES: CASE STUDY .............................................................................................. Joann Leone, MD .............................................................................................. Jim Dayton, MSW ....................................... 5 BEYOND DEFICIENCY MOTIVATION: EMDR PEAK EXPERIENCES AND TRANSCENDENCE .......................................................... Elke Maxwell .......................................... ..... 6 TRAUMA AND SELF TRUST: EMDR CAN HELP . ...:: ·Scott Nelson, Ph.D ...................................... 7 HEALING THE HEART: EMDR IN POST-UNIFICATION MPD THERAPY .. ..................................................... ....................................... Thomas Tudor, Ph.D ................................... 8 EMDR WITH PANIC DISORDER: PATIENTS WHO INHIBIT ANXIETY REACTIONS .............................................................................................. Judith D. Wilcox, Ed.D ........................... ..... 9 AN INTERESTING OBSERVATION . ............................. Edith Ankersmit, LCSW ........................... 10 THE THERAPEUTIC RELATIONSHIP AND EMDR . . Ricky Greenwald, MA ...... ......................... 10 THE POSITIVE CORE ......... .. .......................................... Marie Witt, Ph.D ....................................... 11 MISTAKES TO AVOID IN USING EMDR: OR "DO WHAT I SAY, NOT WHAT I'VE DONE" .............................................................................................. William Zangwill, Ph.D ............................. 13 INTERNATIONAL UPDATE. .......................................... Francine Shapiro, Ph.D.......... ................... 14 NW·TOC.PMS � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter Newsletter Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter - Newsletter Contents https://d1y502jg6fpugt.cloudfront.net/13023/archive/files/daf2e0e477544d8e7b2396783c5d71e0.pdf?Expires=1790208000&Signature=H3QNXuL0sqRA8Jxu01%7Eg0Ed3rtSWnFe1hVmYJvvH7e2O6Dw8OR6A6uJywCZXJL5ZZ2j1UAFyQUpOy2REVqTGCnFtaCuINhxFuAHSFVSRhFk5c3oZMabv7N3ZL4ocfQoSdUeLwOCwSqanV2MoYFxKpPShOCL6U3QWOoHDp7M%7ETF7NGpwtW73RPq4TJg4g3xZWKGQq0w-l6Ij3e7ETBQ94B9cvkyOGUIaucrjACmaZSfqrTuRztIFmzBDFBODkMATfHoy%7EUw8VzMzfTSl1yY3K5HjmnQIgiHytPdlUz-h7KCzIi5K3scydiVEZHro4WO%7EARs2wt4w1nJbu3MaAtcjmNw__&Key-Pair-Id=K6UGZS9ZTDSZM a9591eca7ec9508c98d38af163316e65 PDF Text Text August 1991 Network Newsletter EYE MOVEMENT DESENSITIZATION AND REPROCESSING Copyright @ 1991 E M D R 555 Middlcficld Rd., Palo Alto CA. 94301 (415) 328-5821 This inaugural edition is very excitingfor those of us who have watched EMDR grow over the last five years. Thanks to all of you who made it possible, you cliniciansand researcherswith vision, courage, anda desire to heal. Worth Repeating Francine Shapiro, Ph.D. Mental Research Institute Ti column is devoted to statements that hs were made in the workshop that should be ingrained in the mind of every EMDR practitioner. Since EMDR is still in the "experimentalstage"(i.e., replication studies have not yet iodui;;ed its efikacjj, ihe EMDR-trained clinicians are the frontline spokespeople. In order to avoid misunderstandings of untrained cliniciansand laypeople, please recall the following: EMDR is not a "cookie+utterm Each client is approached interactively. The needs of the client dictate the initial framing, focus, specific target, type of eyemovement, length of set, cognitive interweave (Intermediate level), final debriefing,log assignment, etc. No two clients are exactly alike--and no two sessions are exactly alike. Reprocessing a trauma is like removing a quilt from the bed Only then can you really see the lumps in the mattress. Subsequent to a trauma reprocessing, clients may have to confront a number of dysfunctional relationships, behaviors and attitudes that have been obscured by the rape/molest/accidcnt/ war experience. In addition, the reprocessing of dysfunctional information allows the client to adopt new behaviors that may stimulate other dysfunctional beliefs. For instance, when a client is finally able to be assertive and is finally achieving professional success, the neural network that contains the belief "If I am successful, I will be abandoned" may be stimulated for the first time. The purpose of the log is to have the client keep an ongoing record of new anxieties, as they reveal themselves, in vivo, for subsequent reprocessing. One double session may be enough to reprocess a trauma, but followup is necessary for the "reverberations." Using EMDR is like opening a stuck faucet Once opened, it continues to run. The dysfunctional material starts moving, and the reprocessing is accelerated during the session. However, the processingdoes not end with the session; it merely progresses at a slower rate. Clearly, debriefq the client to expect further insights, memories, connections, dreams, etc., is crucial. Instructing the client to keep a log of material to be used as targets in subsequent sessions is crucial. Suicidal ideation can occur if the client is not adequately debriefed. Client safety is paramount Double sessions are allotted for the treatment of trauma in order to insure that most of the material has been reprocessed before the end of the session. EMDR should never be started without sufficient time for processing and a possible abreactive response. Never let the client leave the office in the middle of an abreaction. Vol. 1 Issue 1 consequences. Likewise, clients should be adequately briefed to allow for the possibility of new connections, memories and possibly repressed material arisihg in any given session. Clinicians should be comfortablewith handlingabreadive responses before initiating EMDR with a client. EMDR is an interface with your clinical skills While every attempt has been made in the training to prepare you for your clients, there is no substitute for clinical skill, experience, rapport, safety, etc. As a clinician, you must evaluate the ego strength, insight level, openness, support system, stressors, medication needs, etc. of each of your clients, as well as your own availabdity, level of competence and comfort before attempting EMDR. You have been taught a procedure with many applications. As a clinician, you must evaluate its appropriateness for any particular client. It is an interactive state of affairs and all safeguards must be in place. At present, only licensed mental health professionals or supervised students are admitted to training. Duringthefirst year, a handful of cert5ed hypnotherapists were trained, with the admonition that they use the procedure only within the scope of legal practice. While no problems were encountered, this practice was discontinued; since there are no licensing agency or ethics committee restraints, we could not insure compliance. Since we obviously cannot vouch for the integrity level of all workshop participants, we can only do our best to use official mandates regarding boundaries and limitations to protect clients and the integrity of the procedure. Never attempt EMDR In a non+linical Clients are a t risk if EMDR is at- setting tempted by untrained clinicians "Demonstrating over a dinner table" can Reports nationwide filter in occasionally lead to unforeseen issues and emotional regarding clients who were harmed by the 1 �attempted use of EMDR by untrained clinicians. Reports include the following: Network Study Groups/Special Interest Groups a) Ocular problems caused by insisti g that the client continue with eye n movement despite obvious pain. b) Hospitalizationfor a near-psychotic break caused by the clinician pushing through the client's defenses. c) Re-traumatization of clients caused by lack of preparation for the kinds of material that could be revealed, the inability of the therapist to accelerate processingthrough the material and/ or inadequate debriefing. Gwrdinatoc Cliff Levin, Ph. D. (415) 326-6465 Regional Network Coordinators "Sam" Foster, Ph.D. Andy Sweet, Ph.D. Howard Lipke, Ph.D. Alan Goldstein, Ph.D. Roger Solomon, Ph.D. California Colorado Illinois Pennsylvania Washington (415) 965-8988 (303) 377-9588 (708) 688-1900 d312 (215) 667-6490 (206)586-8492 Special Interest Group Coordinators While the Certificate of Completion that you recelve does not insure competency, it is proof that you have done your conscientious best to prepate yourself educationally before attempting to discharge your clinical responsibilities. Reading an article, or attending an hour presentation would not prepare a clinician to use hypnosis or any other clinical specialty. EMDR is no exception. The two-day training is a minimal requirement. Make your training known to discourage others from inadequate use of the procedure. The ethics code dictates that untrained clinicians inform their clients of their untrained status. Clients should not be placed at risk without their informed consent. EMDR and Project CAPACITAR in Central America by Pat Cane CAPACITAR is a project of healing and enablement connecting North American and Third World Women. In the past Dwight Goodwin, Ph.D. (408)741-5239 Msll/Resistance & Transference Russ Llewellyn, Ph.D. (415) 595-4500 Children & Adolescents Alice Ruzicka, Ph.D. (415) 948-1405 Enhancing Peak Performance "Sam" Foster, Ph.D. (415) 965-8988 MPD & Dissociative Disorders David Fenstetmaker, Ph.D. (408) 257-5032 Psychophysiological Sally Cappucci, MFCC (408)mm FlSD While reactions to the procedure by untrained clinicians can range from the skeptical to the smug, by far the most dangerous is the latter. This type of clinician disregards caution and, with insufficient information,judges EMDR as "simpletinger-waving." Non-results cause the procedure to be denigrated and can deprive others of treatment, or the client can suffer, as described above. Anxiety Disorders Mark Russell, MS. (415) %9-4390 two years we have traveled to very poor regions in Nicaragua and Guatemala to work with women suffering from the effects of war, violence, and grinding poverty. We have offered group workshops in stress management, body movement, simple acupressure and massage to help alleviate the physical symptoms of stress and trauma--headaches,insomnia, stomach disorders, neck and shoulder pain. In September, 1990, we were trained by Francine Shapiroin EMDR with the goal of usingthe technique with some of these women. During a November trip to Central America, we found that EMDR helped a number of individualswho were suffering from traumas of varying degrees. One woman bad survived a Contra attack during which her best friend was killed. Other women had witnessed massacres or had suffered the disappearance of family members. Because of their poverty, many of these women had little access to medical care, let alone therapy, so our work was done on a volunteer 2 basis. As our project expands, we are planning a summer trip to South Africa and will work with women's groups who have suffered significantly from the on-going violence and racism of the apartheid system. In the fall, we will return to work in CentralAmerica (Nicaragua, Guatemala, Honduras, and El Salvador). This summer two therapists are planning tovolunteer in Central America with EMDR. If you would be interested in helping with the work of CAPACITAR, contact: Pat Cane 3015 Freedom Blvd., Watsonville, CA 95076 (408)724-5526. . Tax-deductible donations (checks made payable to IF-CAPACITAR) help us to expand our work in Third World countries. �Abstract EPIC Chemtob, C., Roitblat, H.L.. Hamada, R.S., Carbon, J. G., Twentyman,C. T. (1988) A Cognitive Action Theory of Post Traumatic Stress Disorder. It is a pleasure to announce the formation of the EMDR Professional Issues Committee. The purpose is to provide a forum for the discussion of ethical and professional concerns arising out of the use of EMDR. Journal of Anxietv Disorders (2,253 275) For further information, comments, or inquiries contact any one of the following committee members: Ferol Larsen, Ph.D., Vuginia Lewis, Ph.D., Marguerite McCorkle, Ph.D., at MRI (415) 321-3055 or Jennifer Lendl, Ph.D. (408) 244-7942. Hope to hear from you. Abstracted by Andrew Sweet, Psy. D. Behavior l k r a p y Institute Aurora, CO. Virginia The authors of this paper attempt to integrate the existing models of PTSD from associative learning theory, psychodynamic theory, and information processing models of the brain. With the integration they elaborate on a "hierarchical network view of cognition" and specifically detail how it might account for PTSD symptoms. According to their view, emotion, cognition, action, and memory all flow from the processing ofinformationin the brain, specificallyfrom parallel distributed neural networks. Essentially, this paper weaves the phenomenology of PTSD sympioms into a quite plausible expianation of how a vicious feedback loop is established in themind/bodyofthe ITSD sufferer. We are led through the role of confiation bias, physiological arousal and an excitatory-inhibitory model of information processing that sounds quite similar totheEMDR theory(i.e., Pavlov). The model proposes the existence of parallel structuresthat allow for the multilevel processing of stimuli. These networks and neural 'switch stations' are actually physical structures that are organized around nodes at different levels of abstraction/ meaning. These nodes are purported to interact at different levels and across levels via mutual potentiation and inhibition. It is the summation of these potentiations and inhibitions that determine whether a node is activatedor not. (It istempting to use this balancing act as explanatory of tbe bipolar s w i g that Dr. Shapiro describes in the EMDR training, and which most practioners using EMDR have seen.) Of major theoretical interest is the proposal that thoughts, images, behaviors, emotions, etc. are all represented in the same sort of networks. Learning, within this model may occur via pre-existing nodes or in the formation of new ones. The authors attempt to include within this exposition the notions of counterconditioning and lateral inhibition, thus layingthegroundworkfor explainingwhy certain therapies work for PTSD (i.e., flooding and desensitzation). They go as far as to say that "...any treatment that i reduces the gain of the feedback loop (n PTSD), reduces threat potentiation, or results in the production ofstrong incompatible competing responses, will be predicted to be effective." (p.271). EMDR may well be promotiq this process. This article does amass an impressive amount of cognitive science research to support its position. Unfortunately, as with most cognitive science, the direct access of these networks, and therefore the testing of these hypotheses awaits significant technological advances. Nevertheless,to this neobehaviorist,it sounds like a fascinating beginning for a map of the brain, and a look into a further explanation of the model for EMDR effects. The EMDR protocol starts with a list of alters or ego states that are part of a specific memory, and proceeds with hypnotic paralysis, and the reminder that the memory will proceed 2 to 4 times faster than it occurred originally, and a reminder for the signal for pausing. The abreaction is then completed using EMDR. Once the abreaction is completed, the memory is checked to determine if it pushes the patient into reliving. If reliving is demonstrated, EMDR is used to metabolize the remainder of the memory. When the abreaction k ccapleted, hypnotic sleep is induced for the alters involved to promote relaxation and healing, and is used to correct cognitive distortions. After the sleep is started, an agreed upon alter is asked to be present until the end of the session, and finally, the hypnotic stillness is removed. There have been 371EMDR abreactions (n = 18 MPDs), two thirds of which have passed the one year anniversary mark. Of these, 98% passed that mark without reliving any portion of an EMDR abreacted memory. EMDR and M P D David Fenstermaker, Ph.D. JFK University This abstract is one portion of a panel on Eye Movement Desensitization and Reprocessing. It was given on Saturday, February 23, 1991, for the California PsychologicalAssociation Conference in San Diego. This paper details a protocol of Eye Movement Desensitization and Reprocessing(EMDR) in the treatment of Dissociative Disorders. 3 EMDR: A Cautionary Note Forthcoming in the Behavior Theraoist Francine Shapiro, Ph. D. Metual Research lnrtitute . The responses to my artide, "EyeMovement Desensitization & Reprocessing: From EMD to EMDR -- A New Treatment Model for Anxiety and Related Traumata" in the May 1991 (Vol. 14, No. have 5) issue of the Behavior Thera~ist, �been both gratifying and, at times, disturbing. After receiving numerous requests for a "description of the revised procedure," and upon rereading the article, I can see that I did not make sufticientlyclear the fact that clients areat risk if untrained clinicians attempt to use EMDR. Since my initial articles were published in 1989, thousands of additional clients and subjects have been treated. Clinical observation,as well as feedback from trained clinicians and clients of untrained clinicians, have clarified the amount of information needed to effectively use the procedure for full therapeutic success. While successfultreatment without trainingmay be achieved perhaps 50% of the time, in the other cases, untrained clinicians place the client at risk, (e.g., experiencing ocular problems, re-traumatization, suicidal reactions, etc.). EMDRis neither a simple technique nor a acookie-cutter." Rather, it is a specialized approach that requires supenised trainingfor therapeuticeffectivenessand client safety. International Update Francine Shapiro, Ph. D. Mental Research Institute There are now EMDR trained clinicians in the U.S., Israel, Korea, Canada, El Salvador, Germany and Australia. John Marquis and his daughter Priscilla have volunteered to lead two Spanish language EMDR trainings for psychologists and para-professionals in Nicaragua (See CAPACITOR article by Pat Cane). It is gratifying to think of all the sulTeringthat canbe eliminated by EMDR in the Third World countries. The trainings are planned for this August. MRI has submitted an NlMH grant proposal to study the effects of EMDR on rape/molestation victims and Vietnam veterans. Principal investigators are myself and Scott Nelson, Ph.D. Research has been launched at Veterans Administration facilities at North Chi- cago, Augusta, GA, and Redding, C k Research is also underway at the University of Pennsylvania, Pennsylvania State University, Harvard University, Temple University, University ofMontreal, Stanford University, and Rockefelier University. Requests for reprints have been received from researchers throughout the world. The research at Rockefeller University is being carried out by Jonathan Winson, Ph.D, author of a November 1990 article T h e Meaning of Dreams" in Scientific American on memory processing during REM sleep. Dr. Winson attended the EMDR training I gave at Temple University and has since been researching the possible physiological explanationfor EMDR treatment effects. He feels that EMDR produces an effect which besides its therapeutic value may allow for a deeper understanding of memory processing and unconscious psychological structure and is consistent with the research he has been doing for the last decade. The research at Harvard University is being conducted by Roger Pitmau, M.D, with the assistance of Howard Lipke, Ph.D., the Director of the Stress Disorder Unit of the North Chicago VA Medical Center. Dr. Pitman has an NlMH grant to investigate the treatment effects of EMDR with Vietnam veterans. All research therapists have received EMDR training from me and on-going consultation with Dr. Lipke. The study will take two years to complete. I co-chaired a clinical round-table with Joseph Wolpe, M.D. (developer of Systematic Desensitization) on EMDR at the 1990 annual conference of the Association for the Advancement of Behavior Therapy. Dr. Wolpe announced EMDR as a major new resource in the field. Also on the panel were Tom Borkevec, Ph.D., of Pennsylvania State University, Tore Nielsen, Ph.D., of the Department of Psychiatry, University of Montreal, John Marquis, Ph.D., of Stanford University/ Pacific Graduate School, and John Patterson, Ph.D., of the Catholic Counseling Services. 1gave a symposium presentation and an invited one-day pre-conference institute at the 1990 annual conference of the 4 International Society for Traumatic Stress Studies. I was flown out to Augusta, GA to train the clinical research team led by Pat Boudewyns, Ph.D., at the VA Medical Center. After the two-day training they invited me to write a chapter for a book they are completing on treatments for PTSD. They are presently planning two studies (physiological andlong-term outcome) on the procedure. Joseph Wolpe, M.D., has included EMDR in the fourth edition of the & fice of Behavior Thera~v, In addition, I have received requests for information on EMDR for anumber ofnewintroductory psychology texts covering the latest advances in the field. My published articles on EMDR are in the Journal of Traumatic Stress (2, 2, 1989), Journal of Behavior Thera~v and Ex~erimental Psvchiatry (20,3, 1989), the California Psvcholoeist (July, 1989), and the Behavior Thera~&(May,1991). The JBTEP articlewas awarded the journal's prize for the best article submitted during 1988. A "Cautionary Note" is forthcoming in the September issue of the Behavior Thera~ist. Many untrained clinicians misconstrue EMDR as a "simple behavioral technique" because some of the publicationshave been in behavioral journals. This is an attempt to set the record straight. The text of the note is included in this Newsletter. As you know, the EMDR trainings are presently "sole source" to ensure that EMDR is taught correctlyuntil replicationsstudies canbe published to substantiate its effectiveness. Until that time EMDR is in an "experimental-limbo"state where special measures seem crucial to ensure client safety and the integrity of the procedure. The goal is to have EMDR taught eventually in univefsities asa treatment of choice. That cannot be done if the model is diluted prematurely by unqualified trainers and practitioners. Articles forthcomingthis year in thenal of Behavior Thera~y Experimenand tal Psvchiatry are a case study by Joseph Wolpe, M.D., an overview of eighty cases by John Marquis, Ph.D., and acase study by Gerald Puk, Ph.D. embers sen rolled �in the EMDR Network will receive copies of these articles, my article in the Behavior Thera~ist the description and published by Dr. Wolpe in the Practice of Behavior Thera~v.We expect to receive reprints to distribute some time in the Fall. I chaired a symposium on EMDR at the 1991 California Psychological Association annual conference. Also presenting were Karen Anderson, Ph.D., David Fenstermaker, Ph.D., Sandra Foster, Ph.D., John Marquis, Ph.D., and DavidWilson, Ph.D. A summary article is in press in the California Psvcholoeist. Joseph Wolpe and I co-chaired a symposium at the 1991 Western Psychological Association annual conference. At that time Dr. Wolpe again declared that he considered EMDR a breakthrough in the field, although he disagreed with adding the word "Reprocessing" to the name since it was not syntactically parallel to "Desensitization"(conceptualrather than purely descriptive). Also presenting on the panel were Drs. Fenstermaker, Foster and Wilson. ? was asked to joln the Editorial Advisory Group oftheJourna.1ofTraumatic Stres~, Time constraints have prevented presentations this year at the APA. I hope that other trained clinicians and researchers will start presenting at professional conferences independently. This year's Association for the Advancement of Behavior Therapy will include four presentations on EMDR. I was invited to present a three-hour "workshop" at the conference which will explore the EMDR model. I will present the applications of EMDR in the treatment of psychological trauma on a panel with Teny Keane, Ph.D. (flooding) and Don Levis, Ph.D. (implosion). I will chair a symposium on latest clinical applications which will include presentations by Alan Goldstein, Ph.D. (Temple University), Howard Lipke, Ph.D. (North Chicago, VA), John Marquis, Ph.D. (Pacific Graduate School) and Gerald Puk,Ph.D. (Forensic Psychological Services). In addition, there is a two-hour special interest group (SIG) devoted to EMDR. The behavioral world is extremely receptive to EMDR since it is open to the concept of rapid change. Anyone able to , make an inroad in the analytic community should submit a report to the Newsletter immediately. Experience to-date has given new dimensions to the term "cognitive dissonance." Offering a new treatment to the academic and clinical community has been a very enlighteningexperiencefor me. Since the effects of EMDR are so rapid, it is understandable that skepticism often arises when it is initially introduced. However, I find the field divided among those who choose to "see for themselves" and those who refuse to accept even the possibility that substantialchange can be rapidly achieved. I greatly appreciate the support of all of you who have written or called either to trouble-shoot or "soothe the waters.' Many people of integrity can respond to EMDR as a "narcissistic wound." Many people cannot bear to become "students"again. We just have to do the best we can. I dedicated the EMDR work of 1990 to Norman Cousins, in the hope that we can continue the work in memory of his loving, humanitarian spirit. I would like to suggest that we establish a scholarship fund for dissertation research in his name. I would like to put this on the September 28 Network meeting agenda. Suggestions for name, amount, practicality and mechanics can be made at that time. Just as EMDR is a "client-centered" therapy, I consider the EMDR Network to be "clinician-centered." Please give us your thoughts, needs and suggestions. Please have patience as we once again reorganize. These are "birthingpangs," I am so as often reminded, so we need all the help we can get. Innovative Uses By Ron Martinez, Ph.D. lkis section will appear in each newsletter and willpresent innovative uses/ variations of the EMDRtechnique that haw been discowred by clinicians trained in the method I would wry much appreciate it ifthose ofyou who haw found new variations on how to 5 use EMDR would write these up and send them to me at the address below, so they can be included injiuure newsletters. Although your write-ups can be informal, I would appreciate your including the specificsteps of the technique, the number ofpeople on which it bar been used, the number ofpeople on which it bar been successfil, speape outcomes you haw consistently noticed, and any firther comments. Please include your name, address andphone number, so that I can reach you with any questions. %nk you. I want to begin this section by discussing the first two variations on the EMDR method that I have used. At first when using EMDR, I found that there were some people who did not get images or thoughts, and who consistentlyseemed to "circle"through one combination of body sensations after another. Furthermore, although they would sometimes change from anger to fear to other interpretations, I never saw anything approaching a consistent reduction in the intensity of the emotional charge. Therefore,the process, while interesting to the client, did not seem to be ~ r o d ~ c i n g rapid i%!he provement that I saw in so many other clients. I began to wonder if there was any way to develop some awareness either of the image or thought that might help the client connect more completely with the internal representation with which we were working. On a hunch (having sent a number of clients to body workers over the years), I asked the individuals to pick the most central area in which they felt the body sensation, and then with their fingertips to "gentlyand gradually increase pressure on the area and notice if an image or thought comes into mind." I have found that about 70% of the people in this category immediately responded with an image, thought, or awareness that we were then able to use to continue the EMDR procedure. Most of these people stopped "circling" at this point, and I began to see responses more typical of other clients with respect to improvement. I urge you to try this and give me your feedback on what the outcomes are. �The second innovative use I discovered is even more exciting. While EMDR has proven to be extraordinary with respect to reducing emotional charge, developing self-awareness, and installing new beliefsandcognitions that prepare people todevelopskills, abilities, and attitudes in which they had previously been severely limited, we often times still get to that point where the question is: "Okay, now that the fear of it is gone, how do I begin to teach this person to be more assertive (or sexually initiating, or more playful etc.)." The answer is typically a step-bystep teachingllearning paradigm more typical of traditional behavior therapy. T i is an excellent method, but I began hs year.TheRedwoodEstates ofice is closed and all inquiriesshould now be addressed to: Finally, I invite him to follow this process on his own, whenever this type of "new behavior" is either called for or can be practiced. Again, my N is only three, but the results so far have been very positive. EMDR 555 Middlefield Rd. Palo Alto, CA 94301 415-328-5821 Iinvite you to try variationsofthis method and please write me about your responses and experiences. r to wonder if EMDR could be used to facilitate a faster experience for individuals "learning new skills." I have used the following method with three different clients, and have had excellent results in each case. First, I asked the client to close his eyes and develop a specificvisualization of an individual who has the desired skills and abilities. Thanks to Diane Jensen and Cloudia Strohm for their assistance earlier this fact, give him a full experience of this new internal state. ' Slattery has joined the Elizabeth "Betsy" staff of EMDR and is taking over the duties of Administrative Assistant. EMDR Study Groups San Francisco: Sylvia Mills, Ph.D. (415) 221-3030 Open for 10 people. Meets Wed 730-10:30pm. Case discussions and group process to determine what the meetings will be like. (415) 692-4658 San Mateo/Burlingame: Ron Martinez, Ph.D. 7 people in group, open for more. Meets second Mon of each month 7:W-8:30pm. Case consultation and practice sessions available. I Palo Altos/Los Altos: John Marquis, Ph-D. Dewey Lipe, Ph.D. 5 people in group, open for more. Meets ad hoc. (415) 851-2855 b The imagined individual must be someone whom the client has seen demonstratingthese skills. (This could be a next door neighbor being playful; Clint Eastwood in a movie being assertive; etc.). Sonoma/Mendicino: Jean Eastman, MFCC Int. (707) 964-7905 6 people in group, open for more. Meets in Santa Rosa 3rd Tues of each month 1230- 2:Wpm at Kay Caldwell's office (707) 525-0911. Primary case discussion,some videos and technique troubleshooting. Palo Alto: Ferol Larsen, Ph.D. (415) 32648% 10 people in group. Meets 1st Wed of each month at 10:OOam MRI conferenceroom. Next, I have the client imagine himself, as vividly as possible, "standingbehind"that image, then "steppinginto the body of the imagined person," and feeling within the client's own body, as vividly as possible, all of the feelings, sensations, awareness and attitudes that would go with "being this new person." I then have the client open his eyesand do a set of eye movements; this seems to "meltin"the experience morevividly than just imagining it, much like installing a positive cognition. Typically, I have gone through three or four separate setsof eye movements until the person has reached the maximum intensity of experience of that imagined individual. I have a conversation with the client, and have him describe, in great detail, how differently this feels, what new ways he would handle different situations, and, in Edith Ankersmit, LCSW (510) 526-5297 East Bay: 6 in group and presently closed. Meets 3rd Fri of each month at 7:30pm. Case discussion only. Edith has 4 more names and is willing to coordinate another group. Snn Jose/Santa Clara: Kent McLaughlLq PhD. (408) 244-9317 Open for 8-10 participants. Meeting dates to be decided. Case discussion, role playing. 1 Los Gatos/Saratoga: Jean Bitter, Ph.D. Liz Mendoza, LCSW Open for 9 people, agenda to be determined. (408) 354-4048 Linda Neider, MFCC Int. (408) 475-3480 Santa Cruz: 4 people in group, open for more. Meets once a month on a F n 7:OOpm. Orange County Karen Anderson, Ph.D. (714) 733-1622 6 people in group, open for more. Meets in Tustin 4th Fri. of month 99-ll:30am. Case presentations, discussions, videos, exchange sessions. 6 I �EMDR Computer Bulletin Board ? We are considering an EMDR computer Bulletin Board. Some of the information being considered are copies of the newsletter and articles related to EMDR. In addition, questions canbe posted regarding problemsencountered in clinical practice and other clinicians can reply with solutions and ideas from their personal experiences. Ideas, data, and information exchange on Special Interest Groups or client related topics would be available24 hours a day, 7 days a week for Network subscribers. If you are interested in such a service or have additional ideas please write and let us know if this would be helpful to you. 1991 EMDR Network Schedule Saturday, Sept. 28th Saturday, Dec. 7th The Network meetings have been moved from Ricky's Hyatt to the Palo Alto Hyatt, 4290 El Camino Real, Palo Alto, (415) 493-0800. It is located 1/2 mile north of San Antonio Road. SCHEDULE - 9:30-10:00am Registration & coffee 10:00-11:30 - Special Interest Groups (SIG) meet to share new information. - 11:30-1230 Lunch [We suggest a second SIG meeting during lunch.] 2 0 0 - 2 3 0 - Coffee & Networking 230-3:30pm - General meeting. Presentations by SIGs and Francine. Newsletter Staff Editor: David Fenstermaker, Ph.D. Co-editor: Ron Martinez, Ph.D. Staff Coordinator Robbie Dunton Admin. Assist.: Betsy Slattery Technical Consultant: A J. Popky Sept. 28th presentations: SIG Groupsled by Russ Llewellyn and David Fenstermaker. Submission Information Our intention is topublish the newsletter quarterly. Submission of general articles can be sent to David Fenstermakm, Ph.D. ,4985 Mitty Ave, Sun Jose, CA 95129-1849. Articles specific to new and innovative use can be sent to Ron Martinez, Ph.D., 1515 TrousdaleDrive, Suite 215, Burlingame, CA 94010. Ifpossible, articles need to be submitted on an IBM formatted diskette. Ihe &ac;line for f e nerr newsletter will be October 15, i 9 . 91 PLEASE PRINT EMDR Network 1991 Name: Address: State: city: Phone (Bus): Phone (Res): Zip: Special Interest Group: Cost for participating in the Network is $60 for 1991. Membership entitles you to attend the National Network meetinp and to receive copies of the EMDR Newsletters and journal articles published in 1991. [If you are interested in only the Newsletters and articles, the cost is $ 0 ) 4. Make check payable to: EMDR Network, 555 Middlefield Rd., Palo Alto, CA. 94301, (415) 3285821 TRAINING REGISTRATION FORM Name: Address: city: State: PLEASE PRINT Phone (Bus): Phone (Res): License: Zip: COST: $285.00. Make check payable to: EMDR, 555 Middlefield Rd., Palo Alto, CA. 94301, (415) 328-5821 Please circle: BASIC: Philadelphia San Francisco INTERMEDIATE: Dec. 14-15 Chicago San Jose Aug. 23-24 Oct. 18-19 If INTERMEDIATE: Your date of Basic Training: Specialty Additional requests for topics in training: For Intermediate training please circle one Proficient/Very Comfortable [ A B C 7 D E ] Unceitain/Uncomfortable �BASIC TRAININGS I Sponsors I June 819 Seattle, WA. Seattle Airport Hilton Rokcr Solomon, Ph.D. Wa! lington State Patrol Sept. 617 Philadelphia, PA. Temple Univ. Medical School Dept. of Psychiatry Alan_Goldstein, Ph.D. Agora hobia & Anxiety Treatment Center ~ e r n University Medical School ~ g San Francisco Bay Area Hotel Sofitel, Redwood City Francine Shapiro, Ph.D. Oct. 415 Chicago, IL. Holiday IM Crowne Plaza Northbrook, I . L Howard Lipke, Ph.D. Director, Stress Disorder Treatment Unit N. Chicago Veterans Admin. Medical Center (708) 688-1900a312 Nov. 213 Denver, CO. Doubletree Hotel Aurora, CO. Andy Sweet, Ph.D. Behavior Therapy Institute of Colorado (303)337-9588 Francine Shapiro, Ph.D. (415)328-5821 Sept. 13/14 C Nov. 8/9 - San Jose, CA. Sunnyvale Hilton INTERMEDIATE TRAININGS (215)667-6490 spa-r~ Francine Shapiro, Ph.D. Aug 23-24 San Jose, CA. Sunnyvale Hilton Oct. 18-19 San Jose, CA. Sunnyvale Hilion Francine Shapiro, Ph.D. Dec. 14-15 Chicago, IL. Holiday Inn Crowne Plaza Northbrook, IL. Howard Lipke, Ph.D. Director, Stress Disorder Treatment Unit N. Chicago Veterans Admh. Mcdical Center EIdDR 555 hliddefield Rd. Palo Alto, CA 94301 Table of Contents Worth Repeating Francine Shapiro, Ph.D. Project CAPACITOR Pat Cane Regional petwork Group Coordinators Special Interest Group Coordinators Review of "Coenitive Action Tbeorv of PTSD" Andrew Sweet, Psy.D. EMDR & MPD David Fenstermaker, Ph.D. EMDR: A Cautionary Note Francine Shapiro, Ph.D. EPIC: EMDR Professional Issues Committee Virginia Lewis, Ph.D. International Update Francine Shapiro, Ph.D. Innovative Uses Ron Martinez, Ph.D. Study Groups Computer Bulletin Board EMDR Network Meeting Schedule Network Registration coupon Article submission information 'kaining registration coupon Basic & Intermediate training schedule \ 1 2 2 2 3 3 3 3 4 5 6 7 7 7 7 7 8 EMDR Network Newslr'ter 8 (708)688-1900 ~3312 - � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter Newsletter Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter, 1(1), 1-8 https://d1y502jg6fpugt.cloudfront.net/13023/archive/files/38539efdd657a06d0e8be4c3eef622bd.pdf?Expires=1790208000&Signature=kjGjNKY9vAT5lEuraQGdaEceKaU44FsR3-Y3S-JwlaKTlRESWmQrqpKjvgHhWWvb5CFlYxTRLvwL5Syh6%7Er9oBP%7E35CR5P7SUhvZ474lmdJxM3xA7NeJ6%7E7bB1wH%7ERx5JCbVTMKPXi6D-OWbJZE7cO2nDib78XMeHEmZh-t-DSD58%7EhXmzW-cRawkBUFz-YmR%7EbkILsLsNhF6ACmO%7E3LfK3rOyIjmvnKqOqXnAyG3dcGkurbDuiy477T-n4E3%7EuR6GgyBjrOlhvo5zHzvN1ljRvXqm5kMqLEqx4n8SmQAfkx71RJaF07%7EGs%7En8G2TJn3sBxbuhZtMahLR5AxZMyRGA__&Key-Pair-Id=K6UGZS9ZTDSZM 31e2c84b9f7f18aecd6149803943973c PDF Text Text December 1991 Network Newsletter EYE MOVEMENT DESENSITIZATION AND REPROCESSIN Vol. 1 Issue 2 Copyright© 1992 EMDR Netwodc P.O. Box 51010, Pacific Grove, CA 93950-6010 (408) 372-3900 [Excerpt] The client is now able to bring up old memories that are fully integrated into a more adaptive perspective. As I have mentioned in the workshops, I feel that there is an experiential base to most existing pathologies. One of the beauties of EMDR is the ability to metabolize quickly the dysfunctional residue of the past and shift the material into something useful and fruitful. In the Intermediate Training (now the level Il Training), I cover ways of rapidly accessing this painful information so that it can be more easily assimilated into a functional superstructure. (In the following material, I am assuming the reader has taken the level II Training.) It has been my observation that the major issues confronting many clients are (1) responsibility, (2) safety, and (3) choice. Specifically, using the cognitive interweave variation on these points, in the order given, can dramatically reduce the therapy time. The primary objectives are to get clients to recognize and attribute appropriate responsibility, and to relinquish the guilt and selfblame that have undercut their feelings of self-esteem and self-efficacy. Once these are accomplished, it is easier for them torecogni7.e that they are no longer threatened and are able to choose safely and appropriately their associates and their actions. I would like to underline that a useful interpretation of these EMDR effects is that the dysfunctional ·material is held in a neural network in state-specific form; this can be interpreted as the "child" perspective. The client is obviously in your office because of his/her belief that something needs to be changed. This accumulation of later information and more functional judgments is also encapsulated in another neural network- the so-called"adult" perspective. The result of an EMDR session may be the link-up of the two networks and an assimilation of the painful material into its proper place, historically-thepast-alongwitha generalization of adaptive cognitions through the hitherto isolated material. In accomplishing this, it is often useful to urge clients to voice to the parent their anger/blame/pain; e.g., "It was your fault that it happened; you shouldn't have treated me that way." I suggest doing this even without perceiving the body signals I have mentioned in the training (e.g., tension in throat or jaw). Time and again, I have seen clients who have been urged to express themselves during the eye movements, give a declaration of independence to the parent. The eye movements are continued as clients are urged to elaborate or repeat their words until their voice is firm, confident and steady. The resultant feeling is often descn"bed in terms denoting emancipation and adulthood. 1 A good clinical ear is necessary, however, for the appropriate timing of these verbal promptings. Make sure there is first a cognitive understanding before proceeding. You should also be very nurturing and reinforcing of the client regarding whatever visual or auditory depictions of violence that occur. Anger untapped for an entire lifetime can be extremely frightening to the client. Give reassurance thatit, too, is "just the scenery, while they are on the train." In the Level I Basic Training, I have often remarked that EMDR appears to me to be almost a window into the brain. Because of the unique opportunity afforded us by the rapid treatment effects, there are many avenues of information processes open for investigation. There are a number of areas that I hope many of us find fascinating, and it would be useful if we could begin to collect some data on them. For instance, during the level I Basic Training I speak about the difference between treating a recent and a more distant trauma. It was my observation from the Loma Prieta earthquake that patients suffering from stress reactions within a month after the quake had to be treated with each separate sense experience as a separate "node." In other words, while an older trauma could be treated by having the patient concentrate on only the most upsetting part of it-and a generalization effect would ensue-no such general desensitization to the entire event would occur with the recent trauma'. It appears as if, on some level of information pro- �cessing, not enough time had passed for a consolidation of the entire memory to take place. This indicated mulijp~ levels of memory, co1)5Q»dation, since the client could give a serial account of the earthquake; however, the differential treatment effect was clear and consistent. To treat recent memories, it appears necessary to ask the client to give a full narrative of the experience and for the clinician to copy it down. Every distinct phrase, such as: "(a) I heard the bureau fall, and then (b) I rocked from side to side against the door and (c) I heard my baby cry . . . " has to be concentrated on separately and reprocessed with a concludingpositive cognitionimtalled. No single reprocessed scene seems to have a profound effect on any of the other remembered material. After all the narrated events are singly reprocessed, the client is asked to "run the earthquak~ like a movie from start to finish and stop if anything becomes upsetting." At that time, new material will emerge that must be separately reprocessed. This is continued until the patient can review the entire episode without discomfort. Then the entire episode is replayed with the eye movements and the positive cognition in mind. It would be useful if we could ascertain at what point in time the memory "consolidation'' occurs. That is, at what point can a single picture be reprocessed and be expected to generalize to the entire event. My guess is two to three months, but I would appreciate your input. How recent a trauma have you been able to process by concentrating on only one aspect of the event? The next subject of interest may be the treatment of OCD. The protocol I suggested in the Intermediate (Level II) Training has been successfully used by a number of clinicians, but some OCD clients have remained intractable. One clinician suggested that the subcategory of pure obsessives (e.g., those structured around number rep- etition, etc., without a physical ritual) may be particularly difficult to treat. Barbara Olasov Rothbaum, Ph.D., at the Emory Clinic, recently submitted a letter to the editor of the Behavior Therapist indicating that cocaine addicts, schizophrenics and OCD clients have all been found to have abnormalities in the orbitofrontal cortex (which has already been linked to visual tracking deficits in schizophrenics), which she conjectures may help us explain the EMDR effects, ''by knowing when it does not work." It would be useful if those of you who have treated any of these three categories with EMDR send me a tabulation of: (1) numbers treated, (2) successes, (3) partial successes, and (4) failures-compared to other cat:egories like PI'SD, panic, simple anxieties, etc. While outcome studies must eventually rigorously test the efficacy of EMDR with any population, our clinicalobservatiom can be invaluable duringtheseinitialstages. Ourpoolof trained clinicians have a wealth of data that can help formulate the future directions of EMDR. Another potentially fntitful area of investigation may be the use of other stimuli such as hand- or finge~tapping during se111ions. The EMDR model suggests that possibly the electrical stimulation generated by the eye movements catalyzes the informationprocessing system. It is reasonable that other movements could have a similar effect. Initial reports of Dave Wilson's study are that exposure without eye movement caused an increase in anxiety, eye movement showed a decrease, and finger- tapping maintained the level of anxiety. The fact that the anxiety didnotincrease shows that there is some beneficial effect of finger-tapping. A number of practitioners have been using hand-tapping when the client is, organically or emotionally, unable to visually track. Robbie Dunton, MA, who treats primarily children with learning deficits, has been using this variation for over a year-and-a-half. She asks the child to hold palms up- 2 ward and rhythmically, alternately taps each palm. She has been very successful in getting desensitiz.ations of prin~.ary incidents, however. gener- · aliz.ationeffects are unclear. Gary Flint, Ph.D.,andPrisdllaMarquis,MS,have also reported positive results with the hand variation, while other clinicians have found that clients who have compared both of these methods report that the "hand" results are not as "powerful'' and do not go as" deep." Some clinicians have reported a temporary effect and later recurrence. Differential effects may have to do with age, severity, longevity or kind of target. For now, therefore, consider using the hand-tapping when the client cannot visually track and then switch to the eye movement when possible. This may prove particularly useful in abreaction work when the client cannot keep the eyes open. If you are able to set up full session comparisons with volunteers, it would be useful to get your reports regarding (1) decreases in SUDs levels, (2) shifts of cognitive structures, including pictures and insights, and (3) maintenance of treatment effects. Please remember that EMDR did not launch from a theoretical basis. The REM hypothesis was advanced as an attempt to explain the treatment effects of the eye movements, and in no way contraindicates the possible effects of other stimuli. Oearly, if the treatment effects do prove to be linked with REM, it does not discount other possibilities in the waking state just because the body in sleep is not capable ofmanufacturingexternal auditory tones, lights, or hand-taps. The article, in your packet, published in the Behavior Therapist gives a long list of possible explanations for EMDR treatment effects, and there is undoubtedly an interaction of many factors. As a total treatment modality, the accent in afDR is on the reprocessing of dysfunctionalinformation. While the model has proved predictive, it is subject to alteration. While �the eye movement is obviously effective, it is subject to augmentation by other stimuli. While the format is effect:ive,.it.is.subjedto.improvement., In other words, the accent is on change. ftllMIIIIDI Hopefully, some of you will remember that in the Level I Basic Training there is a history-taking video; the transcript is contained in the back of your manual. During the subsequent EMDR treatment, the subject goes ''bipolar'' and, from thoughts of "I'm different in social situations," starts remembering a recent occasion where he is "fine in social situations." He talks of a Far Side cartoon that he found particularly funny: "A cockroach having a nightmare." This appears to be the one. Symbol analysis anyone? group of chronic relapse clients in1974, identified the thirty-seven warning signs that were predictive of possible relapse. (For those wbn wish.further information, these warning signs were first outlined in his book, Counseling For Relapse Prevention (T. Gorski, 1982). Many recovering addicts will demonstrate some of these symptoms, to a greater or lesser extent, in the course of their recovery process. Their symptoms will normally begin to appear at six to eighteen months into the recovery process. Of the recovering population, about one third will manage the symptoms with little difficulty. The second third will eventually recover after one or two abortive attempts. However, therelapsers, the final third, will find long term sobriety elusive. Relapser's PAW symptoms will surface during any period of increased personal stress which can occur even after long periods of sobriety and relative comfort. Relapsers will usually experience a greater number of the warning signs that Gorski has identified, and the subjective magnitude of the discomfort they experience will be much greater than others in recovery. Clients report the following six symptoms most often. These symptoms, particularly the mood swings, can be so overwhelming that these clients will opt to return to their "using" behavior rather than tolerate the pain. (1) Inability to think clearly (2) Memory problems (3) Emotional over-reactions or Most therapists who treat Drug/ Alcohol addicted clients have experienced the frustration of client relapse when therapy appeared to be working. Chronic relapse can occur even when the client is fully committed to an abstinent life. Chronic relapsers, and many recovering addicts to some extent, suffer from what Terry Gorski, MA, describes as Post Acute Withdrawal or "PAW." His premise, supported by an analytical study of a numbness (4) Sleep disturbances (5) Physical coordination problems (6) Stress sensitivity Generally, the criteria for diagnosis is that the client has had at least one or more previous residential drug treatments, has had one or more periods of complete abstinence from drug use subsequently, and has been unable to remain sober on a permanent basis, although committed to that life-style. Clients historically have beenrecycled 3 repeatedly through the same failed treatment modalities. The rational was that "they didn't get it the first time." Thosewhoprovidedtreabnent blamed the client for treatment failure. What we call client resistance! Certified Relapse Prevention Specialists, or CRPS, can help the client learn to manage the symptoms in more than 80'- of these cases. This is the 80% that was formerly considered hopeless by the Drug-Alcohol treatment industry, although this belief was seldom acknowledged openly. Since Gorski began his treatment regimen in the eighties, there has been a breakthrough in knowledge that is of particular interest to those who treat chronic relapsers in their practices. The discovery is that there is a direct correlation between chronic relapse and PTSD. Cynthia Downing, Ph.D., determined in late 1990 that 97.5% of chronic relapse clients had experienced a life threatening experience wherein they perceived their imminent death and could do nothing to prevent it. They subsequently generalized the feeling of being powerless to effect their world in any significant way. Downing's work was a blind study using some hundred oddrelapse prone clientsandanequalnumberofnormals in the control group. The life threatening/ powerlessness dynamic was found to be true consistently, with or without the presence ofa history of the other psychic trauma that we have come to expect with the addict population. It is important to note that the presence of the various forms of child abuse per se were not predictive of being relapse prone. Only the client's conviction that death was imminent and that he was powerless to prevent it seems to be the deciding factor. Extreme violence may be a part of a client's past and is frequently perceived as a life threatening experience. Of course, there are other client experiences that can be construed as life threatening, and it is important to be aware that it is the client's evaluation of the experience that is the deciding �factor. Therapists sometimes may ignore the life threatening experiences, expecting that the abuse experiences are,·reel}y the lUKl.edying,, caues of relapse behavior. Downing's study strongly suggests that these life threatening experiences absolutely must be addressed for long term sobriety. The Post Traumatic Stress Disorder symptoms which manifest from these life-threatening experiences are the motor driving the PAW symptoms to client overload. Empirically, from personal experience, I have found this to be true in the relapse clients that I have successfully treated this year using EMDR. Each of these clients had the life threatening experience that Downing identified, and all responded well to EMDR intervention. That is, there was a substantial reduction of anxiety as measured on the SUDs scale and the sense that the experience was now history. "It should never have happened, but it's now history" is the common self-report after one or two sessions using EMDR. This response is particularly important with chronic relapse clients because they have selfmedicated in the past to keep from experiencing these feelings in their "flashbacks." As an example, I successfully used EMDR with a client who had been trapped on a ledge in Yosemite as a teenager. This client was a member of a relapse group that I facilitated in a residential treatment program this past spring. He was non-communicative, depressed, and not able to tolerate the group process. His treatment was almost non-existent, although he said he was desperately seeking to stop using drugs. His drugs of choice were crack-cocaine and alcohol. He said that the group brought up overwhelming feelings of mistrust and fear, so he just "numbed out'' in group. I suggested to him that we try EMDR and explained the procedure to him. His initial response was that there really was not anything that bothered him, like sex or physical abuse, but he was willing to try the procedure. I did an assessment and the incident at Yosemite came up. He was sixteen years old when it happened. His verbal description depicted it as a relatively.m:iao.rincidentfrom along time. ago. The initial SUDs was a body feeling centered in his stomach that he identified as an eight. The number came fromhis "subconscious" and"seemed right" to him. It was necessary to do the EMDR sets for about twenty minutes before there was an opening up of his processes. Body language encouraged me to continue with the client even though he reported no change during these twenty minutes of EMDR passes. Periodically, during this phase we stopped and talked in generalities about what he was feeling. My take was that this very distrusting individual was making some kind of internal assessment as to whether this was a good thing for him to do. When we broke through the block, the rest was relatively easy. The initial blocked feeling was around the perception of his impending death. He knew thathe was going to die because he was losing his grip on the rock that he was holding onto to keep from slipping off the mountain. When he started into the abreaction, I assured him throughout that he was just passing through an old experience, that he had survived it, it was in the past, and that he was now safe. I encouraged him to stick with the experience so that he could finally get through the pain and not get stuck in it again. He had some difficulty staying with it, and we had to stop several times for him to regroup. Each time was a little less difficult for him until he suddenly said, "My father's an asshole." He stopped the process at that point and told me that he had forgotten that part of the incident when his father came on the scene. Two adults had been watching him and 1 ! \ ~ no ef. fort to help him. Instead, they told him what a stupid fool he was. He knew he was going to die and nobody 4 cared. His younger brother risked his own life to pull him to safety, while the adults continued to berate him. His father soon arrived on the scene and . the client"s expectation was tnat the father would comfort him and get the two "big mouths" off his back. Initially, the father showed concern, but then sided with the others. This rejection, on top of the life threatening experience, was encoded and afterward repressed. During the next series of passes he said, "My father never was there for me and that's when I realized it. What an asshole.'' During the next series he started in a polarization sequence. He vacillated between what a good man his father was because he took the family so many places and that he's an asshole. During a rest period dialogue he observed that his father only took him to places that the father wanted to go to. In the subsequent polarization sequence I fed this information back to him. That is, that his father was never there for him and only went to places that pleased the father. This interject [taught in the Level Il trainings] ended the polarization sequence. I also interjected that he was now an adult and capable of taking care of himself and making mature decisions about the safety of situations. He now had information available that was not available as a youth. This final interject was reinforced with EMDR. The combination of the life threatening experience and psychological abandonment by his father were the driving forces of the relapse dynamics. This resolution brought about an immediate change, within hours, of the way he related to his peers. Some of them asked, "What kind of miracle happened in there r' Of course it was no miracle. Only a letting go of the past. Prior to EMDR intervention, this extremely depressed, middle-aged adult could not participate in the group process at all; this was his third l'reatment attempt. He could not trust his peer group, and did not feel safe anywhere. He reported that the feeling of not �being safe disappeared and his ability to trust increased significantly. Prior to EMDR, his longest period of sobriety was apptoxintately three- week-,,. He has been sober for seven months and has not relapsed to date. I beheve his prognosis is now good for long term sobriety, and there has been no return of his depression. I have consistently had the same result with clients who were physically beaten by "crazy" parents until they thought they were going to be killed. I also treated a case of forced oral copulation where the perpetrator hterally cut off the boy's air supply and brought him near death. In conclusion, I think that EMDR therapy is an extremely useful tool for those working with the addict population and particularlywithrelapseprone clients. I have found that EMDR can be used effectively at any time with addicts, unlike some of the other treatment modalities. I have used it very early in treatment on both residential and out-patients with no ill effects so far. Admittedly, my sample is small, so I would advise caution. When treating the relapse prone, the therapist needs to look for the hfe threatening experience that is almost certain to be there and resolve the attendant feelings of powerlessness with EMDR. Also, my personal experience using the procedure has taught me to be patient with it and not expect instant responses from my efforts. Each client hashis/herownblockingmechanisms, and we must work within that agenda and not necessarily our own. sions and reassessed at three months. Self-report results were consistent with those reported by Shapiro, and indicated that a single session ofEMDR desensitized subjects' memories of traumatic events and dramatically altered cognitive assessments with such effects being maintained at a three month follow-up. The purpose of this study was to identify autonomic correlates of EMDR as sampled by common measures of physiologicalfunctioning: respiration, heart rate, blood pressure, and the galvanic skin response. The study focused on six volunteers with complaints related to memories of traumatic events. Shapiro's procedures for EMDR were followed as closely as possible. Dependent variables were: (a) anxiety level, (b) validity of a positive statement/assessment ofoutcome, (c) subjective complaints, and (d) measures of autonomic functioning, as noted above. Anxiety level, Vahdity of Cognitions(Voq, and complaints were measured during the experimentalses- Autonomic measures showed the following distinct, profound changes during EMDR: l)respiration tracked and matched the rhythm of the saccades in a shallow, regular pattern;2)heart rate, which did not show significant increase or decrease during any given set, slowed significantly overall; 3)blood pressure, which increased during early sets, but decreased in later sets, invariably fell during abreactions, and decreased overall; and 4)the galvanic skin response consistently decreased in a clear "relaxation response." The following illustration from a polygraph chart shows a "signature" pattern for El\{l)R. .··--,,;. -...;:.. .,......,,,_ ........ :n.. 7 I .. --,,..,,,_ . .- - - - _ .~ n. • v - ~ :r: c - •'fl 'UII • r.r .... -. 1 - -. N • - A 1-. _ I-. .-. lrl _ \l a, T • ~ -; J • ,.,n• 1111 I •o:..:'"::..: .. ,I 11 tll ~·.. · . i _. r1 W/1111 .,., ryJ!J~ '11 h~ -~ II, "' IIT 111 \h I I \ '- • I~ ---~---~- 1__,.___• ---~· ::..:o~··~·~'"=--.....:.J---.--'~.__-+---1 _ IHltAll".I II ~-=-x ,I ~,.. ou---,,:i .. -:-...---• -uaw. ' : I I ITTI rt • -- I In the illustration, respiration is shallow and rhythmic AND synchronized with the rhythm of the saccades. Heart rate is stable. The GSR (a measure of sympathetic nervous system arousal) rises as the client is present to a troubhng memory, then falls steadily until s/he is instructed to close his /her eyes and take a deep breath. This overall picture- shallow and rhythmic breathing, steady heart rate, and decrease in the GSR-is characteristic of an EMDR set, occurring with minor variations in 80% of EMDR sets. The only significant variations include apneas (holding one's breath) and abreactions. During abreactions, the physiological measures are extremely unstable. The relaxing effects of saccades indicate that at least one of the mechanisms operating during EMDR is desensitization by reciprocal inhibition, i.e., pairing of emotional distress with a "compelled" relaxation response. In contrast to systematic desensitization, which ·requires tea.dung -some mode of relaxation, or .flooding, which requires repeated exposure to high levels of distress without immediate rehef, EMDR utilizes mechanisms producing an unlearned relaxation response. 5 �First of all, let me begin by stating that Francine's statement that EMDR "is not a cookie cutter" is beginning to look more true all the time. Each client/ patient seems to have a great deal of variability of response and, for that reason, the more that we have a forum in which to discuss variations on the technique the better. Gary Flint, Ph.D., recently sent me a seyeral page letter with many observations on his use of EMDR, and I would like to include a few of them here. First, when dealing with an individual whose initial picture of the trauma was too intense to hold in consciousness, [as suggested in Level Il training) Gary asked that she "move the picture away from her until it was less painful." He then did the EMDR procedure, and the visualimage spontaneously moved "closer," with repetition of the process, as it began to metabolize. Second, he found that making a simple statement like, Adjust the color, sound and feeling to obtain the strongest representation of the picture you can," often assists people in developing an optimal visual image. 11 Rather than attempting to intuit which is the best speed, eye focus level, angle, etc., at which to use EMDR with a given person, Gary simply asks the client which one feels best and then proceeds basedonhis/herverbalfeedback. [These innovations were presented at the Dec. Network meeting.) I have developed two further uses, one of which resulted from Francine's observation that you cannot "install" a negative or take anything positive out of the system. Based on that, when I was particularly stuck in working withagentlemanonhis fear of authority figures, I asked him to contemplate a time when he felt the most strong and competent. When he brought up a memory of that time, I used EMDR to "lock it in'' more and more powerfully until we reached the ceiling of intensity. I tnen hacf him hold the memory of that time as vividly as he could in his awareness, alongside the inner representation of fear of authority figures. I asked him to either juxtapose the strong memory and negative representation (hold them side by side like two photographs) or superimpose them (imagine them like a double exposure, one over the other). Then, when he was holding both the positive and the negative representations internally, I began doing EMDR. As predicted by the model, themorepositiverepresentationcontinued to strengthen and become more vivid, while the more negative representation began to fade and become less relevant. The final discovery I have made is that for some people who seem to circle" through endless visual representations or through ongoing sequences of physiological responses, there is often a negative cognition that occurs spontaneously during theEMDR. II With one gentleman, the cognition was "You've always beena screwup, and you always will be." With the part that felt the need to express itself, I used the cognitive behavioral technique of asking him to hear that message repeated in Donald Duck's voice while we were doing the EMDR on the representation we were working with. Hearing the negative cognition in Donald Duck's voice seemed to depotentiate it and take away its meaningfulness, which then allowed the visual and physiological aspects of the inner representation to process through. It is important to understand that hearing the negative cognition in Donald Duck's voice in a normal conscious awaftlWWW [astntggested inthe Level Il training] is different from what I am referring to here. Specifically, the Donald Duck voice presenting 6 the negative cognition is to be invoked during the EMDR processing of the issue on which the negative cognition spontaneously arises. I have no idea whether the depotentiation takes place because Donald Duck's voice represents someone silly, or because it simply is different from the original voice speaking the cognition, but I have found it to work on several occasions. I invite you to try all of the above techniques and get back to me on your findings. Please note the change in training format. The LevelllTrainingisan update of andreplaces the Intermediate Training. The consensus of the previous participants of the Intermediate Training and EPIC is that the second twoday workshop is necessary for a full understanding of the therapeutic utiliz.ation and myriad apphcations of EMDR. Therefore, starting in 1992, graduates of the Levell Basic Training willreceivea Certificate of Attendance, and the Certificate of Completion will be issued only after participation in Level Il. It is recommended that ,4 to 6 weeks of clinical practice with EMDR be completed before registering for Level II. Intermediate graduateJ may attend at half price. ALL BASIC TRAINING GRADUATES ARE URGED TO ATTEND TO INCREASETHEIR THERAPEUTl,CEFFECTIVENESS AND RANG~ OF APPLICATION. My wife Carol returned from the EMDR Level I Basic Training and posed a question regarding the effectiveness of EMDR on chronic pain. It seems that if we beheve that the eye movements in �EMDR produce something that assists or facilitates the brain to reprocess thought, memory, and emotions, then we can speculate or hypothesize that the same procedure could effect how the brain processes chronic pain. It is understood that pain normally indicates that there is a problem and that the person must do something about the cause; however, chronic pain is "just there." For some reason, that part of the body sends a constant or near constant message of pain to the brain creating a chronic pain path. Painclinics use a variety ofapproaches to help the individual live with the pain. These include, but are not restricted to, relaxation and self-hypnosis. H the pain reduction and control techniques donot work, the individual may either take medication or may have to resort to injection of chemicals to deaden the nerves. Is it appropriate then to use EMDR with chronic pain? We feel that the answer is "YES!" H, in fact, EMDR is tapping into the body's capability to heal itself, then it is not only appropriate to allow the body to apply that capability to chronic pain, but it could be considered unethical if the clinician did not allow the individual the opportunity to benefit from the procedure. Forpurposesofthispaper, EMDRhas been used with a sample of ten (10) individuals ranging in age from 40 to 85yearswho experienced chronic pain. The pain was located in various areas, e.g., lower back, knee and hand joints, a wound caused by shrapnel in Vietnam, and others. The duration of the pain in the case of the 85 year-old was 40 years of lower back pain and 10 years for the individual with joint pains. In a number of the cases, the individual had modified his or her body postme to compensete for the pain in the best way he or she could. In some cases, the body posture itself added to or became part of the problem. Thus, it was necessary after the application of EMDR to encourage the individual to modify his or her posture to minimize the possibility of re-establishing the same path of pain (as Francine says, "the tracks are there"). One case reported that while working in her garden, she re-established some of the chronic pain due to overwork. EMDR was immediately applied and the pain was reduced to an appropriate level for the situation (work she was not accustomed to doing). When we discussed the procedure and what happened when EMDR was applied she described it this way, "It was necessary to get rid of the memory of the chronic pain again." Once the memory of the pain was again reprocessed, it left the natural soreness that was appropriate. With the understanding that it is possible to re-establish the old path of pain, we have included in our procedure a brief protocol for SELF-EMDR for those occasions when there is an activity that re-establishes the old path. The client is also cautioned to use the procedure only when attempting to deal with the re-established path and not to attempt to use it on new areas. All clinicians must be concerned with the effects on the individual when he/ she is suddenly without pain. Working with chronic pain is no different from dealing with emotional pain in that we must look at secondary gains and the stability of the individual in order to assist him/her in preparing for the new experience of being pain free. PROTOCOL A. Have the client move or arrange his/her body in a position that maximizes the pain. As when working with emotional issues, it is helpful for the client to visualize those memories he/ she wishes to reprocess. B. Begin the eye movements, keeping in mind that you as the clinician will need to adjust with the client so that he/she can keep the pain at the maxi7 mum and still continue doing the eye movements. NOTE: The eye movements are continued m that position until· the painreaches a low level or is completely gone. C. You then have the client identify the next point of pain. You may find that the pain moves to a new location in the body and you seem to be chasing it. In both cases, the same pain apparently moving to a new location or another chronic area, you continue as instep B. Dr. Winson is a neuroscientist at Rockefeller Universitystudyingmemory processing and specifically sleep related processing. After a briefoverview of the history of dreams and their supposed origins, he sets forth his theory that dreaming is a pivotal aspect in the processing of memory, specifically memory that may have survival value for the organism. Using his research on subprimate animals, Dr. Winson believes that he has isolated a brain wave (theta) that is the electrochemical marker for the processing of survival information in the brain. He furtherreports that in these lower organisms, the only other time this brain wave is present (other than in foraging, escaping, sexual behavior, predating, etc.)is during REMsleep. Using several data bases he makes a convincing case that REM sleep may be the brain's way of organizing, selecting, and filing/processing the abundance of information from the preceaing dAy. The data summarized is indeed impressive, leading the reader to link these theta rhythms with brain activation in those areas of the brain �believed to be ~ t e d with memory processing andstorage. He even states that the evolutionary yalue of REM sleep-ma.y have,,been ·vital in.the-de:velopment of survivability for higher organisms. He likens it to an "off line" method ofprocessingandsortingcentrallyimportantinformation. The next step (in this author's opinion, a fairly large leap) is to state that human dreams reflect an individual's strategy for survival. Dr. Winson cites one interesting data set suggesting that dreams and their associations are frequently linked to childhood themes and patterns. He also aptly points out thatthetarhythmshavenot been found in primates or higher organisms and much more research is needed. The implications of this article for EMDR are fascinating. Clearly if stimuli are "locked" in the brain, and both EMDR and REM seem to release these fragments, then Dr. Winson's thesis may have merit. I am particularly intrigued with the PTSD population which often (though not always) has as part of their history a near-death, or close-callaspectwhich has, in essence, "imprinted" an image in their minds. It is also tempting to link the Maybe it is a sacrilege, l?ut sometimes I yearn for the clarity of the medical model. How simple our lives would be if we need only assess a client for discernible, measurable symptoms and then refer to a diagnostic "cookbook" lor J:reatment re-commendations. However, our lives as psycho: therapists are rarely so uncomplicated. Consider a case I treated approxi- mately eighteen months ago. I had been individually seeing a man in his mid-30's in preparation for marital counseling. The therapy focused on issues related to his alcoholism (he was one year sober at the time ) and work difficulties with a male superior. About three months into treatment, he complained of a nagging image that he found most disturbing. He described a scene wherein he was at his grandparents' house in the desert. He was standing in front of a picture window looking out onto a ribbon of highway lazily winding itself into the distant mountains with the sky painted red as the sun slowly set. He was terrified and longing for the return of his parents who were in thehabitofleavinghim with the grandparents while they took off together. After the appropriate history taking andexp1anations,Ischeduleda double sessionforan EMDR treatment. Soon after we began, the client grabbed his right thigh in the hamstring area with both hands and cried out, "Ouch, it hurts," and began writhing in the chair in considerable pain. Tears were rolling down his cheeks and I had to stand up in an effort to have his eyes continue to follow my fingers. After about a minute, with the pain apparently increasing and not subsiding as I had anticipated, I stopped theeyemovementsandasked him if there was a physical cramping that we could stretch out. He said no, and that the pain was familiar and had been withhim every day of his life since his earliest childhood recollections. A host of medical specialists had treated him, albeit unsuccessfully. Reassured that the pain was of psychogenetic origin, we forged ahead. Various childhood images floated to the surface, usually pertaining to importantmale figuresinhislife-all cloaked by his writhing response to the obviously intense pain. Our macabre "dance" continued for approximately 70 minutes, when out of nowhere he screamed,"Oh, that's itf" We stopped. The client then recalled an infantile memory. His grandfather was pinning 8 him to the changing table, holding him firmly, maybe even savagely, by the right thigh with his left hand while hisrighthand played with his g_enitals and penetrated ms anus. The pain stopped in my office and it appears that EMDR allowed me to successfully treat a "physical" symptom. I am still in touch with this client and the pain has not returned to this day. Trainings are scheduled this coming year in Australia and in Germany, as well as throughout the U.S. Research is underway at many facilities, including: 1. Temple University on the treatment of panic disorder and agoraphobia-headed by Alan Goldstein, Ph.D. 2. Harvard University on PTSD and chronic combat veterans- headed by Roger Pitman, M.D.3. Augusta, GAV.A. onPTSD and chronic combat veterans - headed by Pat Boudewyns, Ph.D. This group just submitted a paper for publication on a small pilot study completed on EMDR. While physiological measures showed no change, the self-report and therapist observational measures were so positive that they have requested further funding from NIMHfor a full-scale investigation. (You have an early report of this data in your packet) 4-Rockefeller University on the neurosdentific explanations for the effects of EMDR-conducted by Jonathan Winson, Ph.D. �5. Philadelphia V.A. on PTSD and veterans -headed by Neal Daniels, Ph.D. I chaired a symposium at the 1991 annual conference of the.International Society for Traumatic· Stress Studies. Appearing were Roger Solomon, Ph.D., and Tim Kaufman, Ph.D., head of the personnel division of Union Pacific Railroad which deals with treatment for critical incidents. Kaufman stated unequivocally to the audience that as the head of a department of"a very conservative company," heis convinced that "nothing even holds the promise of what EMDR has already delivered." It was a very moving and eloquent presen- talion and included very disturbing case material (e.g., an engineer at the throttle when the train hit and killed his entire family). We have audio cassette copies of the symposium available through the office at a nominal fee. It is also very useful for those of you wishing to make professional presentations. An interview of me ~licited by the BBC representatives who attended the conference precipitated a call by what appears to be the British equivalent of NASA. The caller said they were intrigued by the interview because they had started recently investigating eye movements for the effect on "iconic images" that detracted .from the performance of their pilots. We hope to have more information by the next Newsletter. The four presentations at the 1991 annual conference of the Association for the Advancement of Behavior Therapy were "standing room only." At the symposium, Alan Goldstein, Ph.D., presented new pilot data on EMDR treatment for agoraphobia and panic disorder which was quite impressive. Likewise, Howard Lipke, Ph.D., of the North Chicago V.A. presented some new findings which, among other things, dearly indicated that EMDll can be considered a culture-free treatment for PTSD. Hopefully this will spur the National Centers of PTSD towards a more rapid inclusion of EMDR as a treatment modality. So far the response has been"spotty"; there bas. been much enthusiasm among those who have tried EMDRandskepticism .from those who have not. I also gave presentations at the annual conference of the International Association of Chiefs of Police, and a variety of universities, hospitals, and V .A. facilities. These will hopefully yield more research interest in the coming year. Karen Anderson, Ph.D., presented at the Eighth International Conference on Multiple Personality/Dissociative States. She was very well received. The article you received in your packet by Cory Hammond does not seem to be taken too seriously. However, it is an indication of how misinformed some people may be. We are particularly concerned with his suggestions that EMDR be done by the spouse on an agitated MPD client. You have the response of EPIC (EMDR Professional Issues Committee) also in your packet. We have not yet received word whether or not EPIC's response will be published. lhavecompletedthechapteronEMDR to be included in the volume on PTSD treatments edited by Lee Hyer, Ph.D., at the Augusta, Georgia V.A. This next year I hope to complete the first of two books on EMDR, to be published by Guilford Press. As more of the research is completed and published to substantiate the efficacy of EMDR, the hope is that EMDR courses can be moved into the universities with an appropriate training text to draw upon. Once again I would like to ask all of you with any research or writing background to consider applying yourselves to publishable material on EMDR. Journals are apparently quite receptive to brief reports, clinical cases, and preliminary research on EMDRat this time. There are tbree manuscripts that I know of under preparation and three submitted for publication. 9 Howard Lipke, Ph.D., had his article on the first.five cases he treated with EMDR accepted by Psychotherapy. Muchmore is needed, however. Please remember your skills in graduate school and do not minimize your ability to contribute. It really is the ground floor. As for 1992, next year's California Psychology Association annual conference symposium on EMDR will be chaired by "Sam" Foster, Ph.D., with Jennifer Lendl, Ph.D., and David Wilson, Ph.D. I would like to encourage you to give presentations at your own local and regional chapters. There are still many clinicians who have never heard of EMDR. Also already scheduled for my 1992 calendar are invited presentations at (a) the Fifth International Congress on Ericksonian Approaches to Hypnosis and Psychotherapy {I expect that there will be a number of dialogues and symposia comparing approaches for the treatment of trauma), (b) the annual conference of the Association for Applied Psychophysiology and Biofeedback (a panel on new and traditional treatments of stress), (c) the inaugural conference of the International Association of Trauma Counselors, and (d) Gordon Bower, Ph.D. requested that I be one of four speakers at the presidential symposium plenary session of the American Psychological Society. Hopefully, this will spur needed research. Please notify us of any presentations you are planning at major conferences. We will do everything possible to support you. So at the close of another year, I would like to thank all of you who have given so fully to assist in the growth and expansion of EMDR. All of the participants are on data-base, and referral requests for clinicians .from around the country are filled regularly. The Network has continued to grow nationwide, and while clinical reports of "'miracles" are cmmn.onplace; they never fail to remind us of what it is all about. [Continued] �[International Update continued] We know that having a positive cognition in mind is crucial to effective EMDR. Sometimes the patient produces an excellent positive cognition with little help. However, more often, even when asked how she/he would rather think or feel about it, the patient is still unable to produce an appropriate positive selfstatement. Instead, the desired cognition may refer to the actions of others, or contain a negative, or an unrealistic component. These factors limit the usefulness of the statement since an unrealistic cognition will not 'stick' for a variety of reasons; e.g., the person knows better, negatives are very tricky at the unconscious level, the work can never control the behavior of others, etc. When difficulty arises in producing a positive cognition, it is sometimes helpful to offer alternatives to the patient. However, many of us are uncomfortable about "puttingwordsin people's mouths," whichleavesus in the position ofstruggling to help the client obtain a positive cognition. I was asked to create .the following list of examples of positive cognitions for EMDR training purposes. PRELIMINARY CONCEPT POSITIVE COGNITION It wasn't my fault I did the best I could I never want that to happen again It's over I don't want to keep thinking about it I'm free to go on with my life I did something wrong · I learned from my it/my mistake I couldn't get her love She had a problem giving love It's a terrible memory It's just a memory I wish it never happened I survived I should have (run, screamed, etc.) I did what I could It will never happen again I'm safe now I couldn't protect myself I'm strong now He never loved me I love myself I couldn't help it I can help myself now I don't want to stay trapped I'm free I never told the secret I can choose to tell I want to trust more I can decide when to trust I don't need them anymore I can rely on myself NEGATIVE COGNITIONS It was my fault I did the best I could I didn't do everything I could have I did the best I could with what I knew at the time I was helpless/I'm overwhelmed I should have done something It's over I am worthy I have no control It was shameful I have control It's over/I am worthy It -~ne ectivet~s ow e · to patients arest:ru · gwithaposit:ive cogrution. Many patients select'one or more cognitions, since having two or more seems helpful to them; others understand the idea more completely from the examples and are able to develop their own positive statements. 10 I have always enjoyed contemplating the "ripple effect." That just as a stone dropped in a Luce causes movement far beyond the ability of the eye to see, likewise do our actions. And now I feel that we are entering into history as a movement in psychology that can aid in healing a vast amount of suffering on the planet. It just takes people willing to work towards it, to make their hands do the work of their heart. So my gratitude goes out to all of you dedicated clinicians and researchers, SIG- leaders, Network leaders, and facilitators. And in this time of transition and" quantum leap," allow me to give my special thanks to the dedicated support team that holds it all in place: Lois Allen-Byrd, Robbie Dunton, Cliff Levin, and A.J. Popky. And for the initial framework- to Pat Ryleywho contributed more than she will ever take credit for. Thanks to all of you-while we may spill more than a drop on occasion-the intention remains clear. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter Newsletter Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter, 1(2), 1-10 Date A point or period of time associated with an event in the lifecycle of the resource 1991, December https://d1y502jg6fpugt.cloudfront.net/13023/archive/files/210f393fc8347736efd802ce18db2783.pdf?Expires=1790208000&Signature=imVmVsQgj70%7EY%7ECbP06LPhUvFQborhAb0UHfGjy-UGiFTB-0r9MVw0xVrQa9zB9u53q1NhJ05ZsrIS2xdHyqh1CUbG8KSS%7EC8N8bRLOMh8JPkTMS8sib6x4ywBaPx-%7E%7Eql%7E1Qo2nUqdb5PjhkP9jDGfCivTyhHZ0fD6iMoMKTiPlPeTm99tjW19tjWueIFmfj7iLxwhZzo4BweAvdNNNd11xC0x2TYOP8eq-xYrKt9sxHsolkr43AbxGD3mb%7EGwI8ItRjI-ggulCyo6Bi4aiCR-NXPvIrJqfFjTXz9qmjMokZ36TLMjZD%7EaImeh-nA-VSP5wCtDt%7EIEpljMORy3lQw__&Key-Pair-Id=K6UGZS9ZTDSZM f758c6dbab77101d931191a32fcbce9b PDF Text Text # May 1992 N e t w o r k Newsletter EYE MOVEMENT DESENSITIZATION AND REPROCESSING Copyright 0 1992 EMDR P.O. Box 51010, Pacific Grove, CA 93950-6010 (408) 372-3900 Palo Alto, CA Questions have arisen about the use of EMDR in the courts and the comparison to hypnosis. So far EMDR is not well enough known to have been tested in court; it is simply described under the rubric of cognitive-behavioral techniques (as it is for insurance purposes). However, I want to make sure everyone realizes that just because a scene emerges during an EMDR session, does not mean that it is "true" in a literal sense. Things can be "truly experienced without having actually happened. I remember an experience when I was around eight years old. I was convinced I had brought home acrafts project to show my grandmother. I was so convinced that I started arguing with her later in the day, when she assured me she had not seen it. Finally, distraught, I raced back to thecamphouse, only tofmd the project still on the floor where I had left it. If I had not gone back to check, EMDR would undoubtedly have revealed the memory in its original, disturbing, 'true and invalid form. Please make sure if incest, abuse, or other disturbing memories arise, that you use full clinical judgment and cross- checks to determine actual validity. Present thought on cult abuse reports, for instance, is that in many instances adults use trickery to make the children thinkcultsorlarge groups are involved. By the same token, individual perpetrators couldconceivably fool children into believing that their parents were actually present and approved an abuse. A strong enough suggestion could implant that image in the child, which is subsequently repressed. While EMDR may release the repressed "memory," we do not know if it would necessarily reveal the trickery in every instance. All clinical cautions must be in place. I thought it might be useful to include the Protocol for Cancer Patients. This, of course, is not a substitute for appropriate medical care. However, it was successful with one cancer patient I tried it with and was taken up with excellent results by a therapist for self-use after a cancer operation. Having reported on it at the Somatic Disorders section of the EMDR Conference, I am also looking forward to feedback from the field. I do not mean to limit the application to only cancer patients, and expect it will be successful with a variety of somatic complaints. Please let us know your results. With cancer, as with most presenting pathologies, the EMDR model re. quires a search for the touchstone memories, present factors, and fears V O ~ . Issue 1 2 of the future that may be involved. EMDR must be used on all revealed problem areas. A good history may reveal patterns of self-sacrifice and difficulty in dealing with anger. Present factors may include a "nowin" situation that is generating the feelings of helplessness and hopelessness. The future must be dealt with in terms of questions regarding "Who am I without the cancer" and "What do I have to change or confront." If they apply, the memories that laid the groundwork for feelings of low selfesteem and powerlessness must be metabolized. Issues withparents, family, significant others, career, identity crises, and prese~itupsets must be addressed. The question, "Do I want to live," must be explored, along with any negative emotions that arise. An excellent resource for cancer patients is a book called Getting Well Again by Carl a n d Stephanie Simonton. As psychoIogist and radiologist, they received referrals of primarily the terminally ill. They were intrigued by the question of differential survival rates and their analysis revealed that these were often correlated with the attitude of patients and mentalimagery they were using. They suggest helping the patient toformulate a mental image of the immune system as powerful and in some way defeating the weak cancer cells. A good cognitive groundwork is useful here. Assure the client that cancer ceUs are the weakest in the system. �That is why chemotherapy works; it kills off the cancer cells while the stronger, healthier ones survive. Often, a t this point, with EMDR you may have to work on some "nonuseful" statements made by medical personnel regarding t h e cancer's potency. It is unfortunate that there are still some physicians who a r e seemingly ignorant of t h e findings of psycho-neuroimmunology. My client had worked with Simonton and had developed a n image of electricity coming in through the top of his head a n d sparking through his entire body, killing all t h e cancer cells. However, when I first saw him, he reported that h e used the imagery only rarely, a n d the electricity often got " s t u c k in certain parts of his body a n d would not proceed the entire way through. Working with the EMDR, I had my client first formulate a positive cognition to go with the picture. He chose "My immune system heals me." I then had him hold the picture of the electricity together with the positive cognition a n d added in the eye movements until itstrengthened. I then had him close his eyes a n d imagine t h e electricity moving throughout his body. Any place it "stuck," we stopped a n d used the eye movement until it moved freely throughout his body. The objective is to allow a fluid image of the cancer cells being destroyed and leaving the system. We used the EMDR repeatedly in the office on the linked cognition a n d image until he could access both powerfully and easily. He then chose torehearse the imagery every time h e urinated, with the added thought that the cancer cells would be washed out of his system (i.e., "It will take away all the poison.") When possible, have the picture a n d cognition linked and use the eye movements. When that is not possible, for instance, if it is a moving picture a n d the client h a s diEiculty maintaining afocusedattention, then use the eye movements on the positive cognition a t the opening a n d close of the imagery. The client should log any doubts, resistance, pertinent memories, or current upsets. Fears should be addressed with the EMDR, along with all the traumatizing experiences of t h e cancer, including feelings of "body betrayal," real or perceived callousness or indifference of the medical profession, family, friends, a n d emotions related to hospital stays, medical tests, operations, etc. I want to emphasize that I consider most victims of severe illness to be suffering from post-traumatic stress disorder (PTSD). While we can see this clearly in the rape victim, or molest victim, let us not minimize the impact when the perceived perpetrator is the victim's own body or immune system. The sense of powerlessness and self-disgust can be paralyzing. We must be very careful to frame the work a s "self-healing" a n d help restore a sense ofpower and choice. Relaxation and pain control techniques, such a s those I taught in Level 11, can be very helpful to allow a sense of self- efficacy. Also helpful are alternative care approaches such a s massage, nutrition, etc., to help encourage a sense of "self- nurturing" a n d mobilization of resources. Self-careand logging doubts and fears is a n on-going process. Of course the EMDR treatment is never complete until the client is able to envision himiherself healthy a n d cancer-free and a body scan reveals no negative sensations. The image is of course strengthened a s much a s possible. My former client is now adding in the cognition, "I have control of myself-nothing will interfere with my feeling that I can get better," along with using the eye movements a t home. I become a resource if a reallife crisis emerges. He is the healer- doing his own h e a h g . FROM THE EDITOR h i d Fenstermaker, Ph.D. JRU University San Jose, CA It h a s been more than a year since Francine a n d I, while sipping Sake in a small J a p a n e s e restaurant, worked out the basic format for the EMDR Newsletter. I had no idea what it would really take to produce a Newsletter,which is probably the best way to undertake a project like this. There a r e two groups of contributors I want to thank. The first group is those to whom I turn for editorial help a n d collaboration in the publication. Robbie Dunton's talented organizing a n d pubLicizing ability place shape a n d guidance to the project. Lois Allen-Byrd a n d Robbie share t h e substantial task of fine tuning the Newsletter to conform to the subtleties of the English language. This task is both painstaking and time-consuming, although it is one they perform beyond distinction. A. J . Popky, with his computer graphics ability a n d down-to-earth common sense, actually produces the Newsletter. I alsowouldliketo thank Ron Martinez, Assistant Editor, who writes the "Innovative Uses" column, a n d Andrew Leeds, Assistant Editor, who writes the Column entitled "Difficult Cases." Both have put their creative intellect to this project. T h a n k s also goes to Bob Welch, Ph.D., for giving his time as Science a n d Research Editor. The secondgroup that I wish tothank a r e the contributors who have given graciously of their time and clinical knowledge a n d expertise. The demand for all of us to maintain curr e n t information is critical, and, thanks to those who have contributed, we a s a group stand closer to the edge of excellence. I know many of you have p u t up with me saying, "Type that up a n d send it to me," or Francine saying, "Send that to the Newsletter." If you have items of �Massachusetts Pat Penn, Ph.D. "Sam" Foster, Ph.D. Andy Sweet, Ph.D. Pat Hammett, Ph.D. Sandra Paulsen, Ph. D. Dean Funabiki, Ph.D. Howard Lipke, Ph.D. Mike Brenner, MD Me1 Rabin, Ph.D. Elayne Weiner, Ph.D. Marcia Whisman, LCSW William Zangwill, Ph.D. Gerald Puk, Ph. D. Kay Werk, LISW Ray Blanford, MSW Frances Page, Ph.D. Alan Goldstein, Ph.D. Georgia Sloane, MS Carol York, MSW Roger Solomon, Ph.D. interest that you think others in EMDR would benefit from, or questions that you would like to see answered, please put them on a disc and send the disc to me. Your contributions will help keep EMDR a t the edge of excellence. The projects that we are planning are exciting, and they will expand the depth and areas of EMDR utilization. In the November, 1992Newsletter the area of concentration will be interventions with children who have suffered traumatic experiences. These experiences can originate from: family violence, chronic or progressive-degenerative illnesses, natural disasters, accidents, ormolestations. We have a great deal of expertise in defining the problem and using EMDR with adults. We anticipate developing this same expertise with children. To that end we are looking for responses to two questions from those ofyou who work with children. The first question is, after a clinician decides that EMDR would be appropriate for a child, how is this framed (708) 688-1900x4675 for the child; in other words, how is EMDR introduced as a relevant mode of treatment? Eventually our experience base will include this particular "how" for each different age group. The second question concerns how the procedure is actually done for a given aged child. Other helpful information to know would be how recent the trauma is,whatpriortreatment, if any, for the problem has taken place, and what predisposing factors are significant. Thus, the responses should include the following information: age, type of trauma, predisposing factors and prior treatment, presentation of EMDR, and the actual use of the procedure. vention and maintenance of positive mental health. This type of primary prevention will have long standing effects on those we treat following a critical incident. There wdl not be the loss of our humanness from the usual succumbing to the effects of physical illness, nor from the drop into the more long standing effectsof PTSD. Excerpts from Roger Solomon's paper from the EMDR Conference (April 3, 4, 5, 1992) will be highlighted. Roger is nationally known for his work in critical incident stress debriefing, and thepopulation with whom he works includes: police officers, railroad engineers, firefighters, and paramedics, all of whom during sometime in their careers are exposed to critical incidents. Roger largely deserves the credit for the introduction of EMDR into that area of specialization. The Newsletter has been a great pleasure to produce and it has brought me into contact with some very exceptional people. I look forward to meeting more of you through the network meetings and through my travels with EMDR. I also look forward to your participation in the Newsletter. Please send in your articles andcasevignettes; putting your thoughts in writing will help you with your own ideas and will enrich others through reading them. [If possible, please submit mater i a l o n a n IBM floppy disc.] Thank you, David Fenstermaker, Editor. -. , .. - . .,. . ,, , " : _, ." 7 .. ., . . ." ? >2 . . . .- 'm # . .. , . '.-: '. ,". ::FROMWRTHLESS,,. , y' :t':: TO;~WORWG.~ ;.:...:: 5;:_.,-~&~&&r~m& ~cj'w,>; .: ." ' .. ,:'".&rkeley a ,'2: 1 'I,. I ; .', ,**.. The Newsletter of January, 1993, will be premiering work with critical incidents. It will be a review of work within the immediate aftermath of a trauma and the role EMDR can serve in Critical Incident Stress Debriefing. This brings the role of EMDR within the scope of the primary mental health directive in this country, which is to encourage primary pre- * , .. , . ; , ',< , z,.. I . '". :. ' . .*:>: , ;, ., , .. *,. ' .. ' ,, : ' ., .'.i..K. . . ' . , . . . . .' . . :. . Julie, age 40, came to therapy depressed and feeling "stuck." She was married to a verbally, and, a t times, physically abusive man, and had recently quit her job. As a child, she had been verbally abused and beaten �by an emotionally removed andcritical father. She was intelligent and had basic strength and humor. After one individual session, she joined my women's group, with one ofher main goals being to start working again. She was referred to an agency that does vocational counseling for battered women. At her eighth group meeting, Julie came in very discouraged. She and her vocational counselor had decided that she was resisting in her work search, and Julie felt that she would need therapy "every day for a long time" to overcome this block. I asked her what was standing in her way, and she said she felt " worthless." I then asked her if she was willing to doEMDR, and she agreed. This was her first and only session of EMDR, which lasted approximately twenty minutes. I wdl describe what transpired. I asked Julie to close her eyes and remember a time in her childhood when she felt worthless. She did this without telling me the incident, but gave it a high SUDS level. As the EMDR progressed, her parents became physically smaller and she grew larger. I then asked her to bring herself to a scene with her husband. At first she felt frightened. Then, as the eye movements progressed, she was dancing around the table, running away from her husband, saying "na, na, na." In the next scene she was living alone, feeling peaceful. I then asked her to bring this peaceful feeling to a job interview. She came out of the interview feeling "great." I asked her to take the "great" feeling to the original scene with her parents. She did this, and the session ended with Julie glowing, saying she "hadn'tfelt this way in years," not since she lived alone before her marriage. Julie returned to the next group meeting having spent the intervening time intensively searching for a job, and feeling somewhat realisti- cally discouraged by her lack of results. She had also made the decision to have separate friends and to do what she wanted, despite her husband's disapproval. She reported two dreams, which I consider to be continued processing of the EMDR procedure. One dream was of a volcano about to erupt. Julie said it wasn't a scary dream, and she saw it as a message that a change was coming in her Life. I saw it as her considerable strength and energy beginning to burst through, but did not offer this interpretation. The second dream was very bright, in color, and occurred the night after we did EMDR. It was simply of her as a child in her room upstairs over the garage, where her father was always working. She would be nasty and rebellious in an attempt to get his attention. She saw that she used a similar behavior with her huband, and that she goaded him to hit her. She thought she did this soshecould have a reason to leave the marriage. At Julie7'snext group meeting, she told us she had several job prospects and might have to leave the group. The following week she did not show up, and I learned by phone that she had found work and had to start immediately. I offered her therapy at another time of day, thinking she still had issues in her marriage to work out. She said she wanted to take a break from therapy for now. Since then, I have heard from another group member that Julie is happy with her job, and she was enjoying the attention she receives from the men she works with. Thus, Julie ended therapy completing her major goal of fmding work after only ten sessions, but only two sessions after one EMDR procedure. I consider the extreme brevity of the procedure and the rapidity of the results due, in part, to Julie's underlying strengths. However, without EMDR, I am certain she would have been stuck and depressed for quite some time. TWO BOOK REVIEWS by Andrew M. Leeds, Ph.D. h t a Rosa, CA Memow in Mind and Brain: What Dream Imaeem Reveals by Morton F. Reiser, M.D., Basic Books, 1990 . Mindworks: Time and Conscious Ex~erience by Ernst Poppel, Harcourt Brace Jouanouich, 1988 Originally published as Grenzen des Bewu btseins. What is the relationship between memory and consciousness? Can Freud's theories coexist with modern neuroscien tific knowledge? What is the role of emotion in organizing memory and in recruiting stored images during REM sleep? The book jacket from Morton Reiser's, Memorv in Mind and Brain (1990), offers us the lofty promise that the widely acclaimed author of Mind, Brain, Bodv "once again brilliantly integrates data from neuroscience, psychology, biology, artificial intelligence and psychoanalysis to answer key questions about how the brain works." In his book, Reiser takes us on aclear if pIodding journey through the trenches of Freud's interpretation of dreams to the furthest edges of research on cognitive neuroscience. He takes the position that toun1ock"the safe deposit box" containing "the secret of dreams" we need two keys. The fnst key opens a "fde cabinet containing neurobiological and cognitive neuroscientific information about memory." The second key unlocks the fde containing clinical psychoanalytic information about memory. In Section I1 of Memorv in Mind and Brain, depth psychologists, especially �psychoanalytic followers of Freud, are given a detailed review (more than 60 pages) of Freud's "Dream of the BotanicalMonograph." Thepurpose of this lengthy exercise is to present psychoanalytic support for Reiser's central thesis on the organization of memory: "Sensory residues in the mind are organized by affect and arranged a s nodal memory networks" @. 92). Non-analystsare likely to readsection I, with its overview of Reiser's dual-track approach to understanding memory, a n d then skim through most of Section 11. For those who like their science served open faced, Section 111 of Memorv in Mind and Brain gives us adetailed summary ofempiricalstudies in cognitive neuroscience. This summary focuses on a search for specific evidence to support Reiser's central thesis on affect a s a n organizing principal of memory. Animal rights activist's should beware; Reiser reviews some painstaking animal research by Mishkin and Appenzeller (Scientific American, 1987) on one trial object recognition. This extensive research project maps out the pathways in the brain by which "imagery units [are] routed, processed, s t o r e d , r e t r i e v e d , reassembled, a n d reperceived in wakingstates andin dreamingsleep" @. 103). This section is a n excellent review of how images are processed in the brain and is well worth careful reading. For those interested in the theoretical model underlying Eye Movement Desensitization a n d Reprocessing (EMDR), part IV of Reiser's book examines the evolutionary role of REM sleep. Reiser reviews Jonathan Winson's research on REM in the mammalian brain. An article by Winson published in the Scientific American ("The M e a n i n g of Dreams," Scientific American, 11, 1990, pp. 86-96) s u b s e q u e n t to Memorv in Mind and Brain was referred to on page 4 of the EMDR Network Newsletter (1991, Vol. 1, No. 1). In this article, Winson pre- sents his thesis that Theta rhythm passing through the limbic system during REM sleep provides a means of efficiently processing and formulatingsurvival information, thereby reducing the amount of cortical tissue needed to a reasonable brain size. Reiser also reviews several other recent theories on REM and the neurological purpose of the dream state. Reiser is refreshingly c a r e f u l throughout the book to distinguish between hypothesized nodal memory networks (organized by affect) and their underlying neural nets. He began conceptualizing nodal memory networks in the early 1980s, a s a theoretical construct to help integrate psychoanalytical and psychophysiological ideas on anxiety. The platform for these hypothesized nodal memory networks is the involvement of neural nets in the processing of images. These neural nets represent actual biological circuitry. For example, every cell in a neural net of the striate cortex "may be a member of a hundred constellations each consisting of a thousand cells" (p. 163). Reiser's careful discrimination between these conceptual poles helps the reader to retain confidence in the boundary between scientific research andmetaphor, which other authors sometimes overlook or deliberately obscure. Reiser closes with a n attempt to revise Freud's model of dreaming and bring it into conformity with the cognitive neuroscience he reviews in the book. In his epilogue, Reiser calls for further interdisciplinary research to carry forward the integration of psychoanalysis and neuroscience. He mentions the work of Shevrin and Dickman to correlate data on unconscious effort with evoked sensory brain potentials a s one of the few examples of exploratory work in this exciting area of research. Whether we feel the attempt to revise Freud's theory of memory and dreaming is successful, or is even worth his elaborate toil, Reiser's integrative work is a valuable introduction and reference on the neurophysiology of image processing a n d advances our understanding of perception, memory, and dreaming in a significant and i n t e h gible way. Ernst Poppel's Mindworks: Time and Conscious E x ~ e r i e n c (1988) offers a e wide-ranging, but very different exploration of neurophysiology by focusing on our experience of time. Poppel d e k h t s in demonstrating that our conscious experience of duration a n d events is entirely constrained by the physiological limits of perception of which we generally remain completely unaware. Poppel, a vivid and entertaining, strongly dualistic neuroscientist, a.%iiated both with the Massachusetts Institute of Technology and the Medizinsiche Psycholope in Munich, focuses here on the "temporal illusions" of consciousness. Poppel's recurrent theme is that the brain consists ofvarious sensory processing mechanisms, only some of which ever reach our consciousness. He believes that the neurologically imposed limits of our conscious perception serve to protect us from a flood of sensory stimulation that would otherwise overwhelm us and leave us incapable of any integration of perceptions into consciousness or organized behavior. Yet Poppel is quick to point out that although some sensory perceptions a r e excluded from consciousness, they still exert a multitude of influences on the unconscious. In Chapter 19, "The UnconsciousGrey Area of Consciousness," Poppel expands Freud's simple model of the conscious, unconscious, and preconscious into a three dimensional grid of past, present, and future forms of consciousness, a s well as adding terms for five other types of consciousness including infraconscious, paraconscious, and extraconscious. He does not limit his focus to our sense of time; other chapters explore "Pleasure a n d Pain-Missing Border �to the Emotions," "Is Consciousness Contingent on Language," and "On the Gradual Formation of Ideas in Talking." Part of the impetus for reviewing Mindworks came from an interesting aside Poppel makes in Chapter 13, "The Limitless Consciousness of Dreams," where he examines Freud's belief that dreams are "the royal road to knowledge of the unconscious" @. 118). Here Poppel states, "The question is, to be sure, whether one can, or ought, to interpret dreams at all" @. 118). He then gingerly approaches the thesis that dreams might be meaningless, advancing arguments in support of the notion, but without insisting on it. One ofhis arguments is that "the phases of sleep in which the dreams occur have a purpose only before birth. After birth, they are superfluous" @. 118). Poppel's theory is that in the absence of sensory stimulation (especially visual stimulation), REM activity serves toprepare the fetalbrain to be fully functional at birth. Poppel's theory of dreaming as existentially empty will probably leave mostpsychotherapists unimpressed. His theory of the post-natal dream seems to reflect his deep discomfort with the "irrationality and unreality" of the dream, which perhaps we can forgive in Poppel, the neuroscientist. Yet, his theory of the prenatal dream as providing "off-line" stimulation for the developing brain seems extremely useful and congruent with observations of lifespan changes in REM activity. Poppel points out that, "The number of the paradoxical sleep phases decreases continuously from [a maximum in] the uterine period, through infancy and childhood, up until adulthood @p. 118-119). Those who have become familiar with Jonathan Winson's research on the evolutionary role ofREM in the marnmalian brain are likely to discard Poppel's explanation of why dreamingcontinues after birth: "There was no particular evolutionary reason to delete the phases in which dreaming occurs after birth. They were simply left over, after having accomplished their prenatal task of preparing the brain. They could remain left over, because they did not interfere with anything in particular" @. 120). We can kindly set aside Poppel's suggestion that dreaming serves no purpose above the level of stimulating neural circuits and still retain his theory of the pre-natal dream as serving the evolutionary purpose of preparing the visually deprived fetal brain for adequate sensory functioning a t birth. Poppel's theory of the pre-natal dream can be accommodated within the same evolutionary perspective that Jonathan Winson proposes for the post-natal dream, that of assisting the brain in processing survival related sensory information. Mindworks: Time and Conscious Experience, in spite of its dualistic limitations, is a worthwhile explanation of some fascinating research on the neurological basis of perception and the limits of conscious experience. Even ifhe sheds no light on the meaning of unconscious perceptual processing, as Reiser does in Memorv in Mind and Brain, Poppel still reveals and reminds us of the illusions of conscious perceptual reality and gives us an intriguing glimpse of the mechanisms of the mind. NETWORK UPDATE Clifford Levin, Ph.D. National Network Coordinator Mental Research Institute Pal0 Alto, CIA , ".. . ?-* * " The EMDR Conference on April 3rd5th was an unmitigated success with an attendance of about 160 participants. AU of the presentations were of high quality and the primary complaint heard was, "How can I attend two workshops at the same time?" On Friday, Scott Nelson and I presented a full day workshop on the uses of EMDR with partners of survivors of incest. Unfortunately, thatmorning I woke up with absolutely no voice, apparently a case of laryngitis. The hotel was kind enough to equip us with some high quality microphones, so I was able to whisper in an amplified fashion during the morning session. However, I was scheduled to make a two hour presentation in the afternoon. Now you might think that I am about to report that I used EMDR on myself and my voice miraculously returned. Well, I cannot admit to this. However, a t lunch I had a large portion of Hunan Bean Curd (a very spicy Chinese dish) a t a small restaurant near the hotel and the miracle happened. My voice did return enough to complete my presentation. The point of this story is that the whole conference was blessed in this fashion. No matter what the problem, a solution was found and everything ran in an exceptionally smooth manner. The true miracle here was the unbelievable efforts put in by Robbie Dunton, A.J. Popky, and Eirin Gould, who made it all look easy. Thanks a lot guys. The highlight of the conference was the Keynote speech given by Ron Martinez a t the Saturday Banquet Luncheon. Ron is a paraplegic and a guiding light and source of inspiration to all of us who know him. His speech was autobiographical in nature and focused on his recovery from a teenage diving accident which resulted in his paralysis. There was hardly a dry eye in the room by its completion; I know I had a good cry (thanks to Francine for a shoulder to cry on). Our deepest appreciation and gratitude go to you, Ron, for your dignity and character, which puts all of our petty difficulties in perspective. I think we were all changed for the better. During this year, we are beginning to plan an expansion of the Network �to include regional organizations with quarterly Network meetings, much like those we have here in Northern California. As we get these regional organizations in place, we will be sending videotaped highlights from the Northern California quarterly Network meetings. The Special Interest Groups a n d Study Groups are putting an incredible amount of work and effort into developing protocols and procedures for a wide variety of DSM 111-Rdiagnostic categories, and it is important to have this information available to other EMDR practitioners. Lastly, I would like all of you to consider writing for this Newsletter. I speak with dozens of EMDR trained therapists every month and hear stories about such wide ranging topics a s emergency room applications of EMDR to formal research studies in the planning stages with PTSD Vietnam veterans with a dual diagnosis of alcohol or substance abuse.You all have something important to say, even if you don't know it. Please send us your articles about EMDR successes, mixed results, and failures. We aU are anxious to learn. Thank you for your participation in the EMDR Network. I think that we all have the belief that we are involved in t h e c u t t i n g e d g e of tomorrow's world of psychotherapy. . . . . . . .. . .............. .. : . VARIATION IN.,,, J ' .. , : .".'.'..MOVEMENTS. :. ' ' Ruth h w l a r Grainger, PhiD.. . . .-- . . . . . \ 1 ~,", . . .. . . .. . ."..i. . , ..................... ,.. . :. '... . ..". .- -, .. In working with a young woman with multiple personality disorder, diagonal eye movements brought about almost immediate abreactions. (In fact, the first time that EMDR was emerged.) EMDR has been used a t almost every session, each time with the client-preferred diagonal direction. Sometimes it induces abreactions, a n d sometimes only anxiety management. For the past two sessions, with the advice, consent, and watchful eyes of 12 already integrated alters who have arranged to be able to talk with the therapist a s desired, a change in the direction of eye movements has increased the speed and thoroughness of reprocessing. One individual, who is trained in kinesiology,describedhis use ofthe "infinity sign" and its apparent integrating effect on his clients. I utilized a variation of the "infinity signn with a multiple personality client. I began with small figure eight hand movements, progressing to larger sweeps (6 feet in length), and then decreased the size of the movements again. The client has reported that this type of eye movement has caused a feeling of greater peace and control in the multiple system, with a sense of speeded up reprocessing toward mental health. Several clients who have done abreactive work with EMDR now use circular or half-arc movements to relax the body andslow the mind in order to fall asleep. This therapist has noted that sleep comes almost immediately when engaging in circular or infinity movements. For example, after one session of EMDR, an 83 year old client with life-long insomnia reports awakening briefly only twice during the night a s opposed to a history of doing so every 30 to 60 minutes. Research needs to be conducted on the efficacy of the various directions and shapes of EMDR movements a s they relate to myriad symptomatology. , ..-%< I ( I . LZ r DIFFICULT CASES Andrew M. h d s , Ph. D. .. ' ' Petaluma, CA +, % - . -. Have you experienced atypical responses to EMDR, lack of progress, even outright therapeutic failures? You a r e invited to submit your challenging clinical problems to "Difficult Cases." "Difficult Cases" wiU be a regular column in future EMDR Network new letter^. Your proposed solutions a r e welcome, but are not necessary. Remember, you are not the only one encountering these problems. Please send submissions, which may be anonymous, to: Andrew M. Leeds, Ph.D. 621 Nikki Drive Petaluma, CA 94954- 1528 (707) 763-9973 [If possible, submit material on an IBM 5.25 floppy in ASCII or M S Word.] . *. A - , .. - a I 5- I " - . - . INTERNATIONAL UPDATE -. . ' '"~r&&Shapiro, Ph.D. , Mental Research Institute' Palo Alto, CA Planned presentations for 1992 include three proposals submitted to the International Society for Traumatic Stress Studies (ISTSS) annual conference. One panel would include four Directors of PTSD programs within the Veterans Administration Medical Centers: Neal Daniels, Ph.D., VAMC Philadelphia; Howard Lipke, Ph.D., VAMC North Chicago; Roy Richardson, Ed.D., VAMC Tomah, WI; a n d Steve Silver, Ph.D., VAMC Coastesville, PA. AU staffs are using EMDR a s the treatment of conducted with this client, two here- choice for chronic PTSD with excel- tofore unknown, cult-induced, alters lent results. Research is planned at �three of these facilities. Dr. Silver is also compiling statistics on the use of EMDR throughout the VA system. Joan Barron a t Dayton, Ohio, has also inaugerated an EMDR electronic mail group on the VA electronic bulletin board, open only to VA personnel who are trained in EMDR. Access information is available elsewhere in this issue. Regardless of what we thought of the Vietnam War, the nineteen-year-olds who were sent to fight it are still suffering today. The first Vet I ever treated taught me that he was suffering because of his nobility, empathy, andcompassion. Liberation from his pain was due largely to self-acceptance. I saw him again, over four years later, and he has maintained the EMDR treatment effects. Now we just need the research to bear it out in the scientific literature. Anotherpanelproposedat the ISTSS conference would include Byron McBride, Ph.D., of the L.A. Sheriffs Department psychology staffon critical incident treatment, Nancy Baker, Ph.D., also of the L.A. Sheriffs Department on treatment of sexual harassment stress reactions and the linkage to earlier sexual abuse history, and Scott Nelson, Ph.D., of the Mental Research Institute on the treatmentof partnersof sexualabuse victims. . . -.r rr r , . . - 1 -I <* '" .'* " ._ EMDR REFERENCES Boudewyns. P.A.. Stwertka, S.A.,Hyer, L.A.. Albrecht. J.W.. & Sperr. E.V. (August. 1991). Eye Movement Desensitization for ITSD of Combat: A Pilot Study. Paper presented a t the APA annual convention, San Francisco. CA. [Article submitted for publication]. Hedstrom, J. (1991). Anote on eye movements and relaxation. Journal of Behavior Theraov and k e r i m e n t a l Psvchiatrv, 22.37-38. Kleinknecht, R. (in press). Treatment of post-traumatic stress disorder with eye movement desensitization and reprocessing. h a 1 of Behavior Theraov and Ex~erimental Psvchiatrv. Lipke, H.J. & Botkin, A.L. (in press). Brief ,case studies of eye movement desensitization and reprocessing (EMDIR) with chronic post-traumatic stress disorder. Psvchotheraoy. Marquis. J.N. (1991). A report on seventy-eight cases treated by eye movement desensitization. Journal of Behavior Theraov and Ex~erimental Psvchiatry, 22, 187-192. Neilson, Tore (1991). Affect desensitization: A possible function of REMs in both waking and sleeping states. Sleeo Resear&, 20. Puk, (1991). Treating traumaticmemories: A case report on the eye movement desensitization G. procedure. Journal of Behavior Therapy and Experimental Psychiatry. 22. 149-151. Rothbaum, B.O. (1992). How does EMDR work? Behavior Therapist, 15,34. Shapiro. F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2. 199-223. Shapiro, F. (1989). Eye movement desensitization and reprocessing procedure: A new treatment for post-traumaticstress disorder. Journal of Behavior Theraov and Exoerimental Psvchiatrv, 20 211-217. Shapiro, F. (1991). Eye movement desensitization & reprocessing procedure: From EMD to EMDR--a new treatment model for anxiety and related traumata. Behavior Theranist, 12. 133135. Shapiro, F. (1991. September). Eye movement desensitization and reprocessing: A cautionary note. the Behavior Theraoist. 14. 188. Wolpe, J. & Abrams, J . (1991). Post-traumatic stress disorder overcome by eye movement desensitization: A case report. Journal of Behavior T h e r a ~ vand Experimental Psvchiatrv, 22, 39-43. Also planned are presentations a t the American Psychological Society (Presidential Symposium) and the International Society of Trauma Counselors. dently confirm efficacy. Thanks to those of you who did. Gerald Puk, Ph.D., gave a presentation entitled, "Using EMDR with Motor Vehicle Accident Trauma," a t the Eighth Annual Symposium of the American College of Forensic Psychology this April in San Francisco. The presentation wasvery well received and a number of EMDRtrained clinicians in the audience verified his positive reports. It does a great deal to allay scepticism when members of the audience indepen- Alan Goldstein, Ph.D., the Director of the Agoraphobia and Anxiety Treatment Center of the Department of Psychiatry, Temple University, has launched an EMDR study on the treatment of panic disorder. He will be presenting preliminary data a t the EMDR Symposium we are presentingat the Fourth World Congress of Behavior Therapy in Australia this July. Also presenting, besides myself, are CMLevin, Ph.D., on the treatment of partnersofabuse victims, and Robbie Dunton, M.A., on treatment of learning disabilities. Independently presenting a supportingpaper a t the conference on EMDR for the treatment of PTSD is Kevin Vaughan,Ph.D., of Hornsby KuRing-Gai Hospital of New South Wales. In another exciting event, Jonathan Winson,Ph.D.,Department of Neuroscience, Rockefeller University has completed his preliminary research on the brain mechanisms underlying EMDR's effect. An article has been submitted for publica- �tion and we willsendcopies along as soon a s possible. Dr. Winson recently sent me a copy of an article published in 1954 that he had unearthed, which reported the observation of rhythmical nystagmus in therapy patients and which posited a connection between this eye-movement phenomenon and thought processes. We have included that article, along with Dr. Winson'sUThe Meaning ofDreamsV from Scientific American, in the present packet. Clearly as past and present research dovetails in support ofEMDR, wecome closer to full acceptance. NIMH has just approved large-scale research of EMDR a t the Augusta, GA, VAMC. A copy of the pilot data presented to APA was included in the 1991EMDR article packet. The well-respected statusof the researchers and positive results of the pilot data were, I am sure, supplemented with the widespread reports of clinical success among the VA system in the field. Many thanks to all of you who have been vocal in your support. As you know, NIMH grant money is hard to come by these days. On the down-side, there have been a number of published attacks of EMDR. You all know of Cory Hammond, Ph.D., and his use of EMDR without training on two MPD clients. His attack on EMDR as a "California f a d appeared in the newsletter of the American Societvfor Clinical Hwnosis (ASCH). A copy of his attack, along with the reply from the EMDR Professional Issues Committee (EPIC), was sent to all 1991 EMDR Network members. EPIC'S reply was printed in the next issue of the ASCH Newsletter, but unfortunately, simultaneously, there appeared a n attack by Drs. Metter and Michelson, whoreported the same results as Hammond, stating that the effects of EMDR were linked to "emphatically" signally "No" to theclient through the lateral hand movement, e k . , and any successful effects were temporary and the results o f clever manipulations." They also stated that they had been trained by me. In actuality,I had trained them, but it was before I realized exactly what I neededto teach (i.e., guidelines for vulnerability, selection, pacing, rapport, ek.). I also tried to supervise their whole institute by myself, and they only had one experiential trial; therefore, I was unable toobserve many of the participants. I have written a response which should appear shortly in the same newsletter. We are sending it, together with theattack, in the present article packet. While the experience has been painful, it has underscored the need for training the way that it is now done, with extensive supervision. Another attack appeared in the last issue of the Behavior T h e r a ~ i s t . In the last EMDR Newsletter, I reported to you that I had been invited to give a three-hour workshop a t the annual conference of the Association for the Advancement of Behavior Therapy, in which I would be exploring the EMDR model. While most participants were, as usual, intrigued and laudatory, a few came with the idea that they would be trained. When I explained that it could not be done in that length of time, and that client safety factors were involved, they insisted, and one person even informed me that client safety factors were secondary to scientific advancement and should not concern me! While I recognize that there is a lot of pressure to do otherwise, I feel that each of us has a responsibility to uphold the standards of our profession. I fail to see how responsible therapists and researchers can disregard warnings and simultaneously obtain informed consent from their clients and subjects. When EPIC and the majority of clinicians trained in EMDR inform me that our training program is unnecessaq,I'lllisten, but otherwise. On that note. I like this to be the last time I mention the issue in the Newsletter. The attack a n d rebuttal are included in the present packet. Any others wlll be forwarded to you without comment, a s they are received. If you think we a r e doing anything incorrectly, I want to hear about it from you. Likewise, if you think we are doing it well, or have suggestions. However, ifyou see an attack in print you donot agree with, please feel free to respond on your own. Anything I write, a t this point, has limited impact. Once again on the up-side, the first EMDR Conference was a huge success. Over 160 people were in attendance and the overall evaluations were sensational. Clinicians were here from practically every state, Canada, and about a half dozen from Australia. I was particularly happy to see the high calibre of the presentations. Each clinician interfaced h i s h e r own area of expertise with EMDR and the directions, observations, innovations, and insights for each area covered were extraordinary. Also fruitful were the continued observations from clinicians in the audience. I t left me feeling that EMDR is indeed in good hands. I floated through t h e three days repeating,"We have the best people around us." Needless to say, it was personally very gratifying as the culmination of five years of work. We have included in this Newsletter the EMDR areas covered in the conference, the presenters, and access telephone numbers. For anyone interested in pursuing a particular topic, I suggest direct contact. We a r e planning the next EMDR Conference for March 5,6,7, 1993, at the Sunnyvale Hilton. 1 will again hand select the topics and presenters, so suggestions are welcome. During my final keynote address, 1 included a list given to me by Dave Wilson, Ph.D. He said that when he �NETWORK MEETINGS Sandra "SAM" Foster, Ph.D., California Network Coordinator (415)965-8988 1992 EMDR Network Schedule Saturday, June 27th Saturday, September 12th Saturday, November 14th 9:30am to 4:OOpm LESSONS FROM GEESE The Network meetings are held at the SunnyvaleHilton, 1250 Lakeside Drive, Sunnyvale, California (408) 738-4888. SCHEDULE 9:30- 10:OOam Registration & coffee 110:OO-11:30am Special Interest Groups (SIG) meet to share new information. 1 l:30-1:OOpm Lunch [We suggest a second SIG meeting during lunch.] 1 1 l:00-4:OOpm first read it, it reminded him of what. we were trying tocreate. I have been requested by many present a t the Conference to include it in the Newsletter, so here it is as well: General meeting. Presentations by SIGs and Francine. Our 1991 quarterly Network meetings have been a success as a forum for sharing new applications of EMDR, learning about the latest research results, andobserving talented colleagues demonstrate innovative twists with EMDR. EPIC (EMDR Professional Issues Committee) The EMDR Professional Issues Committee is pleased to announce that our response to the Cory Hammond article was published. Each of you should have received a copy of this response (as well as Cory Hammond's letter) in the packet of articles that were mailed earlier this year. EPIC has also decided to write a column for each Newsletter that will focus on professional issues, ethical concerns, or unique situations that you may have encountered in your practice. You may submit any of the above (anonymously if you choose) to Lois Allen-Byrd, Ph.D., 555 Middlefield Road, Palo Alto, California 9430 1. We continue to meet the second Wednesday of the month and have been considering a number of issues in and out of the committee. Some of the situations that have been brought to our attention include the following: suitable minimum background and training required to participate in the workshops, appropriate supervision and the context within which EMDR will be used, informed consent, protocol for EMDR presentations, possibility of training and personnel committees, review of ethical complaints that have been dealt with informally, issues of client safety, and when it is appropriate to use EMDR. If you have any professional issues, conce;ns, or questions, please contact one of the following committee members: Lois Allen-Byrd, Ph.D. (4 15) 326-6465 Joan Fish, MS (4 15) 327-2051 Ferol Larsen, Ph.D. Jennifer Lendl, Ph.D. Virginia Lewis, Ph.D. Marguerite McCorkle, Ph.D. (415) 326-6896 (408) 244-7942 (415) 326-8752 (415) 3224884 Roger Solomon, Ph.D. (206) 943-8987 1.As each bird flaps its wings, it creates an "uplift" for the birdfollowing. By flying in a "V' formation, the whole flock adds 7 1% greater flying range than if the bird flew alone. LESSON P e o ~ l e ho share a common di- w rection and sense of community can get where they are going quicker and easier because they are traveling on the thrust of one another. 2.Whenever a goose falls out of formation, it suddenly feels the drag and resistance of trying to fly alone and quickly gets back into formation to t a k e a d v a n t a g e of the "Lifting power" of the bird immediately in front. F.S.- When I first read this I thought,"What about individuality, inspiration, taking the initiative, etc." Absolutely, and. . .] LESSON If we have as much sense as a goose, we will stay in formation with those whoare headed where we want to go (and be willing to accept their help as well as give ours to the others). 3.When the lead goose gets tired, it rotates back into the formation and another goose flies a t the point position. LESSON It pays to take turns doing the hard tasks, and sharing leadership - with people, as with geese, we are interdependent on each other. F.S.-The conference was about expanded leadership in proven areas of expertise.] 4.The geese in formation honk from behind to encourage those up front �to keep up their speed. LESSON We need to make sure our honking from behind is encouraging- and not something else. F.S.-Please!!-All suggestions and observations are welcome, but please contact me directly regarding negative judgments or attacks. While misinformation and rumors run rampant, they sewe no useful purpose] 5. When a goose gets sick or wounded or shot down, two geese drop out of formation and follow it down to help and protect it. They stay with it until it is able to fly again or dies. Then they launch out on their own, with another formation, or catch up with the flock. LESSON Itwe have as much sense as geese we too will stand by each other in difficult times as well as when we are strong. And so, as always, we are in a mixture of good times and difficult times. However,the Conference showedme, once again, what good company we are keeping. WORKING WITH PERPETRATOR- IDENTIFTED EARLY CHILDHOOD ABUSE S U R W O R W r y Wildwind,LCSW Albany, CA In using EMDR with early childhood abuse suwivors, I often find more resistance and denial than with clients who experienced later abuse. Also, the weakened egoof the patient allows for slower progress through intensely affect-laden work. The technique I have been using seems to help with this kind of patient. I assume that the resistance includes introjects of the perpetrator, as well as the denial and covering mechanisms usually seen. I also assume that fear of abandonment, as actually experienced during sexual abuse, emerges along with the memories, since the memory retrieval negates the internalized image of the perpetrator as a source of positive identification and supplies. This "image destruction" can only take place gradually, using cognitive bridging to avoid overwhelming identity diffusion and anxiety. Therefore, when the resistance emerges during sets focused on the sexual abuse, and the resistance takes the form of remembering the positive things the perpetrator did for the patient, or the fear of giving up the positive image of the perpetrator, I ask the patient to focus on the positive things exclusively, to see all of them together. In the next set, I ask herhim to make a strong, beautiful container, a box, jar, something safe and pretty, and to see all the positive, loving aspects of the perpetrator placed inside that container. I remind the patient that only those things that the person did that hurt the patient are left outside the container. I can then ask herhim to refocus on those hurtful things that happened and, if angry feelings come up, they are only a t the "bad part" of the person whois soloved andneeded chological differentiation from the mother. In cases such as these, I help the patient notice how s h e h e is different from the perpetrator. A patient with MPD recently repeated during several sets, "She's big, I'm little. She's a woman, I'm a boy." Later he said, "I'm not her!" with great excitement. He then could remember more fully what had occurred and feel more free to feel his anger about it. This has also helped with feelings of shame and guilt that seemed very global. In general, the issue of identity change seems central to helping people whose earliest identities are merged with those of the people who hurt them most. Often, in workingin the area of resistance, feelings of confusion, fear of the work, fear of not recognizing one's self, and fear of ending up permanently damaged by the knowledge gained are all expressions of identity loss anxiety. Helping our patients to contain this anxiety until it is naturally resolved can make a great difference in whether the patient can tolerate complete treatment. * . Later, when the person has worked through most of the horror, rage, and sadness, often a sense of inner emptiness emerges. That is when I ask herhim to recall the container, and, this time, to sort through it to see what qualities of the perpetrator now feel positive. After one set, I ask the person to choose those qualities shehe wishes to be like. Often, there are a few that the person can still feel good about. There is often a need to do both cognitive work and EMDR regarding the sense of emptiness and the anxiety that emerges with a shift in identity. With very early childhood molest, abuse, or abandonment, I have found another kind of resistance. Perhaps the patient h a s identified very strongly with the perpetrator, or the molest began before there was psy- .- ' CASE STUDY Liz Mendom-Weitman,LCSW . . San Jose, CA -,v # A ten year-old Hispanic boy was referred by his mother for outpatient psychotherapy. The mother described her son as having been depressed since the father abandoned the family over five years ago. The depression was now worsening, although the mother could not identify any new stressors. The boy was described as having little or no interest in pleasurable activities, doing poorly academically, experiencing significant weight loss, panicking each morning about leaving home for school, complaining of stomachaches every morning, and having sad affect. Additionally, the mother was distressed that the boy had an intense phobia of eating in public and �I. I 1992 ANNUAL EMDR CONFERENCE , - . i: s t , Topics and Presentem CHRONIC DEPRESSION Landry Wildwind, MSW Albany, CA CREATIVE USE OF METAPHOR Carol Erickson, MFCC, BCD Berkeley, CA CRITICAL INCIDENT TRAUMA Roger Solomon, Ph.D. Olympia, WA COMBAT-RELATED PTSD N. Chicago, IL Howard Lipke, Ph.D. DISSOCIATIVE DISORDERS David Fenstermaker, Ph.D. San Jose, CA EATING DISORDERS Los Gatos, CA Jean Bitter, Ph. D. EMDR TARGETS IN SEX THERAPY Leonard Loudis, Ed.D. Denver, CO LEARNING ISSUES AND CHILDREN Pacific Grove, CA Robbie Dunton, MA PEAK PERFORMANCE "Sam" Foster, Ph.D. Mt. View, CA Jennifer Lendl, Ph.D. San Jose, CA PARTNERS OF SEXUAL ABUSE SURVIVORS Clifford Levin, Ph.D. Palo Alto, CA Scott Nelson, Ph.D. Mill Valley, CA PRINCIPLES OF GUIDED IMAGERY Emmett Miller, Ph.D. Menlo Park, CA SMUAL ABUSE Rita Belton, MA San Rafael, CA San Jose, CA Eirin Gould, MA San Rafael, CA Brooke Passano, MA SUBSTANCE ABUSE Norva Accornero, MA Los Gatos, CA Robert Kitchen, MA Hayward, CA Andrew Leeds, Ph.D. Santa Rosa, CA Palo Alto, CA Virginia Lewis, Ph.D. THEORETICAL CONVERGENCES Andrew Sweet, Ph.D. Aurora, CA TURNING LOSSES INTO WINS Ron Martinez, Ph.D. Burlingame, CA IMPORTANT NOTICE! V.A. NETWORK: An EMDR mail group exists on the V.A electronic bulletin board. It is necessary to have access to FORUM to get to the mail group--this is obtained a t your local station. This is open only to V.A individuals who have completed EMDR training.For enrollment,send a copy of training certificate with access name and address to: JOAN BARRON, MN, RN, CS (118) V.A. Medical Center 4100 West Third Street Dayton, Ohio 45428 (513) 268-651 1, ext.2678 I 1 FTS Phone-950-2678 1 refused to do so. He complained of mother was now threatening toplace "picturingvomit" each time he tried him out of the home due to the severe to eat. The boy's stated goal of treatrestrictions and burdens placed on ment was "to stop thinking about her for the past five years. The boy throwing up." He alsoaskedforhelp was seen in individual therapy and " tonotfeelsick every morning, even the mother was seen in collateral though I'm not really sick." His sessions.EMDR was implemented in ' 12 the standardized procedure. The initial treatment focus was the client's distressing memory of an incident at age five when his brother had vomited on him in a restaurant. He reported that it was this image that intruded on him each time he ate food. The boy identifiedfeeling "very scared" (SUDS 9-10) when imaging this memory. He also held onto his stomach where he felt the anxiety, focused on the picture, and the cognition "I'm scared." By the end of the procedure, he reported no longer feeling fear when recalling this memory. At the start of the second and final EMDR session, the boy reported that he was now concerned with a more recent memory of vomiting he had witnessed in a public restroom. (This had not been reported in the first session). The EMDR procedure was implemented again. By the end of the session, the boy reported feeling "fine" and no longer scared by this memory. The positive cognition, "It's over. I can feel good now when I eat," was installed. In the subsequent psychotherapy visits, the boy's mother reported the following changes: the boy's affect was brighter, he was spontaneously showing an interest in others, and reporting to his mother that he was now eating a t school and at daycare. The boy was also no longer crying in a panic upon awakening or complaining about stomachaches in the morning. The mother also reported that she was no longer considering out of home placement for her son. The boy, in interviews separate from the mother, giggled appropriately, smiled spontaneously, showed a bright affect, boasted of eating in public, denied fear of eating in restaurants, and described himself as "feeling happy." Adhtionally, his mother shared that the daycare director no longer found the boy to be irritable or fearful, and that he was showing an interest and enthusiasm in helping her set the table to eat and in other activities in the home. Her reported observation to the mother was "he is Wte a M e r e n t child." �1992 TRAINING SCHEDULE LEVEL I BASIC TRAININGS Sponmorm Apr. 11/12 Philadelphia, PA Radisson Hotel Philadelphia Auport Alan Goldstein, Ph.D. (408) 372-3900 Agoraphobia & Anxiety Treatment Center Temple University Medical School May 30131 Honolulu, HI Hilton Hawaiian Village Sandra Paulsen, Ph.D. Pacific Institute of Behavioral Medicine June 616 San Jose, CA Sunnyvale Hilton Francine Shapiro, Ph.D. Sep. 12/13 Chicago, IL Holiday Inn Crowne Plaza Northbrook, IL Howard Lipke, Ph.D. (708) 688- 1900x4675 Director, Stress Disorder Treatment Unit N. Chicago Veterans Admin. Medical Center Sep. 19/20 New York, NY h e w s New York Hotel William Zangwill, Ph.D. Gerald Puk, Ph.D. Sep. 25/26 San Francisco, CA Radisson Inn S F Airport Francine Shapiro, Ph.D. Oct. 314 Seattle, WA Radisson Seattle Auport Roger Solomon, Ph.D. Washington State Patrol Oct. 9/10 Los Angeles, CA Auport Marina Hotel Ron Doctor, Ph.D. Cal State Univ., Northridge Oct. 11/12 Denver, CO Holiday Inn Denver S E Andy Sweet, Ph.D. Oct. 16/17 Miami, FL Miami Purport Marriott Ruth Knowles Grainger, Ph.D. Nov. 617 San Jose, CA Sunnyvale Hilton Francine Shapiro, Ph.D. -ah -?;?LEVELTRAININGS May 15/16 San Jose, CA Sunnyvale Hilton June 19/20 Santa Ana, CA Crowne Sterling Suites July 24/26 San Jose;CA Sunnyvale Hilton Philadelphia, PA Temple University Medical School Dec. 11/12 San Jose, CA Sunnyvale, Hilton I (808) 523-2990 (305) 595-3399 History-taking and specified questioning for focused identification of problem areas Closing down "incomplete" sessions Axis 11 applications Integration of EMDR with cognitive therapy ~issociative other major disorders & Abreactive responses and alternative strategies Working with difficult/resistant clients Integrating "self-control" techniques Treatment of Process Phobias �r Ron Mmtinez, Ph.D. ;&-editor This section will appear in each Newsletter and will present innovative uses/variations of the EMDR procedure that have been discovered by clinicians trained in the method. I would very much appreciate it if any ofyou who have foundnew vwiations on how lo use EMDR, would write these up and send them to me at the address below, so that I can include them in future Newsletters. Though your write-ups can be informal, I would appreciate inclusion of thespecificsteps of the technique, the number of people on which it has been successful, any specific outcomes that you have consistently noticed, and any further comments. Please include your name, address, and phone number, so that I can reach you with any questions. Thank you. Jessie Rappaport, R.C.S.W. ofEugene, Oregon, sent in this observation: He states, "for clients with persistent negative cognitions such as, 'I don't deserve to be loved', where EMDR saccades,cognitive interweave, and allother variation sfail to effectively shift the cognition, he tells the client, 'I would like you to notice, if you would, how you fee1 when I take over the voicing of that belief and say it to you ...." [An example of this would be 'you don't deserve to be loved'.] He does this with eye movements inducedandoften a t this point reports that the client will dramatically shift the polarity when the beliefhas been externalized by hisvoice. The response is often from the positive polarity, such as, 'I have every right to 'be loved' o r 'the heck with you, I'm tired of hearing that', etc. Hestates that with particularlyfragile clients, this intervention must be carefully framed, such as, 'I am taking over the negative voice that is in you1." Please feel free to try this and send in your responses a s to the results you observe. I'd like to share the results of a case in which I combined EMDR and hypnosis in working with a Vietnam vet. The effect was very powerful, and seemed to be impacting the client on a n archetypal level. This 44 year old Vietnam veteran, whom I shall call Tom, was referred to me by the psychiatrist who was his on-going therapist. Both therapist a n d client had heard of EMDR and were hopeful it mlghthelp with Tom's sleep disturbance, flashbacks during which he often became enraged and assaultive, and periods of severe depression. He served in the infantry in Vietnam when h e was 19years old, and engaged in extensive combat a s a helicopter "doorman." Tom had a n uncle, a few years older and "Like a brother," who was also in combat in Vietnam. The uncle was killed in the war, unbeknownst to Tom until several months after the fact. Tom described himselfas changing "from mean to just plain evil" when he learnedofhis uncle's death. At this point, he recognized a deep shift in himself, which I conceptualize a s archetypal in nature. Upon his return from the war, he used drugs, attempted suicide, was hospitalized for depression, and spent time in jail for smuggling, theft, a n d assault. In more recent years, h e has married, had children, and worked a t jobs that typically last 2 to 3 years. He has assaulted his wife, and has assaulted other men when, during a flashback, h e has mistaken them for guerrillas. He described often feeling "swallowed in blackness" (another archetypal reference) and despair. He reported being unable to experience feelings of fear or grief, and wanted help to "humanize" himself. Because of the nature of the fundmg source for this case, we had a maxi- mum of 10 sessions available for our work together. After two sessions of using EMDR in the conventional way, I began to feel that we would not reach our goals in the time available. Tom would lapse into lengthy stories with each memory that surfaced, a n d it was difficult to keep him focused on the EMDR process. At one point h e mentioned that the only time he'd been able to cry about his uncle's death was in a session with a therapist several years ago when he had his eyes closed. Since grieving his uncle's death was something he'd been unable to do and seemed a key issue for him, we decided to try combining hypnosis with EMDR. We met for 90 minutes in each of the next seven sessions. The procedure was a s follows-I induced a hypnotic trance by taking Tom to a "special place" where h e would be able to safely watch a movie of his life. He watched from a "safe distance" and was in "completecontrol" of what he saw. I suggested that his arms and legs would be very heavy, and he easily achieved deep states of trance. I suggested t h a t he r u n the movie back to something about the war t h a t we needed to work on. He verbally reported what he was experiencing, a n d when h e saw something which was emotionally charged, I instructed him to stay with it and move his eyes back a n d forth while I tapped the backs of each hand. I then asked him to report what had occurred, either following that image or installing cognitions a s in a typical EMDR session. In the first session of this combined approach, h e came face to face with the "cold eyes" of his 19 year old self. He began grieving his uncle's death and the losses h e had suffered from the war. Over the next several sessions, t e a r s s t r e a m e d down h i s face throughout much of the process. Imagining his uncle's death, Tom saw his uncle stop him a s a 19 year old from running around with a gun, and convinced him to "come home" �to a family reunion he envisioned. Between sessions, Tom began experiencing longer and longer periods of feeling sad before the familiar rage would return. In one session he experienced intense pain in his body as he grieved his losses - "I was used. I was supposedtoheb1wasn't supposed to be this way." In that session, Tom's 19 year old self told him, "We need to settle this once and for all." It was apparent in the next session that what needed to be settled was "the war, and whether to Live." I asked Tom what choices he saw, and he responded, " Staying in the war, being depressed in my room (a severe depression he experienced upon his return from the war, in which he literally stayed in his room for three months), or killing myself." When I asked him to generate another possibility, he saw his grandmother rocking him, removing his uniform and bathing him. The words he used to describe this were "Grandmother's love can heal my grief and pain." I asked him to give his Vietnam experience a shape, color, sound, smell and feeling, and flush it out of his body. He saw guns flushingout from his feet, with his grandmother pouring water over his head. (This archetypal symbol of baptismlrebirth seemed especially important given Tom's background as a Catholic and altar boy.) In our next session, I instructed Tom to "settle things once and for all" with his 19year old self. I asked him toconcretize his Vietnam experience and flush it out. He saw a dragon emerge from his stomach, enveloping himself and everything else in darkness. (The dragon has been a widely-held symbol of the Vietnam war.) I asked him to find a way to disconnect from it, and he saw his father carrying him away, tending the wound to his belly where he bled from disconnecting the dragon. I suggested he see the dragon in the distance and dematerialize it. He saw it blow up, and knew his 19 year old il self was gone also. I suggested he £l the space that had been emptied, and he saw his mother holding him as he became a baby filled with Light and a feeling of calm.1 instructed him to bring that experience into the present and he saw himself with his wife and the words, "I am more at peace now." As the session ended, I taught him a simple grounding technique to practice as homework to help him stabilize this experience andcounteract the Light-headedness he reported. Tom felt "in a fog" for the next several days, reacting with rage only once when he was rear-ended while driving his car. We spent a session compacting and flushing out the remainderof the war, with him experiencingit rushingpast so quickly that he saw himselfreach out to catch the positives he wished to keep. I taught him to imagine a "personal space bubble" around him, installing that experience with EMDR while he was in trance. As he saw himself inside the bubble, he envisioned his drunk grandfather unable to enter it, but others able to enter a t his invitation. As I brought him forward into the present while still inside his bubble, he saw the old familiar blackness reappear. This time, instead of being engulfed in it, he saw himself moving safely through it. (I saw this as progress in his ability to disidentify from that experience.) The question "Who am I?" emerged for him, and the answer t h a t returned was "Peace." In our final session, Tom reported feeling many internal shifts during the previous week. He frequently saw himself inside his bubble. He noticed a marked decrease in his reacting to situations with hostility, especially while driving. We focused again on the question, "Who am I," andhesaw hisson tellinghim "You're my father." (This marked a shift in archetypal identification from the "young warrior" to the "nurturing older man.") We ended with install- ing, once more, the phrase, "I am more at peace now," with an image emerging ofhim and his family (those Living and dead) together. In a three-month follow-up contact, Tom reported that he continued to feel that our work togetherUchanged something" on a deep level. He was sleeping more restfully at night, dreaming, and reported having his &st "dream" about Vietnam that wasn't a nightmare. He experienced "recollections"about Vietnam, rather than intrusive flashbacks. He had no recurrence of the "blackness"and felt that "bubble" was "still there." In some situations, where he used to be enraged, he said he felt "hurt." He reported being able to experience sadness again. He had begun tomeditate (which he had triedseveral years before, but stopped when memories began overwhelming him), and felt the practice was extremely helpful to him. He recently held a "ritual burial" ofhis uncle, and felt a t peace with his loss. I believe the combination of EMDR and hypnosis in my work with Tom enabled us to accomplish, in a short period, more than we could have achieved with either technique alone. It seemed important for Tom to have his eyes closed in order to move beyond the interference ofhis conscious mind, allowinghim to work on deeper levels. It appeared that we neededto tap his grief in order to defuse his rage. And, in Tom's words, "humanize" him again. As we worked on an archetypal level, I surmised that we needed to restore the ego boundaries ofhis Self, which were probably weak at best as the 19year old who went to war. I hoped that this would allow Tom to disidentify from the "blackness" and the archetype of war with which he hadidentifiedsocompletely, and to begin to develop a new identi ty. �1 CALIFORNIA EMDR STUDY GROUPS @istedGeographically North to South] REDDING Dave Wilson (916) 223-2777 Meets once monthly a t the Frisbee Mansion on East Street in Redding. Discussions, case presentations, videos, role playing,and "troubleshooting." Open to new members. LOS ALTOSlPALO ALTO John Marquis (4 15) 965-2422 (4 15) 852-2855 Dewey Lipe Meets a d hot a t Pacific Graduate School of P s ~ c h o l o g ~ in Palo Alto. Primarily Case discussion. Open to nen members. SONOMA COUNTY Kay Caldwell (707) 525-0911 Meets in Santa Rosa a t Kay's office the fourth Tuesday 12:30 to 2:00pm. Primarily case discussion with some videos and "troubleshooting" of the EMDR procedure. Open to new members. LOS GATOS/SARATOGA/CAMPBELUW. SAN JOSE (408) 354-4048 Jean Bitter Liz Mendoza Meets the thirdThursday of each month, noon to 1:3@m a t Good Samaritan Hospital, Room TC2, in San Jose. Open to new members. Agenda to be determined. MARIN COUNTY SANTA CRUZ Laurel Parnell (4 15) 454-2084 Linda Neider (408) 475-3480 Contact if interested in monthly Friday afternoon meet- Generally meets once Per month on a Friday a t 7:00pm. Primarily case discussion. Open to new members. ings. EAST BAY Edith Ankersmit (510) 526-5297 Meets third Friday a t 7:30pm. Case discussion only. Group is closed to new members, but Edith will coordi- nate any new East Bay group. WOODLAND H I L L S I N O R T H R I D G ~ S T W O O D Ron Doctor (8 18) 992-507 1 Is willing to coordinate a new group. CENTURY CITYISANTA MONICA Robert Goldblatt (2 13) 286-9490 SAN FRANCISCO Is willing to coordinate a new group in the 90067 zip code Sylvia Mills (4 15) 22 1-3030 Case discussion a n d group process. Open to new mem- area for West L.A. people. bers. WEST LOS ANGELES (Zip Code areas: 90230, 90232, 90265, 90292, 90401, 90406, 90291) SAN MATEOIBURLINGAME Renee Cote (3 10) 988-2166 Ron Martinez (4 15) 692-4658 Meets second Monday from 7:00 to 8.30 pm. The group is Is willing to coordinate a new group in one of the above zip open and conducted a s a forum for people to further the code areas. understanding a n d use of EMDR. Case consultation and DOWNEY practice sessions are available. Pauline Hume (2 13) 869-0055 10642 Downey Ave, Downey PAL0 ALTO Is willing to coordinate a new group. Ferol Larsen (4 15) 326-6896 Meets the first Wednesday a t 10:OOam in the conference room of Mental Research Institute (MRI), 555 Middlefield SAN DIEGO Road, Palo Alto. Case discussion. Limited to 10 particiMarcee Sherrill (619) 233-0460 pants. Times to be arranged. ORANGE COUNTY Jocelyne Shiromoto (7 14) 680-0663 Meets one Tuesday a month from 9:OOam to 11:00am 16 �EMDR Newsletter Staff Editor: Contributing Editors: David Fenstermaker, Ph Ron Martinez, Ph.D. Andrew Leeds, Ph.D. Lois Allen-Byrd, Ph.D. Robbie Dunton, MA A J. Popky, CHT Assistant Editors: Publisher: Coordinators CUT Levin, Ph.D. National Network Coordinator: Facilitator Coordinator: Robbie Dunton, MA "Sam" Foster,Ph.D. California Network Coordinator: Submission ~nfoknation ,. , Submission ofgeneral articles can be sent to David Fenstermaker, Ph.D., 4985 Mitty Ave, San Jose, CA 95129-1849.Articles specific to new and innovative uses can be sent to Ron Martinez, Ph.D., 1515 Tmusdale Drive, Suite 215, Burlingame, CA 94010. [Ifpossible, articles need to be submitted on an IBM formatted diskette.] The deadline for the next Newsletter will be August 1, 1992. PLEASE PRINT EMDR 1992 NETWORK REGISTRATION Name: Address: City: SpecialInterest Group: $40 State: Zip : $60 Phone (Bus): Phone (Res): Cost for participating in the Network is $60 for 1992. Membership entitles you to attend the National Network meetings and to receive copies of the EMDR Yewslems andjournal articles published in 1992. [If you are interested in only the Yewslettets and articles, the cost is $40.1 Make check payable to: EMDR Network, 555 Middlefield Rd., Palo Alto, CA 94301, (415) 328-582- TRAINING REGISTRATION FORM PLEASE PRINT Name: Phone (Bus): Address: Phone (Res): City: State: Zip: P r o f . Lic. #: COST: $285.00. Make check payable to: EMDR, P.O. Box 51010., Pacific Grwe, CA 93950-6010, (408) 372-3900 - LEVEL I: Sept. 12-13, Chicago,IL Oct. 9-10, L.A, CA Sept. 19-20, NY Sept. 25-26, S.F., CA Oct. 3-4, Seattle, WA Oct. 16-17,Miami, FL Nov. 6-7, San Jose,CA LEVEL 11: June 19-20,Santa Ana, CA Dec. 11-12, San Jose, CA July 24-25, San Jose, CA If LEVEL11:Your data ofLevel I B a s i c T r a i n i n g : S p e c i a l t y : Additional requests for topics in training: For Level I1 Training please circle one ProficientNery Comfortable [ A B C D E Oct. 30-31, Phil., PA ] ~ncertain/~ncomfortab �TABLE OF CONTENTS WORTHLESS TO WORKING, Edith Ankersmit, LCSW BOOK REVIEWS, Andrew Leeds, Ph.D. Memorv i n Mind and Brain: What Dream Imarrerv Reveals uth Knowles Grainger, Ph.D. Network Schedule LY CHILDHOOD ABUSE SURVIVOR, Landry Wildwind, LCSW ANNUAL EMDR CONFERENCE TRAINING SCHEDULE MDR: Innovative Uses Ron Martinez Ph.D. ALIFORNIA EMDR ST'UDY GROUPS ubmission Information I Please note: The new mailing address and telephone number for EMDR seminar information is: P.O. Box 51010, Pacific Grove, CA 93950-6010 (408) 372-3900. EMDR 555 Middlefield Rd. Palo Alto, CA 94301 El EMDR Network Newsletter POSTAGE � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter Newsletter Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter, 2(1), 1-18 https://d1y502jg6fpugt.cloudfront.net/13023/archive/files/8261f1fc998205329146899a46c63588.pdf?Expires=1790208000&Signature=wMrCiI8oV4yQpi-3xfmdpwZYwq-rC%7EreTZb9c5rc1Urit5WNg%7E95dysat4VQjo7wyKYSWo2erztjLBQzj0f3YbEwvFNLXid1eDgGIq7q2qBLuh0qJif5zBW4A0dr4XVtXLoGYI5LrMqtchCDhDtVyVYmRGOzcuayucTWnWivdcen5VlJSvqa296PCiTxE1pDl8bmzRBxcGk3ftF4PHsxrPrkR%7EcLtmWcL51LuEAANhbKdyo-OGuZ46F3WQnzF-D16Jc39LxBr2a1cfUFirAhTSUv9FXSvF6NXZ80HLcOF0X1ywxMqkFYdRgx3P%7Ep8-rmyGqXvu1hKXvVYoohrKB1dQ__&Key-Pair-Id=K6UGZS9ZTDSZM 304781ac9dae2129a12c3ec9fd77d565 PDF Text Text EMDR Network Newsletter Dec. 1 9 9 2 December 1992 Vol. 2 1 Issue 2 Network Newsletter EYE MOVEMENT DESENSITIZATION AND REPROCESSING Copyright Q 1992 EMDR Network Frozen Childhood Clinical observations of EMDR treatment sessions indicate that therapeutic results are often achieved through the progressive emergence of an adult perspective, particularly when the client was previously locked into the emotional responses of a childhoodbased trauma. Clearly, most childhood experiences are infused with a sense of powerlessness, lack of choice, lack of control, and inadequacy. Even the best of childhoods have moments when the parents attempt to leave for the evening and the child feels abandoned, powerless, and uncared for. Indeed, an entire generation of children was raised by a book that dictated feeding hours and parents were encouraged to avoid reinforcing the child's crying for food a t other times. Consequently, thousands of children were left crying in the dark for food. Regardless of the fact that language was not yet encoded, arguably, this situation set up certain emotional nodes regarding "Self," "Suffering," and "Others." The EMDR model posits that the wide variety of childhood experiences are neurological touchstones for many dysfunctions. The language of the client often reveals these expressions of the child- P.O. Box 51010, Pacific Grove, CA 93950-6010 (408) 372-3900 hood state: powerlessness, lack of choice, fear, inadequacy, etc. The fifty year-old client who speaks longdistance to her mother and starts reacting with fear, frustration and anxiety, is not reacting to a 75 yearold invalid on the telephone in present time. Rather, the emotions of childhood are stimulated by the sparking of the neural network associated with mother. Earlier touchstone memories that include intense feelings of fear and lack of safety are being triggered. Essentially the client cannot emerge into a state of calm in reaction to the mother until the earlier memories are metabolized and take their place in the past. By catalyzing the information processing system through EMDR, it appears a s though the guilt and fear of the child perspective are able to be progressively transmuted to the adult perspective of appropriate responsibility, safety, and the ability to make choices. What was perfectly true because of physical, "real-world parameters in childhood, or during a rape or combat tour (e.g., lack of control), is no longer valid as an adult in the present moment. The parallel of childhood experience to the experience of the trauma victim deserves to be underscored. In both there are the feelings of self-blame and inadequacy, plus feelings of lack of control, safety, or choices. Adequate information reprocessing allows the material to progress to client recognition of appropriate present parameters on an emotional, a s well a s a cognitive level. Allowing clients to evolve progressively to a state of self-forgiveness, safety, and a sense of control in present time appears to be the hallmark of a vast number of EMDR sessions. BIO-ELECTRICAL VALENCE Since it appears that the adult perspective is able to emerge progressively, it may be useful to metaphorically envision the progressive linkage of neural networks through a shift in synaptic or receptor valence. While we are again exploring a hmothetical model, the idea that information is a t least partially organized through affect is not new. The diagram below 1 indicates the extrapolation that neural networks are organized in part by 1 affect which is linked to a particular , valence. In this diagram, the target memory would be observed clinically, a s containing the affect of intense self-blame and the associated cognition of "I'm detestable �# EMDR Network N e w s l e t t e r Dec. 1992 and worthless." The information stored regarding this memory is encapsulated in a neural network with a high valence. While " Z valence could be hypothesized a s containing information with the most self-destructive affect and self-assessment, "A" valence would be the most adaptive and appropriate assessment (e.g., "I am a lovable, worthy, life-enhancing being.") " Z through "A" would constitute the valences of the receDtors of the variety of information plateaus and levels of adaptive information stored separately in respective neural networks. Consequently, the high valence target network is unable to link into more adaptive information stored in other networks with a lower valence (e.g., various levels of counter-examples, compliments, self-help book information, etc.). Possibly, when 'the processing Bye. tern is catalyzed by EMDR, the va. lenceof the receptors is shifted downward, so they are progressively able to link to the other networks and incorporate the more adaptive inforvalenc+"I'm not mation (e.g., "T' always to blame." "K" v a l e n c c V I did well that time"). This is evident by the progressive discharge of the negative affect, and the evolving of the more adaptive cognitions and positive memories which emerge. The clinical implications of the affectlvalence hypothesis can be ob. served in a variety of areas. For instance, molestation victimsoften report h o d c nightmares in which they are being dismembered by mansters. ~f we suppose that it is the earlier molestation memories that are attempting to be in REM sleep, thenbeingUdismembered by monstersNis the cognitive paral. lel to the high level of affect locked in the earlier memories. In otherwords, a child would experience great terror a t an adult entering the room and pulling her legs open; however, a s a n adult, that level of terror would not be generated by another adult, but rather by a n uncontrollable man- ster. The symbolism is the "cognitive rationalization" of the affect state during the period of processing. Consequently, when EMDR is used to target the dream image, a high level of t e m r is induced C Z valence). As a sufficient amount of the information has been processed, the affect shifts downward. The lowered valence allows the appropriate cognitive connectionsto be made t h r o u ~ h the linkage of alternative neural networks. With this shift in affect, the symbolic representation (i.e., cognitive distortion) can be removed, and the client perceives the real-life players. For instance, the abuse victim who reported being chased by a monster through a cave, after a number of SEM (sets of eye movements) exclaimed, "That's my stepfather (who molested me) chasing me through my childhood home." Other symbolic representations are often found to be the cognitive rationalization of the affect state and physical sensations (e.g., earlier memories of satanic abuse may often resolve to recognition of abuse by an uncle). The interpretations may be due to the activation of the congruent cognitive network of parallel valence. -- ~-~ Ultimately, the goal of EMDR is to t a r g e t t h e dysfunction, whether through the initial memories, dream symbolism, or present reactions in order to reprocess the material to an adaptive resolution. At that point, the affect and cognitions are appropriate to a n empowered adult perspective in present time. --0-- Another possible extrapolation ofthe affectlvalence hypothesis is the escalation of self-abuse behavior observed in many clients (e.g., increased severe cutting, engaging in riskier sex encounters). I t is possible that the affect of the core memories, with the conjoint valence, connects with certain behaviors that are consistent with that client's subjective level of pain. As the behaviors become desensitized through repeated exPosures, the valence of the core memories stimulates other behaviors that had been higher on the disturbance hierarchy (i-e., Just a s SUDS levels drop throughout the hierarchy during reciprocal inhibition), but are now merely parallel to that level of affect. Therefore, what appears t 0 be a level of escalation h m a n external observer is behavior generated internally h m the same level of affect. From the agesof 6 to 13, Melody, who was a gymnast, practiced 6 to 8 hours per day and was thin, lean, and wiry. She cut back on her athletics to focus on schoolwork, but by her senior year in high school had begun a dietary regimen to try to regain her 13 year-old body. This was a goal that seemed healthy in her mind, had been promoted a s healthy by her exercise-addictedfamily, andwas the image she saw paid homage to in the media. Having little more than a couple of glasses of orange juice per day on many days, her weight went down to her goal of 100 and beyond to the dangerous 80 to 90 pound range. Her menstrual periods stopped and she felt nervous and frightened all of the time. After several years she decided, with the help of a nutritional therapist, that "it was not worth it" and aftera couple of months on a health diet, had reached a more reasonable weight of 120 pounds. She felt good, but when she mounted her scale and saw the number 120, she was overcome with panic. Images of herself blowing up into a butterball (as she had become subsequent to a rather sedentary, several month study trip to South America a number of years ago) flooded her mind. a '. �EMDR Network N e w s l e t t e r Dec. 1992 Arizona California Colorado Georgia Hawaii Idaho Illinois Maryland Massachusetts Missouri New York New Mexico Ohio Oregon Pennsylvania Texas Washington Pat Penn, Ph.D. Jean Bitter-Moore, Ph.D. Andy Sweet, Psy.D. Pat Hammett, Ph.D. Sandra Paulsen, Ph.D. Dean Funabiki, Ph.D. Howard Lipke, Ph.D. Mike Brenner, MD Me1 Rabin, Ph.D. Elayne Weiner, Ph.D. Marcia Whisman, LCSW William Zangwill, Ph.D. Don Wright, MA Kay Werk, LISW Frances Page, Ph.D. Georgia Sloane, MS Carol York, MSW Roger Solomon, Ph.D. When I saw her, she was in great conflict. Everyone she respected gave her positive feedback on her looks, including her boyfriend; however, inside she felt "fat" and could not stop thinking with disgust about the soft roundness of her breasts, hips, and thighs. As a result, the fear grew greater each time she placed a fork of health food into her mouth. She felt despair each time she found herself longing for her anorexic body. Working with the EMDR method, it was determined that her SUDS level was 7 or 8 when she thought about her body. The statement, "My body should be weighing 100 pounds or less," was given a VoC of 3 out of 7, and the statement, "My body's just fine the way it is," was given a VoC of 4. Rapport was easy to establish with this sincere, intelligent, attractive young woman in her early 209, and EMDR was initiated. After the first set, her SUDS level went down to 5, after the second it was down to 3, and after the third, it had essentially reached 0 and a look of amazement (602) 770-7407 (408) 354-4048 appeared on her face. After one more set, the VoC of, "My body is fine just the way it is" was given a rating of 7. At this point (after 10 minutes of the EMDR procedure), it was clear that she had a very positive inner image of herself which was rich with sensory details and I switched to a Selective Awareness mode, inducing a deep state of relaxation directly from h e r receptive state of bewildered amazement. Her body image was intensified through imagery and she was encouraged to visualize and experience herself in this body while carrying out her normal activities a t work and with fiiends. An audio cassette was made of this experience for her to use for practice. At the end of the session, she described how a t the beginning, the image of a healthy body seemed far away (she pointed across the room) and felt frightening. With each successive set, she found the image moved closer to her and when the SUDS reached 0, she became one with it. The International Society for Traumatic Stress Studies (ISTSS) 1992 A n n u a l Conference hosted five EMDR presentations. In addition to the three panels I mentioned in the last Newsletter, two independent submissions were accepted: Sandra Paulsen, Ph.D., Pacific Institute of Behavioral Medicine, HI, gave a report on cross-cultural effects of EMDR, a n d Pat Boudewyns, Ph.D., VA Medical Center (VAMC) Augusta, GA, reported on the results of a study on chronic in-patient veterans. In addition, Howard Lipke, Ph.D., VAMC North Chicago, presented the results of his study on one-session desensitization effects and the correlations to perpetrator involvement in the veteran population. He was part of a panel on PTSD. The results of his study will be published in the next Newsletter. Dr. Lipke has also sent out a survey to all EMDR practitioners trained prior to February, 1992. This work is being done under the auspices of the Veterans Administration. Ifyou have not yet sent back your survey, please do so. The results will be invaluable a s a means to obtain a n independent and adequate assessment of EMDR effects a n d possible contraindications. In the last Newsletter I erred by stating that the funding for extensive EMDR research a t the VAMC in Augusta, GA, was NIMH funded. In fact, it is VA funded. To date, we have trained VAMC staffs in Pennsylvania, Illinois, Arizona, Massachusetts, North Carolina, and Georgia, and have attracted individual VA personnel from all over the country. The presentation a t the International Society for Traumatic Stress Studies �E M D R N e t w o r k N e w s l e t t e r D e c . 1992 by the panel of four VAMC PTSD unit directors, whose staff are using EMDR a s a treatment of choice will, I believe, encourage many others in the VA system to be trained. At this point, many veterans who have failed to find relief within previous program offerings a r e being successfully treated with. EMDR. S t e v e n Silver, Ph.D., Director of the inpatient PTSD unit i n Coatesville, PA, has been working with veterans since 1972 and received the prestigious 1992 national VA Service D i r e c t o r ' s A w a r d in M e n t a l Health and B e h a v i o r a l Science. He stated, a s a member of the ISTSS panel, that denying EMDR treatment, a t this point, is "verging on unethical" considering the clinical reports, and the suicide rate of the veteran population. What also clearly emerged h m the ISTSS Conference was the need for controlled research. While clinical reports abound, and by all means should continue, they are not taken seriously by many academics and a significant portion of the mental health population. The controlled studies are going to be vital to give EMDR the credibility it needs to enter the university systems. So far the only controlled study on a pathological population h a s been t h e Boudewyn study a t the Augusta, GA VAMC. As previously noted, while self-report measures h m client and therapist showed positive results, there were not significant changes in physiological measures and standard psychometrics. The interpretations for the lack of changes include problems engendered by the use of a taped combat scene to assess response. While the effects ofan EMDR session are a change in cognitive perspective regarding the memory, the tape recording provided the initial interpretation, and the physiological measures of t h e subject's responses to it could not distinguish between fear and anger. Additionally, the psychometrics were not geared to check responses to single eventreprocessingin multi-event veterans. While the treatment results were positive enough to gain further funding, other studies on a variety of populations a r e necessary. The chronic in-patient veteran population is the hardest to show consistent treatment results due to a variety of secondary gain and compensation factors. If any of you are in practice with clinicians who do not use EMDR, particularly in agencies or centers, we could certainly use your help in formulating and implementing some clinical studies under controlled conditions. Please contact us if this is a t all feasible. As you may know h m a previous mailing, the Association for the Advancement of Behavior Therapy (AABT) 1992 Conference will have no official EMDR presentations, a s politics seems to have prevailed over science. There will be six hours of Special Interest Group presentations which will include: Research Results on PTSD a n d Sleep Disorders, Neal Daniels, Ph.D., Director, PTSD Program, VAMC, Philadelphia, PA; Research Results on Agoraphobia a n d Panic Disorders, A l a n Goldstein, Ph.D., Director, Agoraphobia and Anxiety Treatment Center, Dept. of Psychiatry, Temple University, Philadelphia, PA; Psychometric 7Yeaimeni Ouiwmes of a Complex Case, Ronald Kleinknecht, Ph.D., Chair, Psychology Dept., Western Washington University, Bellingham, WA; Survey Results of 1,200 EMDR 7Yained Clinicians, H o w a r d Lipke, Ph.D., Director, Stress Disorders Treatment Unit, VAMC, North Chicago, IL; and a clinical roundtable by me on "EMDR -Integrative Treatment Effects." I have come to view EMDR a s offering a n Integrative Information Processing model; therefore, it may prove that EMDR cannot comfortably reside a t AABT. I think that would be a n error, but politics and antiquated (in my mind) definitions may prevail. I t will be a subject of conversation a t the November AABT Conference and I will report on the discussions in the next Newsletter. Many of you have done presenta4 tions a t regional and local APA meetings. James Marshall, MA, and John Patterson, Ph.D., presented on EMDR a t the Second Annual International Christian Counseling Congress in Atlanta, GA. These personal efforts continue to be a major source of credibility for EMDR. Please let us know if there is anything we can do to help you in diss e m i n a t i n g information i n t h e appropriate circles. In addition, Sandra Paulsen, Ph.D., has written a description of EMDR which will be included in the next edition of the Encvclo~edia Psvcholow, edof ited by R a y m o n d Corsini, Ph.D. EMDR seems to be sparking considerable interest in many circles, a s I have presented Grand Rounds a t Duke University and University of San Francisco a t Langley Porter. A number of psychiatrists a t Duke University suggested additional information regarding information processing in support of the EMDR model. We hope to have the transcript for the next Newsletter. Worldwide, we now have trained over 3,000 clinicians dispersed through Canada, England, France, Germany, Israel, Australia, El Salvador, Costa Rica, a s wellas thmughout the United States. While some people are attempting to do research without training, with obvious results, most are showing a proper respect for the scientific process. There will, of course, be a number of conflicting reports in the coming years. The reader's first question regarding research might be "Have you been trained?" We already have one report of a study proporting to test EMDR, where the researchers "simpli6ed the procedure" h m my early article and based their research on observed effects of only a drop in 2 SUDS after seven restricted sets of eye movements. Since they never had a n adequate baseline, they considered this a n EMDR effect. Obviously, while the research is severeIy wanting, it will be cited once published. We will send it to you a t that time. The reason I am mentioning C, , �E M D R Netwo ,k N e w s l e t t e r D e c . 1 9 9 2 this study is that I used to believe, a s you might, that this kind of research would be unthinkable. I have learned differently, and it is unfortunately uncontrollable. The problem, of course, is t h a t faulty results will inappropriately sway clinicians into withholding EMDR from clients. On the upside, we trained over 400 clinicians during the workshops in Australia, and many of them are planning to do research studies. We will be returning for another round of trainings in January and should have some news of research a t that time. I want to express my gratitude to all the clinicians who worked toward an EMDR response to the disasters in Hawaii and Florida. We had tried to put on an EMDR training in Florida, but received only four responses from Miami, probably due to the fact that clinicians were more concerned with getting a roof over their own heads a t that time. On the basis of that response, and the flu I had been living with since July, I very reluctantly cancelled theworkshop. We refunded the money to the Miami participants and invited them a s guests to any of the other trainings. We will be keeping an eye on Florida to judge when the time might be ripe to offer another workshop. In the meanwhile, many thanks go to R u t h Grainger, Ph.D., and S h e r y l l T h o m s o n , MFCC, for coordinating relief efforts. In the coming months I will be working with a number of facilitators, who have used EMDR for two years, in order to train them a s trainers. They will then be available to give smaller trainings in different parts of the country. In addition, I will be working on an EMDR text, hopefully to be published in 1994. Once some more of the replication studies are published, the text will be available for those of you who want to supervise others in learning EMDR. The text will not be a substitute for training and the need for a super- vised practicum, but it will assist in the process. The next Newsletter will be due out in January. So let me wish you a joyous Holiday season. Clinicians trained in Eye Movement Desensitization and Reprocessing (EMDR) often describe approaching the method with great skepticism that transforms into enthusiasm and a desire to proselytize. This enthusiasm is often mixed with the lament that more behavioral validation studieshave not been performed. This note records two cases in which people suffering from chronic Posttraumatic Stress Disorder (PTSD) symptoms demonstrated striking behavioral changes after a single brief EMDR treatment. Case A Mr. A had been a police officer for only three months in 1971 when he was assigned to undercover duty. As he was given minimal training and had no practical experience, he was soon detected by the criminals against whom he was working. His first clue that his "cover had been blown" came while sitting in his car. A masked man held a gun to his head and said, "You're a cop and il I'm going to k l you." The masked man then pulled the trigger, but the gun misfired. He pulled the trigger again. The gun misfired again. The officer scrambled out of his car with his own gun drawn, but it also malfunctioned. The criminal escaped. Mr. A sought psychotherapy nearly 20 years later. A cognitive-behavioral approach was used to address his severe anxiety problems which included nightmares, avoidance of the site of the attack, counterphobic behavior that had earned him two medals for valor, and panic attacks. He was taught relaxation techniques and self-hypnosis and engaged in many hours of talk therapy, guided imagery, and desensitization. A psychiatrist assisted his treatment with prescriptions for antidepressant and antianxiety medications and he was also placed on leave from his responsibilities a s a police officer. When he returned to a limited duty position, Mr. A found that he was unable to resume patrol duties a s his anxiety symptoms rendered him dysfunctional whenever he encountered the slightest confrontation. He soon found that even tiffs among his subordinates in his light duty assignment caused him severe psychological and physical distress. He ultimately was awarded a disability retirement. He reported thereafter that he continued to be anxious and apprehensive in confrontational situations, but was more comfortable because of his ability to walk away from them. Being relieved of a police officeis responsibility for intervention apparently helped, but did not eliminate, his symptoms. However, he remained unable to talk about the 1971 incident without becoming extremely distressed. When the site of the event was mentioned, his face would immediately contort uncontrollably and tears would flow. He handled this problem by avoiding a s much a s possible returning to the community where the incident occurred and by totally avoiding the part of town where he was attacked. After finding a new job, Mr. A terminated treatment. The therapeutic point of diminishing returns had been reached a s he no longer complained of nightmares, physical distress, and t h e many other complaints with which he initially had presented. Mr. A was asked to return for a thera- peutic session after this author was trained in the EMDR procedure. Mr. �EMDR Networ c Newsletter Dec. 1992 A was taken through a standard EMDR procedure in which he was asked to envision the incident, to identlfy and focus on any physical discomfort that he experienced, to hold in consciousness the emotions that he was currently experiencing, and to repeat silently to himself the negative cognition. His face contorted and tears flowed a s he followed the instructions. His Subjective Unitsof Discomfort Scale (SUDS) rating was 10. After only a few sets of eye movements, his face relaxed, the tears stopped, and his breathing, initially fast and shallow, smoothed. The eye movements were stopped and he was allowed to relax. He reported t h a t the image was less clear than it had been a t Grst and that he no longer felt so frightened. He was again instructed to focus on the image, his emotions, a n d his physical sensations. After a few more sets of eye movements he reported feeling well, both physically and psychologically. He was able to describe the attempt on his life unemotionally and expressed both joy and amazement that reciting the event no longer was distressing. Mr. A returned to the office in about one month to work on some other matters. He quickly demonstrated that he could talk about the attempt on his life without being upset and said that he had told many people about it since the last session. He reported that the attack was now "just a memory." Case B Mr. B, like Mr. A, was a police officer. He developed strong symptoms of PTSD after shooting and killing a n armed suspect h m a distance of 75 feet. Mr. B was seen with his wife i n treatment for over one year. Treatment included a 30-day in-service alcohol rehabilitation program. Extensive psychotherapy, utilizing the various procedures outlined in the previous case, resulted in his being able to return to permanent limited duty. Unlike Officer A, he took no psychoactive medication after he returned to duty. He maintained his sobriety and completely changed his lifestyle. He expressed great pleasure in his formerly neglected family and in his newfound artistic skills. One symptom remained "untouchable" however. He always developed uncontrollable tremors a t the 25-yard marker on the firing range during his regularly scheduled Gring practice. He inevitably experienced flashbacks immediately after firing his gun and nightmares the night after he qualified. He finally learned to handle the problem by resigning himself to being distressed after shooting and began to regularly schedule "mental health days" the day after he Gred. He, like Mr. A, was offered further treatment subsequent to this author's training in EMDR. He was told to focus on the shooting incident, a s well a s his subjective reactions to it. A standard EMDR procedure was initiated. Although his initial SUDSrating was 10, in less than one hour he reported that he was not experiencing any anxiety when he remembered the event and that he was looking forward to going to the firing range. Three days later, he Gred 75 rounds h m the 25-yard marker. Whereas he had missed the target altogether h m that distance during the previous five years, all but three of his bullets hit the target. Moreover, most of his shots were clustered in the center of the ring. He experienced no anxiety and Gred daily for a few days thereafter with ever-improving results. Discussion These two cases are noteworthy for the following features: 1) Both clients initially presented with long-standing symptoms of Post-traumatic Stress Disorder; 2) Both cooperated with treatment and benefited to a great degree; 3) Although both ceased to exhibit many of the symptoms with which they presented, each had to devise techniques for coping with cer- tain intractable symptoms; 4) With both, care was taken by the clinician to state no explicit expectations of their experiences; 5) Each reported an immediate diminution of subjective feelings of anxiety, followed by a report of the extinction of t h e anxiety response when conh n t e d with the stimuli that had previously been overwhelming; and 6) Each demonstrated behaviors they had been incapable of performing prior to the EMDR treatment. The Grst individual was able to talk comfortably about the life-threatening experience that he had undergone over two decades earlier, and the second was able to fbe accurately h m a distance of 75 feet. Further individual EMDR work is scheduled for previously treated police officers who have residual PTSD symptoms caused by a shooting incident. Large scale, controlled research with police officers who are troubled by post-shooting symptoms is being developed. We would like to inaugurate a Network Directory for 1993. We get numerous calls h m colleagues asking for other EMDR clinicians for family, friends, or transient clients. To assist matters, a 1993 renewal form is provided on page 23 and in the Network flier. These forms request name, business address, telephone, specialty area, level of training, and whether you are open to take referrals. We will list clinicians according to state and local area. This directory will be available to Network members, agencies, and insurance providers, etc. I t has been suggested that a listing be available of EMDR practititoners able to give case consultations. Any suggestions for alternative uses are welcome. �EMDR Netwo k Newsletter Dec. 1992 In order to cover the cost of the direc- tory, newsletter, tapes, and articles, dues for 1993 will be $50. However, members will receive discounts on EMDR Conferences a n d specialty trainings. With sufficient member- ship, we can hire project personnel, including one to deliberately educate i n s u r a n c e providers r e g a r d i n g EMDR, and laison with appropriate media to disseminate information i n a judicious manner. Regional coordinators will set nominal fees for the cost of local meetings. The quarterly California meetings will be a n additional $20. Fees will vary according to region. Please contact your regional coordinator for price, dates, 1 and location [see page 3 . The Case of the Self-Defeating, Telephone Sex Addict: An EMDR clinician, who prefers to remain anonymous, describes a case in which there has been only limited progress in three years of therapy. The therapist has used EMDR several times with little apparent effect. Case Summary by Anonymous Scheduled for the next few months is a formalizing of the EMDR C o n f e ~ ence Schedule. As you know, we have changed the dates to March 1921, 1993, a t t h e Sunnyvale Hilton near San Jose. There will be three days of workshops and presentations that will be of the highest calibre on a variety of EMDR topics. Headliners include: Alan Goldstein, Ph.D., the Director of the Agoraphobia and Anxiety Treatment Center, Dept. of Psychiatry, Temple University, who will present on the use of EMDR with Agoraphobia a n d Panic Disorder; Nancy Baker, Ph.D., Psychologist, LA County Sheriffs Department, who will present on the use of EMDR with victims of Sexual Harassment, and I interaction with previoussexual abuse history; and E m m e t t Miller, MD, who will show how to use hypnosis to augment the EMDR treatment session. The evaluations of last year's Conference were superb, and will be t h e standard for 1993 a s well. If you have any proposals of topics, or research, please send them to me immediately. "Charlie" is a 41 year-old married white male who presentedfor treatment about three years ago for a sexual compulsion. His compulsion focuses on making secretive telephone calls to phone sex services and massage parlors, becoming sexually aroused, a n d often masturbating. When his wife finally learned of his problem, she demanded that he seek professional help. When h e presented for therapy, his monthly phone sex bill was more than $500. 1 "Charlie" worksin his wife's homebased business a s her employee. He had been dismissed from his last position for inappropriate behavior towards a female employee. "Charlie" is well educated and had worked in a professional capacity in another state. In addition to his phone sex problem, there is considerable conflict between "Charlie" and his wife over his productivity a t work. He also makes occasional mistakes t h a t cost the business money or lost time. These mistakes could each be considered inadvertent were it not for their frequency and severity. 1 "Charlie's" wife is a survivor of childhood sexual molestation. She is dramatic in her emotional life, frequently expressing in highly charged ways h e r disappointment, anger, a n d sense of abandonment about his lack of support. There has been a n undercurrent of instability in t h e i r m a r r i a g e t h e e n t i r e time "Charlie" h a s been in therapy. I offered them couple counseling for seve r a l months early i n "Charlie's" therapy, but this did not help much. Each of them continued to feel easily criticized, rejected, and inadequate. I finally referred the wife to another therapist for h e r survivor issues. At my request, "Charlie" has become active in a 12 step program for sexual addiction. His sexual acting out has decreased with periods of abstinence lasting weeks or months, but he does have frequent relapses. "Charlie's" wife h a s asked, and "Charlie" has agreed, to disclose to her any further phone sex episodes. However, most of his relapses begin with periods when he keeps his behavior hidden h m her or from me. "Charlie's" depression has worsened in recent months, perhaps in response to his wife telling him to find a job outside the home business. I sent him to a psychiatrist for medication evaluation and he is now taking Anaiiinil and Prozac. Since starting on the medication, his episodes of uncontrolled crying a n d his suicidal ideation have both decreased. On the other hand, a recent loss a t work has cost the business over $20,000. It is not certain whether "Charlie" was directly responsible for the loss. However, both h e and his wife blame "Charlie." Recently, she has been making comments about ending the marriage and having "Charlie" move out. I have used EMDR in four or five sessions to decrease "Charlie's" urges to act out sexually and strengthen his sense of self-worth. These sessions have focused on memories of his stepfather's random and unpredictable outbursts of anger a n d criticism. ("Charlie" has no memories of his step-father's loving acceptance.) During EMDR sessions, "Charlie" had �EMDR Network Newsletter Dec. 1992 changes in the target picture and shifts to the target memory and no abreaction or expression of emotion. There have been no significant shifts in behavior, feeling, or memories following EMDR sessions. "Charlie" does keep a log after EMDR sessions. Baka, N & McBridc, B.(~uguh, 1991) Clinical Applications of EMDR in a Law Enforcement En~entObservrtim ofthe PyschologicalServiceunit ofthe L. A. County S h d s Deputmcnt, Papa presented at the Police Psychology (Division 18. Police & Public Safety Sub-section) Mini -convention at the APA m u a l convention, San Francisco, CA. Boudeym,.P.A.,StwcrkqS.A.,Hyer..A..Albrecht, J.W..&Sperr.E.V.(August, 1991)EyeMovement L Dcscns~hzahonfor PTSD of Combat A Pilot Study. Paper presented at the APA m d convention, San u Francisco. CA. [Articlesubmitted for publication]. DanielqN, Lipkc, H.. Richardsm, R& Silver. S. (October, 1992)ViettuunVctarvldTreabnc?tRograms Using for Eyo Movement Desensitization and Reprocessing. Symposium presented at lhe Intemahonal Soc~ety Traumtic StressStudiesmual convention,los Angele~ CA. "Charlie's" mood stabilized after beginning the medication and he has asked to resume EMDR sessions. After our most recent EMDR session, I pointedout to ""Charlie"' that he seemed to be "floating" above his feelings during the EMDR work. He said his previous therapists had always told him that he was out of touch with his emotions, especially anger, and he asked what he could do to get more in touch with his feelings. "Charlie" has frequently reported losing control of himself emotionally. He has crying episodes and sometimes he hits the wall with his fist or his head when he gets angry. I had not thought of him a s being out of touch with his feelings. I a m confused about how to move forward with Charlie. He always comes in for his sessions a n d he has asked to continue with EMDR in spite of the limited success we have had with it to date. I would appreciate any guidance you can give me. Case Commentary and Suggestions This is a n extremely challenging case. Anonymous has been providing a positive frame for the therapeutic work. Anonymous involved "Charlie" i n a s u p p o r t s y s t e m through the 12 step group and has made a good beginning with EMDR by identifying touchstone memories for "Charlie's" low self-esteem and self-defeating behavior. Anonymous has "Charlie" keeping a log. "Charlie" presents some borderline features (e.g., the "mistakes" a t work, poor impulse control, and a lack of differentiation in his feelings). Part Goldsttin, A. (August, 1992) Treatment of panic and agoraphobia with EMDR: Preliminary Data of the Agonphobu ud AnxietyTreatmcntCenter. TempleUniva-sily.Papa Presented atthe Fomth World Cmgrcss on Behavior Therapy. Qucmsland. Australia. Hcdstrom. J. (1991). Anote oneye movementsand relaxation. Journal ofBehavior 'Ihmwand Ex~enm Psvchiatrv. 22.37-38. Klicnhecht, R. (1992). Treatment of post-traumatic stress disorder with eye movement desensitization and repro~~ssing. Joumal ofBehavior'lhcra~y andExpcrimentd Psvchiatrv,a 43-50. Lipkc, H.J. & Botkin.A.L. (inpress). Briefmestudies of Eye Movement Desensitization and Reprocessing (EMWR)with c M c p o s t - t a u m d c stressdisorder. Psvchothermy. I Marquis J.N. (1991). A r e p on seventyeight cases treated by eye movement desensitization. Joumal of Behavior'IhcrapvmdR, 22,187- 192. Neil- Tore(1991). Affectdesensitization: A possible functionof REMsin bothwakingand slcspingstates. S l e c Resea& ~ a. Puk G.(1991)Treating traumaticmemories: Amereporton the Eye Movement Desensitization procedure. Journal of Behavior T h m ~ v a n d Ex~erimental Psvchiam 22, 149-15 1. I Rothbuao. B.O. ( 1 W HowdoesEMDR work? theBehavior Themuist, 11.34. Shapiro. F. (198911). Efficacy of the eye movement desensitization procedure in the treatment of traumatic manories. Joumal ofTraumatic Stress, 2 199-223. I Shapiro. F. (198%) Eye movement desensitization and reprocessing procedure: A new treatment for posttraumatic stressdisorder.Joumal ofBehaviaThcrapv and Experimental Psvchiam- 21 1-217. 0 2 Shapiro. F.(1991) Eycmovemmtdesnuitization&reproccssingprocedure: From EMDto EMDIR-anew treatment model for ~ x i e t y a n d related traumata. the Behavior Themoist, 12,133- 135. I Shapiro,F.(1991, September).Eyernovemantdemrsilizntimandrepmcssing: A cautionarynote. he&havior Themvia 14,188. I 1 Shapiro. F., Solomon. R.. Kaufincm,T. & Fenstamdter. D. (October 1991)0rginsand Update; UseofEMDR with Critical Incidents;PreliminaryReswchand Results; Clinical UseofEMDR withDissociativePatienb. Papen presenteda t t t i ~ n t c m a t i Society for TraumaticStsn Studues, Washington, D.C. o~~ Wolp. J . & A h q J.(1991).Post-tramaticsbessdisordaovercome byewmovanentdesensitizdtim Arep&. ~oumal ofBehaviorTherawand Experimental ~svchiabv. 22,3923. of the confusion comes h m considering "Charlie's" impulsive acting out of emotion (phone sex calls, head banging, and uncontrolled weeping) to be equivalent to a n ability to contain and express emotion. They are not the same. Anonymous may find more progress will come h m helping "Charlie" develop a greater ability to contain, differentiate, and express emotion. "Charlie's" inability to abreact or to express emotion during EMDR sessions reflects a defense that can itself be the focusof further EMDR sessions. II I "Charlie's" defensive belief is that it is not safe for him to feel and express his feelings. Have "Charlie" identify the touchstone memories for this belief and process them. Work on resolving t h i s defense may help "Charlie" to work through the challenge of learning to differentiate and contain his feelings. Because of the borderline elements, this work is likely to proceed slowly. The current crisis and instability in the marriage may also slow this work down. You have made a strong therapeutic alliance with "Charlie." He trusts you. �E M D R Networ k N e w s l e t t e r D e c . 1992 The fact that he asks for further EMDR sessions suggests that he has some sense that it is helping him. Write again in a few months and let us know what progress you have made. Have you experienced atypical responses to EMDR, lack of progress, even outright therapeutic failures? Submit your challenging clinical problem to Difficult Cases. Your proposed solutions are welcome, but are not necessary. Additional solutions submitted regarding these cases are welcome, especially if you have successfully treated a similar patient. Send submissions, w h i c h m a y b e anonymous, to Andrew Leeds, Ph.D., EMDR Network, P. 0. Box 51010, Pacilic Grove, California, 93950. If you have any ideas o r suggestions to d e a l with "Charlie's" case, please submit comments. This section will appear in each Newsletter and will present innovative uses/variations of the EMDR that have been discovered by clinicians trained in the method. I would very much appreciate it if any of you who have found new variations on how to use EMDR would write these up and send them to me at the a d dress below, so that I can include them in future Newsletters. Though your write-ups can be informal, I would appreciate you including the specific steps of the technique; the number of people on which it has been successful; any specific outcomes that you have consistently noticed; and any further commenis. Please include your name, address, and phone number, so that I can reach you with any queslions. Thank you. First of all, let me open up by offering my apologies to Carrie Greenberg, LCSW, of Santa Rosa. In the last "Innovative Uses" column, Carrie was the person who sent in the article on using the combination of EMDR and hypnosis while working with a Vietnam vet. The effects were quite powerful and Carrie deserves full marks for combining these two modalities. Unfortunately, due to the omission of a paragraph, it appeared that this was a technique that I (Ron Martinez) had developed and used and I want to take this opportunity right off the bat to thank Carrie for her contribution and her patience during the time in which she was not given proper credit. Edith Ankersmit, LCSW, of Berkeley, has sent in a write-up on several cases in which she combined EMDR with various bioenergetics techniques. Edith is a certilied bioenergetics analyst who has not used this modality for several years. However, she found some cases in which it seemed to work hand in hand with EMDR in a very productive way. The most noticeable case wasof Clara, a 27 year-old woman who had a problem of staying in bed in the morning in what seemed to Edith to be a n angry depression. Clara refused to get up and go to work. As she is selfemployed, this caused a great many problems for her. When Edith began the EMDR process, Clara promptly connected with h e r transfer from public school to catholic school when she was in fifth grade. I t was a d a c u l t transition and she felt she wasrejected by allofthe "cool" kids a t the new school. They threatened and humiliated her, and she felt she had very little power to respond. At that time, Clara developed a hatred of getting out of bed and going to school and would often pretend to be sick. Edith and Clara formulated a positive cognition together of, "It's in the past. I can get up now and nobody is going to beat me up and say mean things." The highest VoC they were able to attain on this was 4. Later, during the EMDR process, Edith asked Clara what she would like to say to those girls who were mean to her. Clara stated that she would like to beat them up. Edith then had Clara go through a bioenergetics technique in which she used a "boffer" while standing in a well grounded position and imagining that she was hitting those girls and also telling them what she thought of them in the process. When she completed the exercise, Clara told Edith that she felt she had her pride back and that now she no longer felt rejected by these girls. Moreover, she no longer felt a n interest or need in wanting their acceptance. They tried the original cognition again a t this point and the VoC was 7. Clara then added another cognition on her own, "I'm a very strong person. I have no problem now telling people how I feel. I've learned h m the past." This too installed easily and powerfully. Upon telephone follow-up, Edith learned that Clara's improvement initially was slow, but then gradually she reached a point in which she was able to get up from bed and go to work regularly. Finally, AJ. Popky, CHT, sent me a n extensive protocol on how he is using EMDR in combination with hypnosis and other clinical concepts in working with smoking cessation. The protocol is too lengthy to go into here, but both A.J. and I would be very interested in hearing the kinds of results that other people would obtain in using this process. For a copy of the protocol, please contact A.J. Popky, CHT, a t 17461 Pleasant View, Monte Sereno, CA, 95030. In my article, "Relapse Therapy" in the EMDR Newsletter (Vol. 1, No. 2), I made reference to a study done by Cynthia Downing, Ph.D.-"Surrender to Powerlessness and Its Re- �EMDR Network Newsletter Dec. 1992 I had reported. While the error was 1993 EMDR Network Schedule Saturday, March 20th at the EMDR Conference, 12:OO-2:SOpm - flfyolc are not attending the Conference, but wish to attend the Network Meeting, contact EMDR oflce (408) 372-3900 orf a (408) 647-9881.] Saturday, June 26th Saturday, September 18th Saturday, November 13th 9:SOam to 4:OOpm The Network meetings are held a t the Sunnyvale Hilton, 1250 Lakeside Drive, Sunnyvale, California (408) 738-4888. I 1 1 SCHEDULE for Jun, Sept., and 9:30- 10:OOam Registration & coffee Nov. 10:OO-11:30am Special Interest Groups (SIG) meet to share new information. ll:30-1:OOpm Lunch w e suggest a second SIG meeting during lunch.] l:00-4:OOpm General meeting. Presentations by SIGs and Francine. The quarterly Network meetings have been a success a s a forum for sharing new applicationb of EMDR, learning about the latest research results, and observing talented colleagues demonstrate innovative twists with EMDR. lationship to Relapse in Recovering Alcoholics" (1991), which was part of her doctoral dissertation for the Saybrook Institute in San Francisco. I incorrectly reported that "Cynthia Downing, Ph.D. determined in late 1990 that 97% of chronic relapse clients had experienced a life-threatening experience wherein they perceived their imminent death and could do nothing to prevent it." The figure 97.5% was incorrect and should have read 41 out of 50 chronic relapsers. She reported that 41 out of 50 chronic relapsers had a history of such a lifethreatening experience a s opposed to 30 out of 50 of the non-relapse prone. Dr. Downing's study included 50 relapsers and 50 nonrelapsers. While this is a signscant difference, the frequency of a life-threatening experience was not nearly a s large a s . inadvertent, the responsibility for it is completely mine. I regret any confusion or misunderstanding that my error caused readers of the article. Dr. Downing found self-reports of physical and sexual abuse histories a t roughly similar r a t e s among relapsers and nonrelapsers. On the other hand, not seeking therapy (as contrasted with prior substance abuse treatment) differentiated chronic r e l a p s e r s (41 o u t of 50) from nonrelapsers (31 out of 50). Substance choice also differentiated relapsers who tended to use alcohol a n d d r u g s (43 o u t of 50) from nonrelapsers who used only alcohol (41 out of 50). While nonrelapsers also frequently have a history of a life-threatening experience, more of chronic relapsers will show this history. Empirically, I have found that looking for a history of a life-threatening experience, and a d d r e s s i n g i t w i t h t h e EMDR method, has enabled me to better serve my clients a s a relapse prevention specialist. Bibliography Downing, C., 1991. "Surrender to Powerlessness and Its Relationship to Relapse in Recovering Alcoholics," unpublished doctoral dissertation, Saybrook Institute, San Francisco. In addition to the obvious referent, the following cartoon struck I le us a good description of those clinicians who push to use EMDR without training-FS 1's CLEAR M I YOURE V M A S I MtiE -lDUxw -fim4 I W N I W S . ICrVilVSE I 1 ny~rwsrs m NCCIEIYEED? MAKES fiE Tl N K I T WfT4QF.D f1 IDN'T ? IL aE 'L SCORNED AND RIDICULED GET AT THAT5 A RISK llnWLLLIM-io �E M D R Netwol k N e w s l e t t e r Dec. 1992 During the course of clinical work, there are times when the VoC and SUDS scale do not provide the information needed in order to set the focus for clinical and EMDR work andlor to determine the probability of change in the client. The Subjective Unit Motivation (SUM) has been useful for ferreting out this therapeutic material. The SUM is measured in percentages of 0 to 100% in order to distinguish it h m the other two scales. The client is instructed to determine how motivated helshe is to follow through on a desired outcome that is presented in the session and to rate this on a scale of 0 to 100%. High percentages can be a n indicator of a desired behavior (e.g., getting a job) or a n undesired behavior (e.g., committing suicide). The same is true for low percentages. Once the percentage is established., the clinician can query the client a s to what is needed to increase or decrease the percentage in the desired direction. This material can then be the focus for EMDR or other appropriate therapeutic procedures. ously resolved (the VoC was 6.5 and the SUDS was 1). When the client was asked how motivated.he was to take the next career step, he rated his SUM a t 60%. The client was surprised t h a t his SUM was not higher. He realized then that he had a greater "desire" for change than "motivation" for change. Once the resistance around the motivation was worked through with EMDR, the SUM increased to 95% and the client followed through with the necessary behavior change. After two years, I feel quite ready to "pass the baton" and a m pleased to announce that Jean Bitter-Moore, Ph.D. (recently married-CONGRATULATIONS!) will be the new California Network Coordinator. Jean will be responsible for conducting t h e quarterly gatherings and helping Network members join existing study groupsor start new ones. I know she will do a n excellent job. After establishing the PEAK Performance Special Interest Group in December, 1990, and leading this group with Jennifer Lendl, Ph.D., I am happy to announce a new SIG leader, Barbara Erickson, RN, MS, of Sacramento. Barbara brings her experience in working with business people and other clients to her role a s facilitator. She will lead the Peak Performance SIG a t Network meetings beginning November 14. Bill Covi, Ph.D., also of Sacramento, will assist her. In the second case, the SUM was used during the assessment phase of therapy. The client rated the following therapy goals and SUM values: attend CODA meetings (SUM 45%), improve self-esteem (SUM 55%), maintain healthy relationship (SUM 75%),complete graduate school (SUM 80%), and get a job (SUM 80%). When asked why the SUM for 12Step meetings was so low, the cli'ent replied, "I would have to admit that I have a problem." The SUM enabled the client to set priorities and the focus for the therapeutic work. The client has started working a s of this writing. This "retirement" allows me more time to complete a project that I proposed to Francine inlate Augustorganizing the research on EMDR into a database that interested persons can easily access. To that end, I a m contacting those professionals who have published, or are in the process of conducting, EMDR research in order to collect summaries of results and copies of protocols and measures. I expect that the database will be on-line by mid-January, 1993. At this time, I only use the SUM sporadically. I offer this information on the SUM in the hope that it may be useful to other clinicians and I would appreciate any feedback. Possible uses of the SUM are: predicting suicide, determining substance abuse abstinence or relapse, changes in relationship issues, determining the success of overcoming performance anxiety, and improving one's health. Case E x a m ~ l e s :(Details have been changed to protect clients' confidentiality .) In the first case, the client was involved i n a career change a n d had become immobile in the process; a consequence of which was iiiction in his primary relationship. Memories regarding this issue had been previ- The database will be organized by population served and diagnosis, a s well a s the researcheis name and affiliations. People with research ideas can obtain addresses and phone numbers of the investigators doing related research by calling (408) 3723900. Please submit requests in writing speclfylng the research you are planning a n d the "key words" in which you are interested. We can then access our database and provide information about how to contact the investigators. As Coordinator of the California Network, I have thoroughly enjoyed the opportunity to meet many of you who have attended our quarterly meetings in Sunnyvale. I t has been a pleasure to interact with such talented people a s the Special Interest Group (SIG) members who share their findings and new applications during the afternoon presentations. , For those graduate students plan- �E M D R N e t w o r k N e w s l e t t e r Dec. 1 9 9 2 ning dissertations using EMDR, a Pacific Graduate School student, Priscilla Marquis, MA, has graciously agreed to assist other doctoral candidates with advice on h e r literature review. She can be reached in the evenings a t home in San Francisco (415) 285-4065. For researchers with proposals in the planning stages, I can answer specifk questions about research design and measures. The best way to enlist my time is to mail a copy of your research proposal or questions to me a t 1503Grant Road, Suite 160, Mountain View, CA, 94040. You can also fax proposals or questions to me by dialing (415) 365-8689. I am very excited about taking on this project and hope to have the A database in place by January. second function of my new role will be to summarize recent research findings for this Newsletter. In this issue, I feature the results of research conducted by R o g e r Solomon, Ph.D., who has been investigating critical incident stress interventions employing EMDR. I. Initial assessment of impact of event. Go through the incident with the client "frame by frame," with the client describing what took place moment by moment. I t is important that the client not only describe the events that occurred, but also the perceptions, thoughts, and feelings he or she experienced. Be sure to ask about the aftermath of the event. Investigations, reactions of friends and s i g d c a n t others, treatment a t a hospital, etc.9 can be v e ~ s t r e s s f u l . merits or images of trauma automati. ,dY manifest.~h~~ may be inchmnological rder, in order of distress to o the client, or in a seemingly random Significantsensoryim~ressions(~.g., order that is meaningful the cli. to sights, sounds, sensations, tastes, o ent. If no other images r moments and Smells) and their meanings to come up spontaneously, ask the cli. the client should be noted a s potenof the incident and pay ent to tial "nodesn for reprocessing. It is attention to images, feelings, sensaimportant to take note of mOtions, or thoughts that arise and rements of vulnerability andlor lack of process them. control-the essence ofthe traumatic hmingfaceto face with 1 have found usingthe client's most ("1 thought I going to intrusive image a s the starting point die"),~erceptionsofhel~lessnessand to be more effective than going by ~ ~ ~ ~ r l e s s ~ e was nothing I Cthere s s order, although empirim could don), or witnessing tragedy, cal is needed to determine especially when one can closely idenwhich method is most effective. tify with the event ("that could have been my child..."), are moments that 111. Reprocess from will need reprocessing. beginning to end. 11. Desensitization of the event. There are several ways to reprocess t h e t r a u m a t i c experience with EMDR. A. The therapist can take the client through the experience in chronological order, reprocessing each traumatic and emotionally meaningful moment. B. Start with most intrusive sensory experience. As an alternative to proceeding chronologically through the incident, the therapist can reprocess the event according to the client's organization of the experience. Start with the client's most vivid image, or whatever images come to mind, and ask the client to focus on the one that is most distressing. This image is often the best starting place because it may be difficult to focus on another part of the incident without the intrusion of the most distressing image. If the "worst" moment is too upsetting to think of, it may be helpful to start with a less stressful image. Quite often upon reprocessing the most distressing image, other mo- 12 After all traumatic images and moments have been reprocessed, have the client go through the entire experience in his or her mind, h m beginning to end, with his or her eyes closed. The stopping point should be when the client felt SAFE after the incident was over. Instruct the client to stop if anything becomes upsetting. It is common during this step that stressful feelings, thoughts, or sensations will emerge that were previously suppressed or blocked. Be sure to separately reprocess any new material that comes up, a s well a s any other moments that still cause arousal. Repeat, going through the entire incident with the client doing the eye movements until it can be completed without discomfort. IV. Installation of positive cognition and integration. The last step is for the entire incident to be replayed with the eye movements and the positive cognition in mind. When the client has replayed the �EMDR Networ k N e w s l e t t e r Dec. 1 9 9 2 entire incident with a low S l . S level, I have found it ecological to ask the client how h e or she is thinking about t h e incident now t h a t it feels better. The answer to this question often yields new positive cognitions that were not thought of, or even conceived of, prior to reprocessing. For example, many clients may not have been aware t h a t they were assuming some responsibility for a n event beyond their control. After reprocessing, they suddenly realize it was not their fault and THEY DID ALL T H E Y REALISTICALLY COULD AT THE TIME. Only after a new vantage point is achieved, can some people realize where they were stuck. The Veterans Administrations h a s awarded Steven Silver, Ph.D., the 1992 VA Service Director's Award in Mental Health and Behavioral Science. Dr. Silver is Director of the inpatient PTSD unit i n Coatsville, PA. H e served in Vietnam as a Marine Corps officer and has been working with other veterans since 1972. V. Intrusions of past traumatic memories. While reprocessing a recent traumatic event, a past traumatic event may intrude. Should this occur, it may be best to stay with t h e past event and follow the client's organization of his o r h e r experience rather than holding off until the current experience is desensitized. VI. Legal cautions. If there is going to be a legal investigation, it may be prudent to p u t off doing EMDR until after legal statements have been made. EMDR often causes gory, traumatic, visual pictures to lose detail a n d become more distant. These details may be important to a n investigation or court case. If there is a chance t h e case is going to court, it may be best to put off EMDR until t h e case is legally resolved. If the court case is not scheduled until some distant time in the future, and it is determined t h a t EMDR should be conducted to ease suffering, be sure to document the client's sensory impressions should they be needed for future reference. This book integrates the most recent advancesin the relationship between cognitive processes and their underlying brain functions. The authors communicate their purpose i n a n engaging style calculated to follow in the footsteps of Cognitive Psvchol(Neisser, 1967), Languages o f the Brain (Pribram, 1971), a n d Godel, Escher and Bach: An E t e ~ nal Golden Braid (Hofstader, 1980). The authors do not, however, retread basic information processing theory. Rather, they celebrate the emerging discipline of cognitive neuroscience and introduce outsiders through example, case study, research, and analog to its distinctive tools--computer modeling and brain scanning. The authors challenge us to see their sweeping vision of the brain-mind interlock. Make no mistake, however. In their survey of this new field, Kosslyn and Koenig come to proselytize, not educate. Polemics are kept to a minimum and the processes for the majority of sensory modalities and for various levels of mode integration a r e patently absent. To EMDR practitioners, these omissions a r e especially disappointing since so much of what is processed in the course of EMDR resides outside visual channels. While Kosslyn and Olivier may paint t h e i r p i c t u r e w i t h overly broad strokes a n d in bright, tacky colors, it is easy for t h e reader to forgive them their excesses-not because the authors a r e so enthused about their subject matter, b u t because they present us with a masterpiece to rival Van Gogh's Sunflowers. The book promises to become a classic which should ignite t h e collective imagination of a generation of scientific readers a n d c o n h n t the rest of u s f o r o u r p h l e g m a t i c conceptualizations of mind. The contents of t h e book may be divided into three parts. The tirst part, which seeks to credential cognitive neuroscience, offers a brief history of its antecedents, a general definition ofthe problem area, unique characteristics of t h e approach, and insight into its assumptive principles. The middle portion outlines the constituent subsystems for brain processes responsible for progressive grades of mental activities beginning with visual perception, moving to visual cognition, then language processes, a n d on into movement and memory. The end chapter, entitled %ray Matters, "looks to the future of cognitive neuroscience by pointing to topics of interesting speculation and extreme controversy. While this user friendly volume is full of information, insight, and innuendo, it is "Visual Cognition," (Chapter 4) which may be of most interest to EMDR practitioners. Each paragraph of t h e text, however, is pregnant with potential, and complete hierarchies of alternate hypotheses to explain our clinical observations of EMDR phenomenon �E M D R N e t w o k N e w s l e t t e r D e c . 1992 suggest themselves on every page. The following is one example of the many eye-catchersin thisbook: Imagine what you would see when you first enter your living room. Most people make eye.movements when imagining the furniture. This makes sense if the location information is stored in a motoric form, and the movement is performed a s part of accessing t h e stored information. Now try imaging your living room again. And then again. Do you move your eyes a s much on the third time a s you did on the first? By the third time you should have recorded the information i n t o a categorical form ...these representations rely on categorical s p a t i a l relationships (which are not necessarily verbal) and do not involve motor commands. Thus, one need not move one's eyes when retrieving this sort of information (p. 142). While it would be sophomoric to suggest that we already have too many arcane tomes on brain-behavior research, I genuinely enjoyed reading this companionable work. Yet, when I put it down, I felt like I had aquired more from it than a n ego massage. If the growing body of neuropsychological literature seems too daunting to attack, or if you have walked away from your growing pile of journal articles and textbooks on the subject feeling like Orpheus emerging from Hell, perhaps Doctors Kosslyn and Olivier have written something you might be interested in a s well. At the last Network meeting in San Jose, CA, participants voted unanimously to allocate a Norman Cousins scholars hi^ of $1000 to research costs for Hurricane Andrew's victims. Francine will personaly match this, giving a total of $2000. A project advisor familar with research protocol design is being sought. association links between trauma. For example, one patient said, "The original memory has no more power over me." However, there were continuing memories t h a t did have power over her that needed to be worked through before she could feel a s though she had mastered the experiences she was describing. When working with patients with a history of sadistic and ritual abuse, judgment needs to be made a s to his or her readiness to continue when alters present for EMDR. For example, in preparing one patient for EMDR, a child alter presented. Feeling that this was her starting point, she began to realize she was not yet prepared and felt too much was coming a t her. In another patient, a "non-feeling" satanic alter presented. I assumed the starting point was of a state that did not feel and that the processing would lead this state to the pain of the others (which it did). Another woman recalled concentrating on "Satan's" robe when raped, seeing i t w a s not ironed, b u t wrinkled, and asked herself how a demon could present with a wrinkled robe. She was on the way to becoming more realistic. When working with this population, one needs to be cautious about a number of factors. First, in dealing with ritual abuse, we want to be cautious that our enthusiasm for EMDR does not detract from our awareness that patients with severe and chronic abuse are going to have a great many traumaticepisodes that are linked with many nodal points; some of which are equally painful to the one a t which the patient starts. They also may not understand that they are to return to the original memory to see whether it has decreased in power. In my personal experience, where the patient may end up is still somewhat unpredictable. He or she might end up in a very painful place because of the fi-equent nodal points of trauma and Secondly, a s therapists, we need to recognize that it is not necessarily our job to know for certain that what is being reported to us represents an historically accurate event. It has been very easy for therapists caught up in reports of this kind of abuse to want to feel the material is somehow true and actual a s it is being de- scribed when, in fact, it may be sub- ject to a variety of distortions that therapists may not have been trained to think of or recognize. I have seen issues surface of malin- gering, contagion or the absorption of someone else's memory where the origin of the memory had dissipated and the patient re-experiences it unconsciously a s his or her own, where loose fears and ideas attach them- selves to actual events so that the new "memory" is a combination of both real and unreal events, a s well a s other kinds of distortions. Fantasy and contagion that are dealt with in periods of trauma require more scientific inquiry thancurrently exists. Are they re-dissociated? The use of hypnosis itself is a potential source of contamination which may make it possible to create traumatic memory even a s we are alleviating the same memories we create. Bofore we automatically decide with what it is we are dealing, these are subjects t h a t need more complete study. Fortunately, our patients will be pre- senting these experiences in ways that are similar to actual memory and they will often follow the rules, and therefore the shifts in cognitive sets one sees with dissociative stor- age. With this degree of trauma, one will need to see to what extent sig- - �EMDR Network N e w s l e t t e r Dec. 1992 d c a n t cognitive distortions remain concerning the way the clients think about these issues once the issues have come to surface a n d a r e "known." It isoRen true that memory not only needs to be "known," but it needs to be thought in a n adult, well perceived, and integrated fashion through the mind of a n adult. In the long run, we are bringing some patients through a long series of =cult material, whether we use EMDR or any other therapy. There may be certain patients who are sufferingexperiences we do not yet know how to recognize a s a r t s c i a l from those that are real, and the patient may struggle inordinately when it is not necessary. This information will be available more clearly to us a s research and investigation bring us more accurate evidence. Presently, the average therapist needs to take a very cautious, nonjudgmental, and open minded stance when dealingwith memoriesof ritual abuse. One should not automatically assume everything that is heard has occurred in the way one hears it. Further, one needs to be aware that a variety of distortions which could be introduced or attained may come into play. This is something a patient may do in finding histher own truth. However, we need to begin to develop clinical and research profles to separate out those individuals who have experienced chronic traumatization, show more history of trauma, or who are highly suggestible and compare them to others reporting amnesia for real documented abuse. This way, a t least, some comparative testing can be used a s data to determine whether what we a r e hearing represents some aspect of an actual set of events or the production of distorted or inaccurate events that may need to be worked through even more to uncover the more realistic issues that are their underpinnings. This whole area is potentially wide open for study and one of great interest ifwe can do it carefully and thoughtfully. We must highlight caution in our approach to patients. Treatment issues surround not just remembering and resolving specilk events in a patient's life, but also in working with a patient a s a whole individual, constructing a life that he or she would like to choose for himself or herself and finding the proper perspective to place on multiple trauma in individuals who feel disempowered and have very little self-esteem. Finally, we need to be aware that in this particular field we are applying a new method of EMDR that was designed for briefer and less d s c u l t times of post-traumatic stress disorders. Therefore, potential complications need to be thought out in a straight forward manner and discussed openly rather than simply making claims of massive success without reporting difficulties that may simultaneously occur if information comes out too quickly or prematurely without the ability to contain it between sessions. Many more EMDR trained therapists are needed to work in the three locations welcoming our skills, including the worst hit city of Homestead. Teams of 2 therapists a t a time would be of great assistance in the next few months. When Ruth's &st attempts to get airlines to donate tickets failed, I did not stop. I successfully wrote a letter to the Chief Executive Officer1 Administrator a t College Hospital (Psychiatric), Cerritos, CA, where I have hospital privileges. I requested the hospital sponsor me by buying a round trip ticket to Miami and cover the cost of a one week rental car. Generously, the hospital chose to provide the ticket. I would like to encourage all EMDR trained therapists who might be considering donating a week in Florida or Hawaii to ask in your own community for sponsorship to assist you with transportation. If they deny you a ticket, ask them to make a tax deductible charitable financial donation to Therapy Research Institute, Inc., 8585 Sunset Drive, Ste. 65, Miami, FL 33143. The teams coordination in California is competently being handled by Sheryll Thomeon, MFCC, (510) 465-2542 if you are interested in joining in this very needy and worthy research project. Item #2: I attended the Network meeting in Sunnyvale and I was deeply moved into action when I received the compelling request from Florida EMDR therapist Ruth Knowlee Grainger, Ph.D., asking me to join a Volunteer Disaster Response Team of EMDR trained therapists to work with Hurricane Andrew andlor Iniki survivors. I will join Dr. Grainger in Miami November 29 thru December 6 along with a t least one other therapist. Judy Albert, MA, asks: Does your arm, elbow, shoulder get tired after using EMDR? Sometimes mine does even after using both arms. I had to search for a n arm relief alternative since I will be going to Miami, FL, to work on the EMDR Disaster Response Team treating Hurricane Andrew survivors. My success came when I found a n Emphasis "Pocket Pointei' which is extendable to 25" in length and retracts to the size of less than a small ink pen and has a clip on it to attach to a pocket. They are used in lectures as pointers for presentations. Some even have a �E M D R Netwo k N e w s l e t t e r Dec. 1 9 9 2 following the EMDR treatment. No control groups were used for this field research. Due to the diBculties inherent in a disaster, SUDS levels and IES were obtained from only a portion of those treated. (Also, there were Spanish-speaking individuals with whom EMDR was conducted with an interpreter and they did not fill out the English scale.) Pre- and post- SUDS levels were obtained on 16 clients, the pre-SUDS averaging 8.0, and a post-SUDS averaging 2.2. light on the end. I purchased my metal pointer a t a large stationary store for $4.98. My body and clients have responded very favorably. 22 clients filled out the Impact of Events Scale, with a n intrusive subscale mean of 23 and a n avoidance subecale mean of 21 with the total mean of 44 (out ofa possible 75). On November 1, 1992, a three-person disasterresponse teamof EMDR trained therapists, consisting of Nancy Walker,MFCC, fromSunnyvale, CA, and Bill Reid, LSW, and Bill Owens, LISW, h m Columbus, OH, paid their way to Miami for the privilege of working with disaster survivors and utilizing EMDR. The team was oriented to the disaster area, including a self-guided tour, during which time the team saw four clients. The Team worked 5 days in three locations (Homestead, Cutler Ridge, and Sunset area), and 30 clients were seen that 1l t h week after Hurricane Andrew. Clients ranged in age h m 3 87 and included police officers, nurses, administrators, managers, real estate salesmen, attorneys, nursing faculty, and volunteer relief workers. Those treated were from t h e US, Columbia, Cuba, Guyana, Nicaragua, Panama, Peru, and Puerto Rico. The procedure was often conducted in English a n d through a translator in Spanish. Six clients returned phone calls to participate in the one week followup, reporting SUDS levels which averaged 2.3 and IES totals of 31 (Intrusive mean 13and Avoidance mean of 18). The newer rating method of 0,1,3,5 was utilized. The average number of hours spent by the EMDR team was 1.5 hours per session. 14 out of the 30 seen had lost their homes (nearly 50 %). The major symptoms complained of were: irritability/anger/frustration (16), sleep difliculties (9), depression (8), anxiety (5), eating difficulties (4), nightmares (4), crying (3), and physical complaints such as palpitations, nausea, high blood pressure, headache, and asthma. Other reports included feelings of guilt, pity, disorientation, hopelessness, helplessness, fear, and worry. - Clients wrote comments regarding their treatment: "The experience I have had with this therapy is truly amazing. It's like being able to look a t yourself, from within, but also h m without. My feelings and emotions came through, without really knowing that I felt so strongly about some of these things. I really like the feeling of peace I have a t this moment. Thanks." The original purpose of the Team working in Miami was to provide EMDR treatment to Hurricane Andrew survivors. After the first day, however, we decided we would be able to conduct preliminary disaster field research. The project was designed and forms printed that night. Each client listed hidher symptoms since the hurricane, filled out an Impact of Events Scale (IES), and reported SUDS levels prior to and I and thoughts substantially, and am now more hopeful about the future." "Excellent therapy provided by an excellent therapist. Through (this) procedure, I've been able to feel a calm that I haven't felt in months." And on one week follow-up, comments included: "It worked. If you want a recommendation from me, just call." "Calm ... the most striking thing was calm. My problem is still there, but I can handle it." A three-year old child who screamed every time the wind blew, refused to have the door open or to play outside, was treated with EMDR. The next day the mother reported he left the door open and was happily playing outside in the wind. We are greatly encouraged by the response of the clients we were able to see. Teams of EMDR trained therapists will be arriving in South Florida November 29, and will be here through December 17, and will once again be providing EMDR treatment to Hurricane Andrew survivors, without cost t o t h e individual. Sheryll Thomson, MFCC,continues to coordinate efforts h m California. Please call her a t (510) 462542 to volunteer for the team. We have several slots still open. Research indicates the most di€ficult time psychologically is the 3-6 month period following the disaster (Christmas falls right a t 4 months). We are concerned about imminent depression and increase in the suicide rate during that period. Hopefully, the Team's arrival in early December will mitigate that. The need for EMDR in South Florida will continue for months, possibly years. If the estimated 75-80% of disaster survivors resolve their 'I have reduced my negative feelings culties naturally, and without psy- �EMDR N e t w o r k N e w s l e t t e r D e c . 1 9 9 2 chological a s s i s t a n c e , in 16-21 months, that-stillleaves several hundred thousand individuals who eventually will need treatment in South Florida. At this early time after the disaster, almost evelyone is having symptoms of post-hurricane stress to some degree, and could benefit h m EMDR. The Team felt like there is a "window of opportunity" when survivors are vulnerable after the disaster, making EMDR even more effective. We anticipate this psychological window to last for the next several months, and would be grateful to have a s many survivors treated a s possible, hopefully preventing l'TSD. Please mnsider volunteering to spend a week in Florida. The Disaster Response Team needs funds for airline tickets, rental cars, food, lodging, copying, posters, research requirements, stamps, secretarial support to schedule appointments, supplies, etc. If you can not volunteer in Florida, please make a contribution for the Team, payable to: Therapy Research Institute, Inc. Donations are tax deductible according to the Internal Revenue Code. An EMDR mail group exists on the VA electronic bulletin board. You need access to FORUM to get to the mail group-this is obtained a t your local station. This is open only to VA individuals who have completed EMDR training. For enrollment, send copy of training certificate with access name and address to: JOAN BARRON MN, RN, C.S. (118) V.A. Medical Center 4100 West Third Street Dayton, Ohio 45428 (513) 268 6411 ext 2678 F ' Phone # 950 2678 IS - - sented the most painful experience of this revieweis professional career. Not an Endorsement This book is the well-written account of aloving Kleinian therapist's work with a dying 7 112 year oldboy. The author opens with a vely articulate and informed discussion of the concepts of death and dying, with particular emphasis on children's attitudes toward death. Her presentation is richly textured with psychodynamic impressions, interspersed with literary allusions and metaphors. These opening chapters lay the groundwork for the heart of the book, a day-by-day journal of the therapist's work with Robert who is suffering h m leukemia. Robert's family has opted for an experimental treatment which affordshis only, though slim, possibility of survival. The author attempts to place this treatment "within the context of new developments in hospice and hospital care" and concludes the book with a plea for informed consent regarding medical treatmenti.e., a clear understanding of the compromise to quality of life that experimental procedures may entail. Ironically, the authois understanding and enlightened approach to alternative medical, group, and hospice care does not seem to be mirrored in her own psychological treatment of the dying child. This is highlighted in her day- by-day journal, the reading of which repre- The book reveals a therapist with "training in psychoanalytic psychotherapy," attempting to "share and explore the aspects of the child which previously were not accessible to his conscious mind" (p. 61). As such, "the transference and its interpretation becomes one of the main tools in bringing about change" (p. 6). While the author readily notes limitations that the hospital setting places on this form of therapy (e.g., the inability to keep the session time constant, and the need to focus on the child's response to the illness), she fails to alter the traditional analytic stance by t h e introduction of other approaches during her own treatment sessions. Consequently, during the two and a half months of treatment, primary interventions of this therapist are limited to a form of interpretive play therapy, e.g., "you're like the baby (doll), lying down a lot and having to be looked aftei' (p. 87) and pointed observations. Particularly illustrative of the authois therapeutic approach is her deduction that Robert's picking a t his nose is a form of masturbatory play and a n attempt a t mastery and control because of his illness and hospital confinement. On the basis of this interpretation she "talk(s) to him about how busy he is with his nose, and how important it must be to be the one who decides now about poking in, when doctors and nurses have to poke in a lot these days, in different ways" (p. 106). Similarly, she observes of the gurgling intravenous tube, "The drip is deciding to feed you. Even your tummy isn't deciding when it's hungry .... It's being automatically fed every few moments" (p. 106). At no time does the author introduce any pain control o r self-mastery techniques, guided visualizations, hypnotic fantasies, cognitive restructuring, or relaxation techniques. Instead, as readers, we are forced through the �EMDR Netwol k N e w s l e t t e r Dec. 1992 disheartening experience of watching the day-by-day disintegration of a child in pain, picking his lip and nose to shreds-while the therapist, albeit sorrowfully, observes that analytic writers have concluded that "nose-pickingappears to be more of a masturbation equivalentn than facefingering @. 130). ARer the boy's death, the mother reconciles her feelings and states to the author, "You were there for Robert, and he valued you. That's the important thing" @. 145). However, an equally pertinent view might be found in a question the author herself posed a s she observed nurses popping their heads into the room while she was treating the boy: "Some seem puzzled about who I am and what I'm doing here" @. 100). The question transcends any particular perspective on debatable issues such as the manner in which a person should face death, or the long-term effects of rapid psychological change. Perhaps, the question can more fruitfully serve clinicians to focus attention on their boundaries and limitations, how they interface with the unique needs of the client and situation, and the degree of informed consent of the client regarding alternative approaches. It appears to this reviewer to be an ethical mandate that the client and situation dictate the formofthe therapeutic practice. As extrapolated from this text, we a s clinicians must remember that theoretical approaches, other than those we favor, may be sincerely held by honorable and competent people, and ultimately that the client must be offered choices. Just as informed consent is ethically mandated medically and in research, no less should it be mandated clinic- ally. For this, the present volume, though inadvertently, provides a n eloquent plea. Sometimes t h e EMDR work can bring unexpected delights. I was working with a client whom I had been seeing for close to a year for general anxiety and procrastination. We were in the middle of a session, involved with constructing a cognitive weave regarding a projected behavior. The positive cognition was, "Taking even a small step is good for me." Following the set of eye movements, the client in his customary "deadpan" fashion said five (VoC = 5). I asked the client to repeat the sentence to himself again and proceeded with another set of eye movements. This time he responded, in the same deadpan fashion, five and one-eighth. He saw the puzzlement on my face as I began to comment about what fine gradations of truth he was able to evaluate. Without cracking even the hint of a smile, he looked directly a t me and said, "Taking even a small step is good for me." Another client I dealt with was referred for the loss of a finger in a n industrial accident by a psychiatrist who was not able to help this client psychologically adjust to the loss. The EMDR method seemed to deal with this issue completely in one session, although the chain of association led to some other life events and stressors for which we spent quite a few sessions. Yet, how do we know that a n event so traumatic as losing part of ourselves is really dealt with in a complete fashion? A couple of weeks after we worked on the loss of the finger, the client came in with a big smile on his face a s he settled down in his chair. m i c a l l y , I would surreptitiously examine the stub of his finger a t the beginning of each session to make a layperson's evaluation about how it was healing (e.g., checking for any sign of inflammation or infection). This time, my glance downward was rewarded by one of the most unusual sights I have ever seen. The client had fabricated a small leather cap that perfectly fit over the finger stump and had inserted into the top of the cap a small brass hook (yes, he had become the Captain Hook of the industrial accident crowd). As my sense of immediate shock dissipated, we both broke into laughter and shared a moment which I will always hold a s precious. The efficacy of the EMDR procedure may certainly be approximated by reduced SUDS and increased VoC levels. However, a smile or a funny line can also signlfy the subtle shifts we see with clients and can certainly touch my heart. We would like io include similar case siories in future Newsletters. Pkase consider sending in your favorite "heart warmer." There is more to professional support than sharing the "pain"!Let's also share the joy. Francine �EMDR N e t w o r k N e w s l e t t e r Dec. 1992 Informed Consent While we had hoped to distribute a sample informed consent form with this packet, EPIC has recommended that it be reviewed by a n attorney to assess any redflags not obvious to lay people. We will attempt to send the form with the next packet. It is necessary to keep in mind, however, that regardless of a single attorney's response, each clinician should have it reassessed, since each state will have different legal criteria. EPIC (EMDR Professional Issues Committee) The EMDR Professional Issues Committee (EPIC) is recruiting new members that have either experience or interest in professional and ethical issues. We meeton the third Wednesday of each month h m 10:OO A.M. to 11:OO A.M. in Palo Alto. Contact one of the following: LoisAllen-Byrd, Ph.D.(415) 326-6465 Virginia Lewis, Ph.D.(415) 326-8752 M. McCorkle, Ph.D. (41 5) 322-4884 Fighting Predjuce I a m asking for ideasor collaboration in developing interventions for modification of prejudice. During my work in the Mississippi Delta a t a community mental health center, it has often seemed that individual patterns of intense prejudice could be viewed a s schema driven clusters of intense negative affect, irrational thinking, and behavior which result in both avoidance of cue exposure and maintenancelsupport ofcore cognitions. Many victims have also experienced related traumas or long series of "mini traumas." EMDR could be part of a schema-focused, cognitive-behavioral intervention. Contact: Richard Sayner, Ph.D., Life Help, P.O. Box 1505, Greenwood, MS, 38930. EMDR In Employee Assistance Program (EAP) EAP professionals who are using EMDR are invited to network with other EAP professionals to explore selection criteria, contraindications, evaluation, and research possibilities. Contact: Robert J.Peters, LCSW, CEAP, Mgr, Employee Assistance Program, Rocky Mountain Adventist Healthcare, 2465 S. Downing Street, Ste. 200 A, Denver, CO 8021 0, (303) 778-5272,FAX (303) 778-5769 Surveys H o w a r d Lipke, Ph.D., Director of the Stress Disorder Treatment Unit of the N.Chicago, VAMC, sent out surveys to all EMDR clinicians trained before Feb., 1992. Please return the survey to him before January. I t will be invaluable for an independent assessment of EMDR treatment effects and pitfalls. Results will be published in 1993. Clients With Head Injuries Clinicians who are using EMDR with this population are invited to network with other clinicians to explore indications, contraindications, evaluation, and research possibilities. For more information. Contact: Robert J. Peters, LCSW, CEAP 1720 S. Bellaire Street, Ste. 805 Denver, Colorado 80222 (303) 790-5762 Disaster Research Tools Ruth Grainger requests copies of disaster research tools. If you would like to consult on a longitudinal disaster study to determine the efficacy of EMDR a s a post-disaster treatment, contact: Ruth Grainger, Ph.D., Therapy Research Institute, Inc., 8585 Sunset Drive, Ste. 65, Miami, FL, 331 43 (305) 595-3399 eve. Volunters for Rape Research Priscilla Marquis, MS, and And r e w Leeds, Ph.D., are planning a n EMDR research project using rape victims a s subjects. This project i n t e n d s to a n s w e r criticisms of Francine's original 1989a study. They are looking for interested Level I1 trained therapists who live in the Bay Area or who are willing to travel to the Bay Area for a research training. The time commitment will involve a one day research protocol training and approximately an additional ten hour commitment. Clinicians who participate must be willing to videotape their sessions for research purposes and have access to videotape equipment. Therapists will participate on a voluntary basis. Priscilla and Andrew hope to recruit 15 clinicians. The project should begin in December, 1992, and last approximately three months. Contact: Priscilla Marquis, MS at (415) 285-4065. EMDR Bulletin Board We are still considering a n EMDR computerBulletinBoard where questions can be posted regarding problems encountered in clinical practice where other clinicians could reply with solutions and ideas h m their personalexperiences. Ideas, data, and information exchange on Special Interest Groups or client related topics would be available 24 hours a day, 7 days a week for Network subscribers. Contact: A. J. Popky, CHT, (408) 395-8541, fa: (408) 395-0846 �EMDR N e t w o r k N e w s l e t t e r Dec. 1992 firat utilized, followed by a gradual tapering off of both frequency and intensity as sessions progress. More interesting, however, are dramatic changes in the content of remembered nightmares, Many of my clients are combat veterans who have been experiencing their various PTSD symptomatology for 20 years or longer. Because of the extremely subjective nature of their experiences, and the fact that gains in reprocessing do not necessarily transfer into immediate behavioral changes, I have sought ways to document my clients' progress a s treatment continues. Among the most common symptoms reported by my clients are sleep dis- turbance and nightmares. Soon after beginning to, use EMDR, it became apparent to me that both the frequency and content of these night- time SUDS were being affected. In general, I am noticing an immediate short-term increase in sleep disturbancelnightmares when EMDR is The first time I noticed this was with a 100% disabled vet who was suffering combat oriented nightmares 2-3 times a week. The most common of these involved his being chased by Viet Cong eoldiers through thejungle. On the night following his first EMDR session, he had a dream that he was chasing several Viet Cong who ran up a ridge and disappeared over the crest. This was the first time that he had dreamed of himself in a power position regarding Vietnam. He has since reported a dramatic decrease in the rate and intensity of his nightmare terror experiences. Other changes reported by my clients include a n initial sharpening of images in cases where the perceived threat is unknown, and a gradual fading of emotional intensity a s the Sexual Harassment Nancy Baker, PhD. Department Psychokgiit L.A. County Sheriffs Department Aaoraphobla b Panlc Disorder Alan GoWtdn, PhD. Director,Agoraphobia 8 Anxiety Treatment Center Dept.of Psychiatry,Temple University Combat-Related PTSD Howard Upke, PhD. Director,Stress Disorder Treatment Unit VA Medical Center, North Chicago MultlplePersonalityblsorder LhWdFenstemaker,PhD. JFK University,San Jose, CA images are re-experienced after several sessions. Long-standing recurrent dreams seem to undergo revision with treatment, and this revisioning almost always pertains to an increase in the vet's ability to negotiate the imaged threats in the dream sequence The gain in image clarity has proven extremely helpful for "fancy footwork" intervention to identity and remediate issues related to the individual gestalt of a particular vet (e.g., earlier traumas, his relationship with authority, etc.). I have also noticed a n improved ability to dream andfor remember dreams among my clients with whom I use EMDR. (I see this a s basically an increased access to their repressed imagery a s reprocessing continues.) These observations are obviously anecdotal and preliminary. I would be most interested in hearing from other clinicians who utilize dreamiing in their work with EMDR.W l liam Larsen, MFCC, PO Box 1061, Grass Valley, CA 94945, (916) 2655950. AuamentlngtheTreatmentwfthHvpnosls Emmett Miller, MD Director, Source Learning Systems Palo Alto, CA Crttical lncldent Trauma RogerSdomon, PhD. Department PsychologistWashingtonState Patrol Additional EMDR Topics include .Sexual Abuse .Eating Disorders .Self-Enhancement .Learning Disabilities .Current Research Findings .Cross-Cultural Applications .Obsessive Compulsive Disorder .Theoretical Convergences .Substance Abuse .Chronic Depression .Children 8 Sexual Abuse .Problems and Pitfalls .Art Therapy .Inner Child Work Cocktail Party Network Luncheon-SIG Meetings 20 Presentations & clinical roundtables �E M D R Network N e w s l e t t e r Dec. 1992 b s t e d Geographically North to South] REDDING CUPERTINO Dave Wilson (916)223-2777 Meets once monthly a t the Frisbee Mansion on East Street in Redding. Discussions, case presentations, videos, roleplaying,and 'troubleshooting." Open to new members. SACRAMENTO Barbara Erickson (916)737-1789 ICoordinating new group. Meets on 2nd Fri. 1-3pm Gerry Bauer (408)973-1001 Meets 2nd Wed. 2:00 - 3:00 pm. Case consultation. Open LOS GATOSISARATOGAICAMPBELL Jean Bitter-Moore (408) 354-4048) Meets the 3rd Thurs. 12:OO-1:30pm a t Mission Oaks Hospital, Conference Room 1. LOB Gatos. O ~ e n . SARATOGAtW. SAN JOSE SONOMA COUNTY Dwight Goodwin Meets Fri. loam-12:30. Open Kay Caldwell (707) 525-0911 Meetsin SantaRosa atKay's offie the4thTues. 1230-2:0@m. Primarily case discussion, videos addutroubleshooting"ofthe ~ M D ~ ~ r o c e d u k . Ooen. (415)454-6149 FRESNO Darrell Dunkel (209) 435-7849 Meets 1st Fri. a t Fresno VAMC. Primary case discussions. Open EAST BAY I SANTA CRUZ Linda Neider (408) 475-2849 Meets every monthon a Fri. 7:OOpm. Primarily case discussion. Open. MARIN COUNTY Steve Bodian Coordinating a new group. Open (510) 526-5297 Edith Ankersmit Meets 3rd Fri. 7:3Opm. Case discussion only. Groupie closed to new members, but willing to coordinate a new E. Bay group. . . EAST BAYIALBANY Sandra Dibble-Hope (5 10)843-1396x48 Meets 1st Mon. 8-9:30pm, 1035 San Pablo Ave., Ste. 8. EAST BAYIOAKLAND HankOrmand (510)530-1875 Meets inLake Merritt area on Fri. 10-11:30am. Open. PALMDALEILANCASTER Elizabeth White Coordinating anew group. Open. (415)241-5601 (805) 2728880 WOODLAND HILLSMORTHRIDGE/WESTWOOD RonDoctorlGinger Gilsen Seeking new members. Contact Ginger (818)907-7506 CENTURY CITYISANTA MONICA Robert Goldblatt (2 13)917-2277 Coordinating a new group in the 90067,9040 1 zip area for West L.A. SAN FRANCISCO SylviaMills (415)22 1-3030 Case discussion and group process. Open to new members. Stanyantis, MD Open to new members. (408)241-0198 WEST LOS ANGELES Geof&y White David Ready ~ o o r d i n a t i n new group. Open ~a (310)202-7445 (310)479-6368 DOWNEY SAN MATEO/BURLINGAME/REDWOOD CITY RonMartinez (415)692-4658 Meets 2ndMon. 7:OO-8.30pm. Forum to further the understandingand use ofEMDR. Case consultation and practice sessions available. Open Pat Grapinsky Florence Radin Coordinatinga new group. Contact Florence. (415)692-4658 (415)593-7 175 Pauline Hume Coordinatinga new group. Open MANHATTANIREDONDO BEACH Randall Jost Coordinating a new group. Open FerolLarsen (415) 326-6896 Meetslst Wed. 10:OOam in MRI conference room. Case discussion. Limited to 10 participants. (2 13)539-3682 TORRANCE James Pratty PAL0 ALTO (2 13)869-0055 (800) 767-7264 Coordinating a new group. Open ORANGE COUNTYIHUNTINGTON BEACH Jocelyne Shiromoto Meets 2ndTue. from9:30 - 11:OO AM. Open (7 14)680-0663 (714)764-3419 LOS ALTOSIPALO ALTO John Marquis (415)965-2422 Dewey Lipe (415)852-2855 Meets ad hoc a t Pacific Graduate School of Psychology in Palo Alto. 1 Primarily case discussion. Open. SAN DIEGO M a r e e Sherrill Times and dates to be arranged. (619)233-0460 �E M D R N e t w o r k N e w s l e t t e r Dec. 1 9 9 2 EMDRNewsletter Staff Editor: Co-editors: Publisher: Nat'l Network Coordinator EMDR Coordinator: 1993 Newsletter Publication Dates Deadlinefor Submissions Jan. 2,1993 for Jan. 20,1993 Mar. 15,1993 for Apr. 20,1993 Jul. 15,1993 for Aug. 20,1993 Oct. 15,1993 for Nov. 20,1993 David Fenstermaker, Ph.D. Ron Martinez, Ph.D. Andrew Leeds, Ph.D. Lois AUen-Byrd, Ph.D. Robbie Dunton, MA A. J. Popky, CHT Cliff Levin, Ph.D. Robbie Dunton, MA Submit all articles io EMDR Network newsletter^, P. 0. Box 51010, Pacific Grove,CA 93950-6010, (408) 372-3900. [Address articles for "Innovative Ideas" to Ron Martinez, Ph.D., and "Difficult Cczses" io Andrew Leeds, Ph.D.1 I f possible, articles need io be submitted on an IBM formatted diskette, Apple hi-density diskette or typewritten. The deadline for the next Newsletter will be January 2, 1993. 1993 NetworkRegistration Form $50 (Print following information as you want it to appear in directory.) Last name: Professional Degree: $70 (IncludesCA Meetings) First name: City where practicing: State: Zip: [Mailing addtess and residence phone number will s t appear in directory.] Mailing Address: Phone (Bus): Professional Licensing: Specialty Areas: AABT Membership: ISTSS Academic Affiliation: SIGs or special interest areas: EMDR Level: [ ] Level I - Year trained: Comments: City: State: Willing to take referrals: yes Zip: no APA Other: Research Interests: [ ] Level I1 - Year: [ ] Facilitator Costfor participating in the Nat'l Ndwork is $50 for 1993 1570 inclrrdes Nat'l Network meetings in Ccllry Bay Area] Nd'l membership e n W s you to receive copies of the EMDR Nousleiters, journal articles, directory, sekctkd audiotape^ and discounts on the EMDR Conference and specialty trainings. Checkpayableto: EMDRNetwork* P. 0.Box 51010* Pacific Grove* CA 93950-6010"(415) 328-5821 Newslscter Training Registration Form Name: Phone (Bus): Address: PLEASEPRINT NAME THEWAY YOU WANT IT TO APPEAR ONTHE Phone (Res): CERTIFICATE City: State: Zip: Prof. Lic. #: COST: $285.00 [$315 postmarked 15 to 30 days before seminar date, $345 less than 14 days before seminar, CEU $101. Make check payable to: EMDR, P.O. Box 51010, Pacific Grove, CA 93950-6010, (408) 372-3900, fax (408) 647-9881 Please circle: LEVEL I: Location: Date: LEVEL I1 Location: Date: Specialty: IfLEVELII: Your date of Level I BasicTraining: Additional requests for topics in training: [For Office use Only: Amt Ck Confrm 1 Ncw#lstcer �EMDR Network N e w s l e t t e r Dec. 1 9 9 2 I Date Location Local Sponsor Jan. 21/22 Thurs.lFri. Perth, Australia Parmelia Hilton GrahamTaylor, MA Chris Lee,MSC Jan.29/30 Fri./Sat. Sydney,Australia The Ritz-Carlton Robbie Corbet,B.S.C.,Dip.Psych. GaryFulcher,M.Psych. Feb. 314 Wed.murs. Wellington,NZ ParkRoyal Feb. 19/20 Fri./Sat. San Jose, CA Sunnyvale Hilton RobbieDunton, MA Coordinator.EMDR Feb.27/28 Sat.lSun. Dallas, TX Holiday Inn DFWAirport N. Deborah Corley, MA Dir.,DiamondMt. CenterlDallas Apr. 314 Sat.lSun. Washington,DC Omni Shoreham Sherrie Vavrichek,LCSW ConnieOlsen,LCSW Myron Brenner, MD ManuelMorales, Ph.D. Apr. 17/18 Sat./Sun. Denver, CO Sheraton Denver Tech. Center Andrew Sweet,P8y.D. Behavior Therapist Inst.of CO (303)759-3720 May 112 Sat.lSun. Chicago, IL Holiday InnCrowne Plaza Northbmok, IL HowardLipke, Ph.D. Dir., Stress Disorder Treatment Ctr. N. ChicagoVAMC (708)688-1900x4073 May 14/15 Fri./Sat. San Jose, CA Sunnyvale Hilton RobbieDunton, MA Coordinator, EMDR May22123 Sat./Sun. Honolulu,HI PacificBeach Hotel SandraPau1seqPh.D. Pacific Inst. of Behavioral Med. June 18/19 Fri./Sat. New York, NY Loews NY Hotel (Slat. &Lexington) June 27/28 Sun./Mon. Portland, OR Sheraton Portland Airport I RobbieDunton, MA Coordinator, EMDR Apr. 23/24, 1993 FriISat San Jose, CA Sunnyvale Hilton J u n e 12/13, 1993 SatISun Denver, CO Sheraton Denver Tech. Center July 10111, 1993 SatISun Chicago, IL Holiday Inn Crowne Plaza Phone (01161)23894021 (01161)27366550 (214)350-1431 (808)523-2990 Jean Sutton,LCSW History-taking and specified questioning for focused identification of problem areas Closing down "incomplete"sessions I Axis I1 applications Integration of E D with cognitive therapy M R Dissociative & other major disorders Abreactive responses and alternative strategies Contact: Robbie Dunton, MA Coordinator, E D M R (408) 372-3900 fax: (408) 647-9881 Working with difficult/resistant clients Integrating "self-control"techniques Treatment of Process Phobias I �................................. .......................... ......................................................................................... ................................1 STRAYTHOUGHTS r e p W.D : ANOREXIA, BODY W E . AND SELFACCEPTANCE....................... E ~ eMD...... .................................................. r; ........-........2 INTERNATIONALUPDATE Rancine Shapiro.Ph.D .............................................................................................................. : : 3 REGIONALNETWORK COORDINATORS.......................................................................................................................................................... 3 BEHAVIORALVALIDATIONOF EMDR:ZWOPTSD CASES.................... RobertFlint, Ph.D............................................ ..................... 6 NElWORKDIRECrORY.......................................................................................................................................................................................... 6 1998 EMDRCONFERENCE ..................................................................................................................................................................................... 7 DIFFICULT CASES.................................A n Ph.D............................................................................................................................... 7 EMDRREFERENCES.................................... ..................................................................................................................................................... 8 EMDR INNOVATIVE USES .............................. o n M a r t i Ph.D.................................................................................................................... R 9 ERRATUMAND CIARIFICATION............................ b e e MA....................... ............................................................................. 9 1998 EMDRNENVORKSCHEDULE .................................................................................................................................................................. 10 SUBJECTIVE UNIT OF MOTIVATION............Linda N e i d r MA, ATR .................................................................................................1 1 ... EMDR RESEARCH DATABASE........................ n F rP D.................................................................................................................. S 11 PROTOCOLFORDESEN!3ITIZATIONOF RECENTTRAUMATICEVENTS.............. ogerSo10mon Ph.D ........................................ R 12 BOOK REVfEW: Ronald Kauhan, MS w...... e by Stephen Koaslyn and Oliver Koenig........13 USINGEMDRWITH PATIEXWSWLTHAHISTORYOF SADISTICANDRITUALABUSE.......... WalterYoung. MD........................ 14 DO YOU HEAR FLORIDA CALLING? J u d y A l MA........................................................................................................... 16 HURRICANEANDREWDISASTERRESPONSETEAM...................................... RhKnowlee Grainger.Ph.D ........................................ 16 BOOK REVIEW ...; ..... Francine Shapim. Ph.D ........ w W o r d e : by Arthy Judd ..............................7 1 V A N E T W O R K B ~ B O A R ...................................................................................................................................................................... D 17 THEHEARTOFEMDR...................... lif%evin,Ph.D......................................................................................................................................... C 18 EIKDR HELPWANTED............................................................................................................................................................................................ 19 MONITERINQTHERAPEUTIC CHANGEVIADREAMCONTENT............. WiUiamLamen.MFCC ...................................................... 2 0 CALIFORNIAEMDRSTUDYGROUPS ............................................................................................... ........................................ 21 SUBMISSIONANDDEADLINE INFORMATION............................................................................................................................................ 22 1998 TRAIN7NQSCHEDULE............................ ................................................................................................................................................. 23 - .. . . ....... .......................... ....................... EMDR Network PO Box 61010 Padfic Gmve. CA 989604010 . EMDR Network Newsletter Dec 1992 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter Newsletter Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter, 2(2), 1-24 https://d1y502jg6fpugt.cloudfront.net/13023/archive/files/d8d4f9c16efe18bdedbe93a43704bd19.pdf?Expires=1790208000&Signature=oKk2v3W2LBfXmX2aV-FV9jQRkuGcGnnwU6dxahWoAEuY3a1mhxkvT3BiIjgoSZwUpb8N6rwqQekzQEfperjLfj%7EKYaBDbLQF8uzs0lxHV60lOcHWn5a-wJrq1ZPbibNqb6IonIiZVhAI7oTX-493c38Nv%7EW1wH-b7P2fbPvISGwZrZJBAUQIuUU52k5itZOTBWTSRkZmOomPJ24h2g8HObbdxnsHk-4lwSnp0Hwcht5CTKI4H63TlvDlp01ffv-F5XJi2G%7E82iUyMhnkmbtSwRVCDj0MutwXUDGxWFBuDzhCqB8nr5iSfByDM%7ERXIu84kpTGAJpPZPubJ2Q7LnTs-w__&Key-Pair-Id=K6UGZS9ZTDSZM 26ebba6817d972f999c62ee2576974bd PDF Text Text EMDR N e t w o r k N e w s l e t t e r W i n t e r 1 9 9 2 Winter 1992 a m 0Network Newsletter ~ Vo1. 2 Issue 3 EYE MOVEMENT DESENSITIZATION AND REPROCESSING Copyright 0 1992 EMDR P.O. Box 51010, Pacific Grove, CA 93950-6010 (408) 372-3900 IN MEMORIUM Ron Martinez, Ph.D. It is with the deepestsorrow that weannounce thepassingofRon Martinez, P h D., from a very rapid and virulentform of cancer. Ron was an extraordinary clinician, facilitator, and co-editor of the Network Newsletter. As the keynote speaker at the 1992 EMDR Conference,he illuminated the heart of EMDR He moved the entire audience to a thunderous standing ovation-for who he was, and what he offered Knowing Ron was an honor and a privilege. As a quadr&degic, resulting from a freak accident during adolescence which &bed him of his prized athletic ability, Ron chose a life of service, rather than of self-pity, and was an inspiration to all who knew him With a quiet sense of surety, hefoughtfor what was truly valuable in l i f being open topossibilities with a self-worth born of "love, laughter, and learning. " He taught that, regardless of the adversity and the depth of pain, the human spirit can triumph over despair and make an indelible mark on the lives of others. He said he wasproud to be apart of the evolution of EMDR and was gratefulfor what it allowed him to offer his clients, yet he empowered more than he receive& as a "light," a support, and a living example of "It's not what happens that matters, but how you deal with it. " Hesaid hisfinal lesson was "All that counts is whoyou love and who loves you back." Very simple, and yet very hard to fully comprehend and live by-moment by moment, day by day. AllIknow is that he died as he lived, with grace, peace, and dignity. He passed withoutfear, knowing it was the right time, and that he had done all he needed to do-comforting those around him with love and compassion. He will be missed He will not beforgotten. F.S. Memory Retrieval It appears as though one of the heritages ofthe psychodynmc model is the belief in the need for "uncovering memories" as necessary prerequisites for "working themthrough." Consequently, it appears as though some EMDR-trained clinicians have decided to use a combination of EMDR and hypnosis for "memory retrieval." While hypnosis has been a highly successful and standard form of practice for many years, its interaction effects with EMDR have not been systematically investigated. Therefore, I would like to issue some additionalwords of caution in this regard, since each clinician is bound to approach issues of possible "repression" and "resistance" in ahighly subjective manner. The points are made below in order to highlight factors that might possibly have been forgotten or overlooked by some clinicians in the merging of variant models. (1)As I have repeatedly mentioned in the trainings, there is no way of knowing whether a memory that emerges is true or not. The very attempt at "memory retrieval" as a goal may set up a frame that a memory exists, that it should be revealed, and that there is a perpetrator. This may be a perfect set-up for a false �EMDR Network N e w s l e t t e r W i n t e r 1992 California Colorado Connecticut Georgia Hawaii Idaho Illinois Maryland Massachusetts Missouri New York Jean Bitter-Moore, Ph.D. Andy Sweet, Psy.D. Steve Lazrove, MD Pat Hammett, Ph.D. Sandra Paulsen, Ph.D. Dean Funabiki, Ph.D. Howard Lipke, Ph.D. Mike Brenner, MD Me1 Rabin, Ph.D. Elayne Weiner, Ph.D. Marcia Whisman, LCSW William Zangwill, Ph.D. Gerald Puk,Ph.D. New Mexico Pennsylvania memory syndrome. When a memory is revealedwith EMDR, there is a possibility that the event in question was vicariously experienced (e.g., identification with a characterin a Story) or that it is the result of trickery k g . , a perpetrator dressed as Satan). Either of the above factors could be responsible for the client's belief that family members participated in a molest. circumstances. EMDR is not designed to bring visual memories to the surface, but is rather an attempt to process infonnation that is dysfunctionally stored in the nervous system. Therefore, the concentration is on the symptomatology, and what would be necessary to alleviate the pain experienced in present time. A metaphor that the client may appreciate is that the VCR can be whether or not the n~onitor on. Consequently, is The "revelations" of horrible abuse can there can be a shift in the dysfunctional be extremely disturbing to clients. TO reactions and triggers without visually insist that the memories are true may accessing the core events that set the only add to the distress for some clients. problems in motion. An appropriate A more appropriate stance m y be that stance with the client might be a discuswe cannot know for Sure whether the sion of actual gods in therapy. Would it memories are true or not; therefore, it is be appropriate to alleviate the pain withimportant to c43nCentrate m r e O the out surety of cause? If the client is not in n present symptomatology or distress. agreement with this, then EMDR should Focusing O the intm'd reaction to the not be offered as the only dternative, as n possible perpetrator will be necessary it is by no means certain that the actual whether or not the memory is accurate. memory will surface. (2) The ability to retrieve memories of abuse or large blocks of childhood events is questionable even under the best of (3) Client readiness should also be a consideration before treatment. When there are a number of "consensus real ity"problems in the client's life (e.g., job or family crises), uncoveringwork should be kept at a minimum. Regardless of the form of therapy, the client should be stabilized in his or her ability to handle his or her present real-life experiences before adding the additional emotional load of early trauma work. The midsession disturbance caused by the information processing can causethe client to be unable to handle the real fundamental financial and legal needs that are out of his or her control and that he or she cannot put on hold. Please recall that the cautions regarding the use of EMDR with any individual client include the appropriate assessment of all real-life constraints. Ifthe exhaustion or distress that sometimes arise with EMDR would be detrimental to present functioning, then other methods should be used until a more congenial time. (4) Hypnosis and EMDR may not be an appropriate combination. While light trances are induced in dissociative der clients by some clinicians, the use of dSp trance may be contra-indicad because the altered state of hypnosis may not permit all the idomtion to be Aequatelyprocessed.Jwtastraumashould be ,,wgeted when a client has been off any medication in order to check for any remnants in state specific form, the same may be said of hypnosis. Further, the use of hypnotic suggestion construct a fanmy is not amethat nable to actual processing, just as indi,,tions have been that delusions are not susceptibleto change with EMDR until the experiential cause is targeted (e.g., wife leaving by choice as opposed to a kidnap delusion), hypnotically induced fantasies and false memorieslikeare wise not necessarily able to be shifted. ~ddin~ EMDR to a hypnotically induced memory my be severelydisturbing to the client and not allow adequate resolution. ( 5 ) Signs ofprolonged distress and inadequate resolution of memories with EMDR are a sign that other methods ������������������� Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter Newsletter Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter, 2(3), 1-20 https://d1y502jg6fpugt.cloudfront.net/13023/archive/files/93308102505141fa3cc4133f83ff7b21.pdf?Expires=1790208000&Signature=Qa8jgScv%7EWRqis8xIjfM9lGre9YtezVeFRb5h8sVhbWVgF5fS%7EkVsFmqqITbz-mOE9ZOf%7EILRiI9h2ANyD2qqgOPEd2xd8Y8zJNeBYRXoC9%7E1dIHVfEflSsdaJ3m6T5nCHetr-EYStfGiMqqOQLGaZsZ0u3iULomfoIQjxLy-SleLgmkZsJNfKT%7EH7njoKSaP8Ab7Xk8tFKf0rG8Bx9OnAj2vloeIkDzJbkQU%7ERHyn4jfVNbjPFIabVGiZlvJvd8BaeVoN1Fzpsbh9yaErG5V-QxLOLus9lm3VWzovdg9ty6QcKAy7rMYT5qzDJ1HHRk4an7LDY%7EfpqwJOpq8YoftQ__&Key-Pair-Id=K6UGZS9ZTDSZM 4fa47d7c9ec49e37cac5d2072efc6a1c PDF Text Text L Spring 1993 1 Vol. 3 Issue 1 Network Newsletter EYE MOVEMENT DESENSITIZATION AND REPROCESSING Copyright O 1993 EMDR P.O. Box 51010, Pacific Grove, CA 93950-6010 (408) 372-3900 What does happen is that its opponents gradually die out and the growing generation is familiarized with the idea from the beginning" (The Philosophy of Physics). - The following is the full text of the Keynote address I only partially gave a t the 1993 EMDR Conference. I say only partially gave because one-quarter of the way through, I decided that I could not bear to read it and just went "free form." Upon rereading it, I thought some of the ideas were provocative enough to retain, so here it is. The Boundaries of Quantum Psychology We have gone from Kitty Hawk to a man on the moon in only fifty years, and yet we have not had a major paradigm shift in psychology since Freud nearly 100 years ago. Clearly, attitudes change more slowly than technology. EMDR appears to represent a paradigm shift that has similarities or parallels with the two most significant paradigm shifts in the last one hundred and fifty years--quantum physics and the theory of evolution. However, as the famous physicist, Max Plank, once said: 'An important scientific innovation rarely makes its way by gradually winning over and converting its opponents . . . I'his quote has been sent to me by nore than one EMDR therapist, for ~bvious reasons. The problem with accepting a new paradigm appears to Je the need for certainty. The model ,ve grew up with is the one which gives u s comfort and asense of surety. Accepting a new paradigm challenges l u r sense of security, of the known. Just as the abused child clings to what is known, we often cling to our limitations rather than face the unknown of new possibilities. This clinging to order, rather than facing the chaos of a new beginning, brings u s to the threshold of one interesting parallel between EMDR and quantum physics-the concept of certainty. In reference to theHeisenberg Principle of Uncertainty-the unpredictabihty of sub-atomic particlesEinstein declared his disagreement that the universe could be governed by chance by stating that, "GOD would not roll hce." While I have a great love for Einstein, I would, however, point out that GOD would play h c e since he would already know the outcome. How can chance and prediction, chaos and order exist simultaneously? The ultimate message for u s is not to be afraid of paradox. Life is a constantjuxtaposition ofhorror and beauty, spaciousness and limitation, :haos and order Some people think that by finding the :awe and effect of behavior, or reducmg behavior to a physiological level, they are taking the mystery from the human mind. However, the mystery ~f the world does not vanish when :ause is sought or found. The search that has led to quantum physics is a perfect example, one which is alive with mystery andparadox. The search for certainty led to the Principle of Uncertainty. To be and not be simultaneously. To be in two places a t the same time. Perhaps further investigation will show another level where apattern again emerges. What seems Like chaos a t a thread's eye view emerges as pattern when seen from above. Those who view the physiological causes of pathology as reductive do not see the continued mystery. In EMDR, clearly a form of quantum psychology, consciousness remains free. The body and brain are either playground or prison of consciousness. The equation might read that consciousness plus brain equals "mind." The mind is awash in fear and all of the mechanisms of survival are inherent in the "hard-wiring" of the body. The goal of c h i c a l psychology is to liberate consciousness from these hctates. One of the attributes of quantum psychology is that it has been liberated from the constraints of time. One of t h e observations of quantum �PLEASE NOTE: As of August 1. 1993, the Colorado Regional Coordinators will be Laura Knutson, LCSW, (303) 620-7198 and Jana Marzano, LPC, (303)220-1151. Spring 1993 - (408) 354-4048 Connecticut Hawaii Idaho Illinois Maryland Massachusetts Missouri New York New Mexico Ohio Oregon Pennsylvania Texas Washington Don Wright, physics is that an electron can be in two places at the same time. I t can move from one orbit around t h e nucleus to another orbit in "no time." Similarly, this liberationfiomthetemporal, the ability to move rapidly through information and pathology, is a hallmark of EMDR. Critics of both fields point to this as being "incomprehensible" and, therefore, reject them. However, the lack of the ability to comprehend does not and has not dictated the boundaries of reality. For example, the fact that gravity is not yet understood does not in any way limit its obvious presence. The lack of predictability of individual process is inherent in both fields. In EMDR and quantum physics, neither the path of the particle, nor of the individual, can be ascertained in advance. The unique nature of the experience as the client interacts with the inner world is, however, a sign of the strength, not the limitation of EMDR. The limitations are found only in those clinicians who demand absolute certainty. The only thing certain in quantum physics, or psychology, is that things are uncertain (203) 787-0227 (404) 633-4796 (808) 523-2990 (509) 334-0677 (708) 688- 1900x4673 (410) 771-4438 (617) 444-6620 (617) 639-0457 (314) 644-1241 (2 12) 663-2989 (9 14) 635-1300 (505) 255-8682 (614) 274-7000x349 (503) 297-0302 (2 15) 667-6490 (5 12) 343-9550 (206) 586-8492 a t an individual level. Both can trace a path previously taken, both can evaluate an end-point, but neither is liberated from the power of observation that is inherently part of the process of change. Observation will determine the path of the particle. Observation will determine the transmutation of the inner experience. Interaction is the key in both. Paradoxically, the demand for absolute certainty in the field of psychology will define our limitations rather than our liberation. This demand for certainty is found in the commitment either to lock.step techniques or to the need for the passage of time itself. Clinicians limited to certain behavioralorpsychodynamicviewpoints will taketheseopposingandyetultimately equally circumscribed views. Both positions are ultimately detrimental to treating the client as a whole person. Another paradox is that the primary schools of psychology, in diametric opposition, contain inherently the same flaws. Our role as quantum psychologists is to look for the synthesis and interac tion of causes and effects. There is no certaintyof an easy answer, but rather the adventure of exploration. Each client isunique, each session is unique; thus, the processing of subjective information parallels the transmutation of consciousness and liberation from prison to playground. What are the possible limitations to full liberation? How can these questions possibly inform our exploration? A comprehensive theory of psychology should take into account not only the whole person, but the inhvidual's placement in the continuum of time andspace. While humans have developed more complex forms of social structure and technology, the history of humanity is still no more than a blink of time. If life on this planet has been in development for over 3.5 billion years, how can we consider humankind as distinct from this developmental process? Many answers may perhaps be found in the evolutionary nature ofthe human species. Perhaps the for evolutionary survival can be viewed as hard-wired into the nervous feelings etc., be viewed as matic whereas these emotions are built in, the content is acquired by experience. Therefore, the example of the child reaches Out a hand to catch father's arm and is hit in the face, has fear and danger as responses. The i s p re-existentr b u t t h e contextualization is specified by the experience. Hence, "fear and danger" are linked "I can't get what I want." may have a hard-wired response and the need to please because these tendencies increase the likelihood that the child learn the of the Weties that are neededfor However~this response become detrimental when it is connected to actions such as molestation and abuse. Making things the for is likely to take on the ����������������������� Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter Newsletter Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter, 3(1), 1-23 https://d1y502jg6fpugt.cloudfront.net/13023/archive/files/b8d58215c85194c71951bd0cb0737588.pdf?Expires=1790208000&Signature=FyvVOn6RCNMzvRE44E99CgpezUyLg9LYq-zgUgsEAWr35GrbUraa9wpiyPlRET%7E0W4WCAQl5pIwtimEqDz8n1ujfn43xyq31y3aQGWTxD3mNdMOyeh9q0i%7E31deNb199AhA3KAU3%7Ev%7E4I4aOsMGkVQHAVLnPcC%7EGpGaNixV27qjZq-1gY058Gy%7Ei0glT3%7E1oPQeNrMK89gpUbr5CiYHllLuTDvXOSYObd51yo6AcUMByn5S78T9qV0sjh0xq-o9dI2VZkHET0Ha5ddbnPLbqzPEOYjqDeg5N1Nm0Ny64yaTIWBAU56EcBd0X5HgKsdvOD4pd1qDbeAs2WF7T6y3qRg__&Key-Pair-Id=K6UGZS9ZTDSZM 82c4d0ad8d58edec3580b85044561e0b PDF Text Text Fall/Winter 1993 Vol. 3 Issue 2 Network Newsletter EYE MOVEMENT DESENSITIZATION AND REPROCESSING Copy right© 1993 EMDR Network P.O. Box 51010, Pacific Grove, CA 93950-6010 (408) 372-3900 Cautions I have compiled the following list that should be kept in mind in regards to client safety factors. It is being included in this column both as a reminder and as an incentive for clinicians to write in with other items they consider important for screening or client care. 1) Level of Rapport with the Client. Will the client feel safe in possibly experiencing high levels of vulnerability, lack of control, the physical sensations of the abuse inherent in the memory being treated, etc.? Will the client be willing to tell you the truth about his or her experience? If, because of insufficient trust or a high susceptibility to demand characteristics, the client inaccurately reports a low level of distress and inappropriately concludes the session , greater mid-session discomfort will proba bly arise and the clien t may be forced to deal with abreactive level material without the appropriate support. Suicidal attempts h ave been reported when the client has withheld information from the clinician . 2) General Ph ysical Impairment. Is th e client physically appropriate for the memory reprocessing? Are there debilitating effects of age such as a cardiac or respiratory condition? Equal sensitivity should be given to pregnant women. The effects of the level of emotion arousal on the fetus should be taken into account. While there have been no adverse reports to date, it is always better to use caution. A medical consult would be appropriate. 3) Office Consultation or Inpatient Treatment. What kind of memory should be treated at the office versus inpatient with hospital support? During one reprocessing of a near death experience, the client stopped breath· ing. The clinician was a psychiatric nurse, however, and had previously made provisions for resuscitation. In another session, a client was being seen on an inpatient basis. During reprocessing of a memory of electrical torture, h e began writhing and convulsing in bed as if presently being shocked. The psychiatrist was able to complete the processing, but clearly the experience would have been much more traumatic for both h ad the client not been in a protected environment. There should always be an assessment of the need for appropriate restraint, medical attention, or medication n eeds, as in cases of attempting treatment of schizophrenia, active drug or alcohol abusers, or neardea th memories; with the physically impaired; or when in doubt regarding suicidal tendencies, lack of ego · strength , or inappropriate life-supports. 4) Neurological Impairm ent. Pos- 1 sible neurological contraindications should be ascertained. Since the EMDR model posits a stimulation of physiological processes, there should be sensitivity to any history of neurological abnormalities or organic brain damage. It has already been reported in the literature (Rothbaum, 1992) that crack cocaine addicts have received no benefit from EMDR treatment. The marker for this deficit appears to be a metabolic abnormality of the orbito-frontal cortex. While EMDR has been used successfully with clients evincing a range of neurological complaints, caution should be observed when attempting treatment and a medical consult should be con· sidered. There is bound to be some form of brain damage that would cause either no response or extreme discomfort. One instance of required hospitalization for a high level of anxiety has been r eported with a client who had abused amphetamines daily for the past 20 years. 5) Epilepsy. While a number of clients with epilepsy have been successfullytreated withEMDR, caut ion should also be observed as a matter of course. Consultation with the client's physician should be an irnportan team· ponent of t reatment. There have been r eportsofonlytwoclientshaving small seizures during session . In one instance, the memory being r eprocessed was seizure-related. In that instance, theclientcametoconsciousnesswithin five minutes, washed her face , and went on unbothered. That was the only seizure experience in more than �EMDR Network Newsletter Fall/Winter 1993 Arizona c.-lifornia Colorado Connecticut Georgia Hawaii Idaho Illitiois Maryland Massachusetts Missouri New York New Mexico Ohio Oregon Pennsylvania Texas Washington Pat Penn, Ph.D. Jean Bitter-Moore, Ph.D. Laura Knutson, LCSW Jana Marzano, MA Steve Lazrove, MD Pat Hammett, Ph.D. Sandra Paulsen, Ph.D. Dean Funabiki, Ph.D. Howard Lipke, Ph.D. Mike Brenner, MD Mel Rabin, Ph.D. Marcia Whisman, LCSW William Zangwill, Ph.D. Gerald Puk, Ph.D. Don Wright, MA Kay Werk, LISW Ann Kafoury, LPC Georgia Sloane, MS Carol York, MSW Roger Solomon, Ph.D. a dozen sessions. Another clinician has reported a similar experience, in that a small seizure was stimulated, but, interestingly, the client was never troubled by seizures again. Also noteworthy is one client who had been successfully treated for a case of PTSD, and attempted the eye move· ments on h er own whenever she had an "aura" or other sign of an oncoming seizure. She discovered that the eye movemen ts enabled her to avoid the attacks. Research in this area would be highly desirable. 6) Eye Problems. There has been one report of a client sustaining se· vere ocular damage (i.e., blindness) at the hands of an untrained clinicia n. According to the report, the client reported consistent eye pain, but the clinician, who had n o baselin e of prac· tice effects, continued the sets of eye movements (SEM). Under no condi· tions should EMDR be con tinued if the clien t reports pain. Should that occur, the client should be sent to the appr opriate physician with an accurate description of the kinds of move· ments that would be r equired. The (602) 770-7407 (408) 354-4048 (303) 620-7198 (303) 220-1151 (203)787-0227 (404) 633-4796 (808) 523-2990 (509) 334-0677 (708) 688-1900x4673 (410) 771-4438 (617) 444-6620 (314) 644-1241 (212) 663-2989 (914) 635-1300 (505) 255-8682 (614) 274-7000x349 (503) 297 -0302 (215) 667-6490 (512) 343-9550 (206) 586-8492 physician should assess the physical capacity of the client for these kinds of distinctive movements. Some clients may be unable to sustain continued SEM. They too should be sent to an ocular specialist for examination and, when appropriate,·be in· structed in eye exercises to increase them uscle strength n ecessary for con· tinuous movement. Clients who wear contacts should be cautioned to bring their Jens cases so that the contacts can be moved ifany sign of dryness or irritation occurs. When eye move· ments are not possible, asin the above cases, or when blindness includes loss of eye muscles, the clinician can em· ploy alternate forms of stimulation. 7) Dru~ and Alcohol Abuse. Ex· treme care must be taken with substance abusers to have appropriate life -supports, such as 12 Step pro· gram affiliations, in place before inaugurating EMDR treatment. Clinicians have reported that while some clients easily let go of abuse behavior durin g treatment, for others, the stimulation of old material causes a reactivation of the activity. Whether 2 this is caused by an attempt to medicate against the stressful material emerging, or because the old desire is being stimulated, clinicians should · take special care with this population to brief the client as to potential problems, and set up safeguards against potential abuse. 8) Le"al Requirements. If a crime victim or police officer is being treated for a critical incident, it is essential to establish whether a legal deposition , or any specific kind of trial testimony, is required. If during the EMDR treatment the image of the event faded, blurred, or completely disap· peared, the client would then be able to tell what occurred, but would not be able to give a vivid, detailed descrip· tion. In other instances, the client may be able to give a more detailed description of the event and actually see the picture more clearly. However, there is no way of knowing how any particular event will process for any given client. In addition, if the prosecutor needs an hysterical witness on the stand, that will probably not occur post-EMDR treatment. Clients should be informed of these pos· sibilities and encouraged to ccnsult with appropriate parties. At the time of this writing, there has been no test of EMDR in the courts, but the clini· cian shouJd be cautious. Having vid· eotaped interviews with the client pre· treatment may be useful, but may not be sufficient in any given case. 9) Systems Control. Treating the client also affects the entire family and social structure equilibrium. As the earlier trauma information is pro· cessed, and new self-assessments a re engendered, client behavior will change spontaneously. If the client is in a dangerous home environment where new assertiveness would be detrimental, care must be taken . As clients begin to open to new choices, skills training (e.g., assertiveness, dating, career) must be available. Cli· nicians should have the appropriate peer support and training groups ar· ranged at an early stage of treatment. Clients can process material at a sur· �EMDR Network Newsletter Fall/W'inter 1993 1993-1994 EMDR Network Schedule sa,urday, Nov. 13th sa,urday, Mar. 5th Saturday, May 21st Saturday, Sept. 17th 9:30am to 4:00pm 12:00 to 2:00pm (at the 94 Conference) 9:30am to 4:00pm 9:30am to 4:00pm The Network meetings are h eld at the Sunnyvale Hilton, 1250 Lakeside Drive, Sunnyvale, California (408) 738-4888. SCHEDULE for Nov., May, and Sept. 9:30-10:00am Registration & coffee l0:<>0-1 l:30amSpecial Interest Groups (SIG) meet to share new information . 11:30-1:00pm Lunch [We suggest a second SIG meeting during lunch.] 1:004:00pm General meeting. Presentations by SIGs and Francine. The quarterly Network meetings h ave been a success as a forum for sharing n_ ew applications of EMDR , l ea r ning about the latest research results, and observmg talented colleagues demonstrate innovative twists with EMDR. prisinglyfastrate, and they must be . able to prepare for the resistance they may encounter in some of their still dysfunctional family members or friends. 10) Secondary Gains. Special care must be made to assess the possible positive consequences or identity needs served by the presenting pathology. Clie nt s may h ave constellated their existence around the pathology and these fact.ors must be addressed, at least cognitively, before any changes should be expected during the EMD R trea tm en t. 11) Session Time . Is the client's work schedule amenable to session requirements? Clients should have been briefed via informed consent thatEMDR sessions may entail emotionally intense work and that no important or long work hours should be scheduled immediately following treatment. Care must be taken to provide adequate time during each session to process completely th e presenting traumatic memory. It is r ecom· mended that the initial history-taking be done in a separate session(s) and that subsequent trauma work be assigned to 90-minute sessions. Al· though long by conventional standards, the 90-minutesession provides only adequate time for processing most client traumas. If a single trauma is treated rapidly in a given session, more than one memory may be addressed. As mentioned earlier, if the trauma is insufficiently processed, the client will most likely be left with a higher level of end· and mid-session disturbance. Under no conditions should a client leave the office during an abreaction. The usual 50-minute client hour will increase the likelihood of the client remaining in distress·. Regardless of circumstances, some disorientation may occur post-treatment so that decisions should be made about the appropriateness of driving. Sufficient time must be left at the conclusion of the session to debrief and have the client regain equilibrium. When materialhas been insufficiently processed, extremely strong empha- 3 sis should be placed on a proper debriefing, and guided visualization techniques or hypnosis should be used t;o assist the client in regaining emotional balance. It is useful t;o train clients in self-control techniques before undertaking EMDR treatment. These techniques can be drawn on t;o close incomplete sessions, and also provide a source of relief for clients if mid-session spontan eous processing causes emotional distur· bance. Even under the best of conditions, there is the possibility that a t rauma will be insufficiently processed even in the 90-minute session. Some traumas will take many more than one session to defuse, and some clients will be resistant to single-session treatments. Always use caution if any client remains in distress, and assess any special needs in returning to work or the home environment. 12) Timing. Because of the poten· tial for continued disturbance, reprocessing should not be attempted unless the client is able to come in for additional work. Therefore, initial reprocessing should not be started before vacations of the client or the clinician. Care should be taken to schedule sessions later in the day for clients who have a high level of responsibility; for example, CEOs should not have to return to work after major abreactive sessions. 13) Medication Needs. At times, a client may be currently stabilized on medication, or may be assessed as needing the influence of medication to maintain equilibrium between ses· sions. Thus far , no medications have been contraindicated, as long as the client's eyes are able to move (e.g., an inability to move has been noted in patients on morphine). However , when clients are on any medication, they should be carefully monitored in order that they may be weaned off at th e appropriate time. Clearly, as th e dysfunctional material is processed, it alleviates the attendant �anxiety/depression and obviates the neecl for tha drug. In addition, clinicians should plan to reprocess the presenting traumas once the client is off the medication. It has been found that if a client is asked to reaccess the treated memory at postmedication, it will appear with appro:,,c:imately 50% of the disturbance regenerating. For instance, an initial comliat trauma presenting at IO SUDs will appear as OSUDs post-treatment. However, once weaned off medication, the combat memory will elicit a 5 SUDs level This indicates that there is some residual dysfunction in statespecific form and is in contrast to stable treatment effects with non· medicated patients. 14) Stability. It is vital that the client be assessed for the appropriate stability of ego-factors and external circumstances. Reprocessing of extraneous, earlier trauma should not be attempted if the client is undergoing major areas of pressure, dead.. lines, or crisis. It is important that appropriate clinica] judgment be used regarding the connection of earlier trauma to present life conditions, along with the client's ability to handle the additional disturbance often engendered by the reprocessing. Ifthere are major fmancial and career deadlines or systems crises, trauma r eprocessing generally should not be attempted. While many of the items listed above are salient to most forms of trauma work (e.g., hypnotic abreactions), they a r e especialJy important to keep in mind when attempting any form of EMDR treatment, as even the most innocuous presentation can rapidly shift into an abreaction of early childhood material. Once again, clinicians should please write with any additional red flags or cautions. References Rothbaum, B. 0. (1992). How does EMDR work? Behavior Therapist, 15, 34. After my first training with Francine in 1989, in Israel, I was excited by this promising method and infected with her enthusiasm. I went on to use EMDR whenever I could in my work at the Nazareth Ilite Educational Psychological Service and in my private practice, as well as during my present sabbatical leave in London. I often incorporatedEMDRinto my work and felt comfortable and confident with a wide range of clients, ages, and difficulties and was ready to explore further with the method. Since my Level II training in November of 1992, I have learned to be more discerning, perhaps even overcautious for the time being, in applying EMDR. Reflecting over my earlier years of bolder and freer uses of EMDR, I did not encounter any negative effects. The worst that happened was that nothing much happened, and this occurred in a minority of cases (perhaps in less than 20%). Even with those cases, I had noticed that there may have been a tendency to underestimate positive effects. One of the subtle difficulties I observed in assessing outcomes was that the cognitive changes that occurred were sometimes so spontaneous and "natural" that the client took them for granted. I first noticed this phenomenon clearly in two cases. The first case involved a young navy man, 20 years of age, who was referred to m e after a crisis in which there had been a suicide gesture. In the course of working with him I identified, amongst other difficulties, a fear of heights which had manifested when he raised a flagon theroofof a building. While raising the flag (which he had been ordered to do), he experienced a panic attack which caused him great concern. He traced the onset of this phobia to an early childhood experience while on holiday with his parents in Japan. He r emembered being in a cable car, 4 becoming terrified, and laying on the floor in a panic. Using EMDR on this memory, and subsequently on the flag raising incident, resulted in a much reduced SUDs level and a reasonably confident VoC that he could handle raising the flag. During our next meeting, when I askedhimhowthings had gone, he answered, "Not that well." When I specifically asked about the flag raising, he said, "Oh that, that's nonsense--of course I did it; but I wanted to see if I had overcome my fear so I climbed up a mast on a ship, to the crow's-nest (about lOOfeethigh), and could only stay there about ten minutes because I felt uncomfortable." I was taken aback at first by his lack of recognition of his conspicuous progress. There are probably other factors involved in his not recognizing his achievements, but I felt that it also had something to do with this "spontaneous" nature of cognitive and af. fective changes with EMDR. The second time I identified the spontaneous changes was in 1990, when I was still very eager to try out EMDR on anything that moved (its eyes). This presented itself in the form of a 13 year-old female who had warts covering both of her hands. Although I was ready to take on the challenge, I r emained somewhat skeptical. She had 37 warts (we counted and drew them) of over three years duration on both hands and fingers which had not responded to medical treatments (e.g. , liquid nitrogen freezing on several occasions had only res ulted in discomfort and a return of the warts). This teen ager was generally well-adjusted and although did not particularly complain a bout her warts, clid give an initial SUDs rating of 8. For eight Sets of Eye Movements (SEMs) , her emotional response to the sight of h er warts went up to a charged 9.5 and stayed there as her milder cognition remained, "It's not unbearable, but I would prefer them to go." A brief discussion helped her to recognise h er more matching underlying belief of "They're n ever going to go away!" Two furth er SEMs began to reveal a chink in this h opeless belief which moved from "nearly no chance" ... �and "unlikely" ... to "I'm half despairing and half hopeful." However, her SUDs remained at 9. I paradoxically suggested that she imagine how it could get worse. One SEM was sufficient for her to access her real anger, forcefully asserting, ''I'm fed up with it, I want it to get better!" The SUDs level was still high, but her VoC for the positive belief that they would eventually go away was now 4.5. I decided to switch focus to this positive cognition to see if there could be any movement here. Three more SEMs led to more specific positive cognitions, which she rapidly came to believe with increasing confidence: "One doctor said it would simply disappear during adolescence" . .. "I'm beginning to believe it" . . . "It's already starting" . .. "There's a possibility, it's my las t hope"; going on to "I believe it more n ow" (VoC 6) ... and finally to "I think it will h appen before my 14th birthday" (in six weeks time). Despite her shifts in cognitions and VoC and acknowledging her feelings about the warts, sh e retained a high SUDs level and was disgusted by th em (they were not a pret ty sight). This was possibly an honest t eenage response standing for an expression like "gross." However , th e high VoC was encour aging. One-half an h our and 16SEMs h ad passed and we h ad to stop . I was left doubting and wondering what else I could have done and thought of coming back to it some time later . As things turned out, this was not necessary. Within two days, an improvement was obseived. After five days , there was noticeable shrinking of most of the warts. After two weeks, there was considerable flattening and many had entirely disappear ed. After three weeks, ther e were residual marks on the skin surface and two or three small r emainin g warts on the sides of two fingers. Within one month, both hands were entirely healed. A curious thing about witnessing this astonishing physical change was th at I was more excited and surprised than this 13 year-old, who was so cool and laid back about it. She apparently ~ it was going to happen and had already taken it for granted. Until now, over two years later, there has been no recurrence. A plastic surgeon who had seen her warts confirmed that they had been viral and could be regarded as benign tumours. So what happened here? Did EMDR facilitate a change in her beliefs about her warts, and then somehow h er immune system became better able to deal with the virus responsible for them? This, of course, may have obvious implications for other diseases and reminds me of the Simontons' hypothesis linking attitudes to the functioning of th e immune system. Furthermore, when reviewing the hypnotic literature, I found it reports that 6070% of warts respond to suggestive therapy. Kroger (1977) wrote: "It has long been r ecognized th at wart tumours, even though benign, are du e to a viral involvement and often respond to suggestion and/or hypnosis. This notewor thy example of alteration in tissue pathology is pertinent to the discussion of psychophysiologic factors in cancer" (p.284). He went on to write that Simon ton's technique ofstrength. ening mental attitudes, inculcating positive attitudes, and bolstering the will to live h ave had some good results, butamajor sh ortcomingis"how does one get a person to really believe in positive thinking?" (italics mine). I have found it useful to use metaphors in describing EMDR to my clients. I have gathered together several that are from the Training and the Network Newsletter , as well as oth ers that I have developed. Each of these metaphors underscores different positive aspects of using EMDR and have opened my clients to the amazing potential for healing that is provided when working with EMDR. EMDR Uncovers Hidden Aspects of Your Problem EMDR is Like Peeling Back Layers on an Onion<2) There are many layers to every problem that we have, m any of which are hidden from view. When the r eprocessing begins, the outer layer s are peeled away, revealing th e deeper layers of the problem. This may come to th e surface through memories, though ts, or changes in sensations in the body. EMDRisLike Removing a Quilt From the Bed(2) Once the quilt h as been removed, you can see the lumps in th e mat tress . The lumps represent those aspects of yourself that are ordinarily hidden from view. EMDR Gets You Unstuck and Allows a Natural Movement Toward Healing Kroger , W. S. (1977). Clinical and experimental h ypnosis. P hil adelphia: Lippincott & Co. EMDR is Like Opening a Stuck Faucet<l 2 Once the faucet is open ed, it con tinues to run . The problem material star ts moving and is available for h ealing. Memories, decisions, and feelings th at h ave been repressed are now available to be experienced and moved through. Simonton, 0. C., Matthews-Simonton , S. , & Creighton, J. L. (1980). Getting well again . Bantam Books. EMDR is Like Moving a Log J am All th e logs you need are in place, but they are compressed and twisted to- EMDR may be able to pr ovide a valuable new way to approach this qu estion . References 5 �EMDR Network Newsletter Fall/Wlnter I. 993 gether and immobile. The reprocess· ing l:>eginstomovejust therightlogto get the whole pile oflogs moving along the :river again to their destination. EMDR is Like the Sun Thawine: the Winter Snows Traa1matic and unresolved feelings frorr1 your past can be "frozen" in your unconscious mind, so that consciously you are not even aware that they exist.. Just as the sunlight in springtime melts the winter snow, allowing it to flow into streams and rivers, EMDR shines a light into the uncon· scious and begins to thaw out those "frozen" feelings so that they can eme:rge into awareness and be healed. EMDR Generates A New Perspective of Your Problem EMDR Gives the Blind Man Inner Vision There is thefamiliar story of the blind men describing the elephant. They each were at a different location at the elephant that led to different conclu: sions of what an elephant is. One said an elephant was like a wall, another said it was like a sturdy tree trunk, and yet another said it was just like a rope. We are all like the blind men in that our fixed relationship to our problems gives us a narrow viewpoint and can lead to false conclusions. EMDR gives the blind person within us an inner vision that can bring new per· spectives to observe our problems. After reprocessing with eye scanning, clients often come up with amazing insights and understandings that they never had and sometimes report that for the first time, they can view the problem more objectively. EMDR is Like Movin~ From the Playine: Field to the Grandstand In football, there is a coach th at is positioned in the grandstand. From this point of view , he can have a full view of the playing field and can ma ke observations that are impossible for the players in the gam e. This distance also gives him a potential for greater detachment in making his observations than are th e players who are caught in the intense emotion of the competitive struggle. EMDR of· ten provides an experience of separa· tion from an upsetting experience. This distance begins to allow for awareness and observations that were not possible when you were caught up in the trauma. EMDR Allows You to Go Directly to Your Healing Destination and Eliminate Incorrect Pathways EMDR is Like Fixine: the Switches on new pathways and possibilities. . EMDR Accesses the Natural Healing Abilities of Your Deeper Self EMDR is Like Healing a Wound·· Accessing the Natural Healing Properties of the Mind, Body, and Spirit(3) After a person is wounded, the place of the injury is cleaned or stitched in order to allow the natural healing properties of the body to begin a transformative process. There is inf'ormation within the cells that immediately begins a process ofhealing the injured area. If the wound, however, is not properly prepared, this process cannot occur. The healing of a psychic wound may be analogous, in that EMDRelicits the natural healing process of the mind, body, and spirit. When the traumatic experiences are repressed or frozen in time, then this natural h ealing process cannot occur. EMDR cleanses the psychic wound and stimulates the natural healing abilities of your deeper self to transform the psychological wound. a Train Tracklifc The process is ' e taking a train trip. You may know where you want to go and have all the best intentions going straight to, and arriving at, your destination. However, while on the jour· ney, something (triggers) switches the train to another track toward a nega· tive outcome. These specific switches are identified and neutralized by EMDR. The switches are changed so that when those triggers occur in re· ality, they will not switch the direction of the train . The train can therefore continue successfully along the track toward the desired outcome, while you can relax and enjoy the trip. · EMDR Develops the Ability to Let Go At each stop along the way (end of a cycle), some of the negative you have been carrying gets off and some of the EMDR is Like Wisdom Coming to the positive gets on. Some scenery from Monkey, Guiding Him to Let Go of your life will pass by your observing His Trap window, but you can essentially re- Hunters have used a method of carving out a coconut and putting a ba· main safely on th e train. nana inside to trap a monkey. The EMDR Creates New Pathways coconut is secured to the ground. Beyond the Limitations ofYour When the monkey reaches inside to get the banana, h e cannot pull the Previous Route banana through the opening. Be· EMDR Facilitates the Creation of New cause of the monkey's unwillingness Tracks so that Your Train Can Travel to let go of the banana, he remains trapped and is easy prey for the to New Territory@> A journey on a train is limited by the hunter . We ar e all like that monkey route of the tracks. A passenger can in our ability to let go of outmoded go no further tha n the end of the line. attitudes, b eliefs, a nd behaviors. In th e same way, your reactions and EMDR encourages you to let go of the behaviors are routed by pathways laid tight grip that you h ave and release down many years ago through child- yourself from self-imposed traps. This hood experiences and decisions. You letting go is an incredibly r eleasing are habituated to those familiar ways and freeing experience. of responding. EMDR can sh ow you EMDR Installs Positive clearly the familiar pathway~ that you use to process your experiences Behaviors a nd Allows You to Connect to Useful Resources and th en can assist you in creating 6 �EMDR Network Newsletter Fall/Wlnter 1993 Within Yourself Method EMDR is Like Working with a Com· During the initial interview and all subsequent sessions, biofeedback in· struments were attached to subjects as follows: puter in its Ability to Install New Programs and Create Linkage to Other Essential Data in Your Own Computer Banks Once you have new software for your computer, it is easy to install that program and have it available for use. The latest programs also allow links to be made with other programs so that new data placed in one program are instantly available to all other linked programs. EMDR is capable of facilitating the installation of new pro· grams and abilities in your uncon· scious mind so that it is available when you need it. EMDR also makes it possible for you to link up to other relevant resources (past learnings, abilities, positive role models) that can be integrated into the h ealing process. Bibliography (I) Popky, A J. (1992, Winter). Smok· ing cessation protocol. EMDR Net· work Newsletter , 1. (2) Shapiro, F . (1991 , August). Wor· thy Repeating. EMDR Network News· le.ttfil:, l. (3) Shapiro, F. (1993, May). EMDR Level Basic Workshop. r .- 111111. - - 11111 - - ... . 111111 - - 111111 • fll:~~'!.;;;,,~ J · . ! ~ The Department of Veterans Affairs has awarded Joan Barron, M.N. , R.N., C.S. , the 1993 VA Service Director's Award in Mental Health and Behav· ioral Sciences, in recognition of her achievements in enha ncing clinical care ofveterans being treated in men· talhealth programs. Joan is a Psychi· atric Nurse Clinical Specialist at the VA Medical Center in Dayton, Ohio and is coordinator of th e EMDR Bulletin Board on the VA Forum . One of the tasks of psychotherapists is to attempt to reduce anxiety in their patients. They determine the level of 1. Frontalis: This placement was this anxiety through patient reports, used with most subjects (approxiobservations of body language, intu· mately 98%) throughout the study. ition, or results of projective and ob· BIT 401 Electromyograph (EMG) was jective tests. They then gauge thera· used during the first six years, and peutic effectiveness by the amount of during the final three years an anxiety reduction as indicated by these Autogen 1500b EMG was substituted relatively subjective measures. Even to provide a wider response range. behaviorists, who make much use of numbers in their evaluations, are not 2. Abdominal wall: During the final measuring anxiety but its effect on six years, Autogen 1100 EMG active the client's behavior . It is my conten· electrodes were placed one inch below tion that subjective measures of and three inches to each side of the anxiety are not appropriate scientific subject's navel tools and, if we are to progress in the development of more effective tech· 3. Ankle: During the second and niques for removing or reducing anxi- third years, BFT 401 EMG active elec· ety, we must devise more objective trodes were placed on the anterior and accurate techniques for measur- surface of both ankles of 2% of sub· ing this state which we describe our- jects. In these cases, this was the only selves as "treating." BFB instrument used. During the r emaining six years, ankle placements In an attempt to demonstrate that were made with the majority of subsuch objective techniques are avail- jects using the Autogen 1100 EMG. able and valid, I undertook a study to demonstrate that biofeedback (BFB) When the above devices provided unmonitoring of client stress levels can clear results during intake, additional provide therapists with immediate, monitoring was obtained, as follows : continuing, objective information about changing anxiety levels in the 1. G&W P ulsewatch (Model 420) patient, thereby facilitating more was attached to the first finger of the rapid, accurate diagnosis and therapy. subject's right hand. (Required in less The results of that nine-year study than 3% of cases.) were reported at the 17th Annual Meeting of the Biofeedback Society of 2. Autogen 3000 Galvanic Skin Re· America in 1986 in San Francisco. sponse (GSR) was attached to fingers The following is a digest of that re- of subject's right hand. (Required in port: less than 1% of cases.) Subjects The totalnumberofsubjectswas 1266, with 47% adult female, 39% adult male, and 14% children (ages 5 to 17). All were the author's private clients during th e previous nine years. The only clients excluded were those who worked primarily with interns using this technique since they were not under the author's constan t observation s. 7 Although various BFB applications were used with many subjects, par· ticularly during the early years of the study, typical BFB applications with subjects during the final four years included EMG electrode placement on the frontalis , abdominal wall, and ankle sites, as these wer e found to produce the most consistent inform a· tion . It is this data which are summ arized in th e results. �EMDR Network Newsletter Fall/Wlnter 1993 Durig the intake interview, subjects disC'1Ssetl the presenting problem and wecethen asked about other areas of possible anxiety (e.g., feelings offailure, sexual concerns, demonstrated an~Er, disappointing others, etc.), while levels of BFB indicated stress we:r:-E observed and correlated with subjects' reports of anxiety. After major anxieties were identified, the nat'1re and anticipated effects of im· plosive therapy were explained, subjects were introduced to self-hypno· sis, and attempts were made to reduce theseanxieties primarily through the use of in situ and present time implosive therapy (I.T.). BFB stress levels were monitored during and posttherapy and correlated with subjects' self·reports and therapist observations. average peak at 2. 9 mv. The majority of subjects peaked within plus or minus 1 mv of 2.9 mv which presents evidence of a normal curve with a skewing factor noted below. 4. Subjects in superior physicalcondition (athletes or others with daily exercise habits) peaked at the highest mv values and showed the longest elapsed times before onset of stress reduction (decay). 5. Elapsed time between peak mv achievement and beginning of decay varied from 20 seconds to 48minutes. The average elapsed time is estimated at three minutes, which provides further evidence ofa normal curve skewed by subjects discussed in paragraph 4. 6. ·Anxiety reduction as a result of At the close of each session, subjects were congratulated on their performance and their success was demonstrated to them in terms of reduced levels of stress when again confronted with the target anxiety. Results 1. In 94% of the cases, frontalis activity, with an average baseline of 1.9 mv , was reduced by more than 75% at times during which subject reports, therapist observation, or other BFB displays indicated subjects were in severe stress. 2. 84% of the subjects showed first BFB evidence of increased stress in legtension (ankle electrodes). Baseline was 2.2 mv with peaks during stress as high as 270.0 mv. Average ankle placement readout peaked at 12 mv. 89% of the subjects showed first BFB evidence of stress/anxiety reduction (decay) in leg tension. 3. BFB indications of increased abdominal muscle activity correlated most closely (96%) with subject reports and thernpist observations of anxiety. Baseline h ere was .7 mv with marked consistency (97%). Peaks at· taine<l during implosiv e therapy var· ied from 1. 2 mv to 14.0 mv with the successful implosive therapy was indicated (93%) by iaadual reduction of abdominal wall BFB activity. Sudden reductions in BFB readings in this area were usually found to indicate avoidance behavior. For maximum effect, it was found necessary to continue I.T. stimulation until the mv readout showed reduction (decay) to 33%ofthepeakvalue. Auditorystimulation in increasingly graphic detail was necessary in most cases to reach andmaintainpeaks (i.e., "Think about your wife looking bored, think about her rejecting you, think about her leaving you , think about her divorc· ing you, etc.") Tears or "I don't care" statements by the subject usuallyindi· cated the imminent onset of decay when they occurred after peaking; however, early onset tears were usu· ally found to be avoidance techniques. 7. The effectiveness of therapy in reducing the target anxiety was best determin ed by: a. post I. T. drop of abdominal wall electrode output to sub-baseline levels (average .6 mv); and b. resumption of I.T. stimulation after 20 seconds in sub-baseline phase resulted in maximum peaks of .9 mv (92% of subjects). 8. Post I.T. abdominal wall read· 8 outs remaining above baseline were usually (88%) due to subject memories of similar past trauma. These . were removed in the majority (85+%) of cases by hypnotic regression and in situ I.T., resulting in sub-baseline readings. In most cases, the correct target memory of the regression could be determined from BFB displays without subject confirmation which was, however, always obtained. 9. In 27% of the subjects, the anxi· ety was identified as singular and not enmeshed, and it was possible in 90+% of these cases to identify and remove (reduce to levels below the subject's conscious awareness) that anxiety by the end of the initial session. 10. Approximately 7% of subjects were initially unable to develop stress during I.T. despite intense attempts to stimulate the previously identified target anxieties. In the majority of such cases, pre-therapeutic ingestion of mild tranquilizing medication re· sulted in markedly increased ability to reach adequate stress levels. Dur· ing the final four months of the project, it was found that these resistant subjects could develop anxiety in the tar· get area withoutmedication ifan anxi· ety-producing topic outside the target area was introduced without overture. For example, if the target area was a husband's infidelity and the subject was toofrightenedtofacethis , she might be asked to think about one of her children being severely injured. As soon as she demonstrated anxiety, she was redirected to the spousal infi· delity. In the majority of cases, this technique resulted in effective stress levels and successful I.T. results. 11. As verified by subject report, experimenter observation, behavior during subsequent therapy, and post· ch ecks , 78% of the major anxiety causes were corr ectly identified during the first intake hour, and 92% within the first five hours. 12. The same criteria indicated BFB readouts were 96% accurate in deter· mining implosive therapy intensity levels and effectiveness. �EMDR Network Newsletter Fall/W1nter 1993 Discussion l. 1Vith the exception noted below, there appears t.o be a strong positive correlation between BFB indicated stressandsubjectanxiety. BFB, when usecl to monitor subjects during therapy, has been shown t.o provide the tllerapist with ongoing, relatively accurate, objective information regarding the subject's anxiety level, and thus p ermitting more rapid, accurate diagnosis and therapy. 2. The use of EMG frontalis placement to obtain r eadings of subject stress should be questioned. In almost all cases, there appeared t.o be a strong ne~ative correlation between frontalis m v output and increased subject stress. It is interesting to note that jaw muscle tension , which contributes heavily t.o frontalis mv output, is associated primarily with aggressi on, whereas a tense abdominal wall is thought of mainly as a defense posture. 3. The m ost reliable indications of subject stress in this study were obtainedfrom EMGabdominal wall electrodes. 4. 93% of subj ects who were confronted with discrepancies between r epor ted anxiety and BFB-indicated stress levels admitted false reporting, and subsequent discrepancies reduced markedly. Recognition of their vulnerability seemed to collapse their defenses, and therapists using this technique must be prepar ed for any complications th at this may introduce. One of th ese is instant rapport with marked dependency, which some pa· tients find so frightening they do not appear for second appointments. This is particularly tru e for, but not exclusive to, adolescentandimmature adult males. It is imperative th at any patient who has been made consciously aware of a previously unconscious str esso1 undergo I. T. to reduce that · anxiety during th e same session. 5. Peakin g with subsequent gradu al reduction of BFB readings is a more reliable indicator of implosive th erapy effectiveness than level of stress attained. 6. There appears to be a strong correlation between abdominal muscle fatigue and absence of anxiety, which would seem to lend support t.o the James-Lange theory. 7. In many cases where identification and removal of anxiety were accomplished rapidly and thoroughly, subjects frequently interpreted their changed attitudes as resulting from a rational decision on their part. "I just decided to stop being afraid." Discussion of this attitude often revealed a conclusion that since a specific fear has been removed so quickly, that removal "obviously" could not have been the result of therapy. 8. The most beneficial effect is the reduced time necessary for effective therapy. Rapportis immediate. Little time is spent with presenting problems or cover stories, the client's underlying anxiety is open and available, and effects of attempts to r elieve it are immediately known. 9. Implosive therapy is aimed solely at th e r eduction of anxiety in individuals. Systems therapists may argue th at the techniques involved h ere are of little use in dealing with malfunctioning family systems, but it is the anxiety of the individuals in any system that produce the problems. If you reduce the anxiety of any member of a system, do you not also change the system? 10. Suggested Research: a. More effective electrode placement. b. Use of computers to provide r elativ e values for each electrode input and averagin g. c. Investigation ofEEG BFB diagnostic potent ial. Having reached the conclusions presented in that paper, I h ave, over th e past six years, continu ed usin g biofeedback to man itor client anxiety levels and the eITectivenessof therapy (which in my case is almost always 9 implosive or exposure in nature). I have continued t.o find such monitoring much more effective than subjective client reports. After my introduction t.oEMDRin the Levell workshop in Novemberof 1992, I was excited and, t.o be honest, almost overwhelmed by the possibilities of an additional and exceedingly effective therapeutic technique. However , in incorporating EMDR into my use of exposure therapy, I have found that client reported SUDs levels are frequently underreported. In these cases, although the biofeedback instrumentation indicates body tension at levels normally associated with panic, the clients frequ ently will ignore this tension and r eport that they feel comfortable. When this discrepancy is brought to their attention, the clients in most cases will agree that they do feel body tension, but do not associate it with their anxiety, although before and after that period they did and do associate the two. I regard this as a kind of disassociation. In cases where I am attempting to use EMDR to produce the in· creased anxiety necessary for exposure to be effective, and where clients were unable or unwilling t.o focus on anxiety producing stimulation and, therefore, unable to increase th eir muscle tension to levels adequate to produce the muscle fatigue necessary for exposure to succeed, the use of EMDR h as, in most cases, increased th e biofeedback indications of tension to adequate levels and successful con clusions; both in terms of biofeedback readout and client report. My own use of exposure is based essen tially on the James-Lange t heory that muscle tension is necessary for the presence of anxiety and observations that appropriate muscle fatigue is a necessary precursor to anxiety removal. In view of the fact that EMDR appears to be effective in removing a n xiety without accom· panying marked mu scle tension and fatigue, I am led t.o propose that there are three conditions necessary for the installation of post-traumatic stress �EMDR Network Newsletter Fall/Winter 1993 syndrome: I . Acognitive awareness of an event reg~ded as threatening in the present and potentially in the future . 2. ] !uscle tension appropriate for fightor flight, but in most cases for defo11se. In this respect, I wish to poin.tout that in my experience, most PTSD victims do not fight or flee; rath E the y are helpless and submisr, sive , and submissiveness among social animals frequently involves displaysofhelplessness and exposure of vulnerability to the dominant party. · This gives an interesting angle of conjecture to my findings that the most relevant tension levels are in the abdominal wall muscles. 3. A third and equally important requirement for the placement of permanent trauma is eye fixation . In anecdotal evidence of this, I submit the tunnel vision that occurs routinely with increased a nxiety and the descriptive "thousand-yard stare" of long-term combat veterans. I assume th at these three factor s are all n ecessary for the perma nent impla ntation of trauma in a form not available to the conscious mind (a la PTSD), and that they work together of n ecessity so that when ever a ny cognitive a wareness of the event is trigg ered, ther e must be simultan eous muscle ten sion and eye fix ation for the affect to be felt at a conscious level. If these three do work together in such a n establish ed r eflex, then if one interfer ed with muscle tension or eye fixation during a cognitive review of the tra uma, the en tire r eflex deteriorates, the r epressive process is inhibited, and cognitive a nd affective aspects of th e tra u ma ar e available to the conscious mind for normal out processing. At this writing, I h ave only worked with abou t 20 clients using EMDR and, ther efore , can only cite an ecdotal evidence. At th e beginning, I used EMDR only when h ypnotic r egression wasin effoctive in getting the client to reexperience the traumatic event. In each of those cases where I encountered resistance in hypnosis to the development of the necessary lev· els ofanxiety to implode or adequately expose the trauma, the use of EMDR has been effective in producing increased muscle tension and anxiety in the client so that he or she could then proceed to effectively be exposed to the original trauma with subsequent reduction in anxiety levels. Assuming that this theory is accurate, one can move to further propositions, such as the use of Cognitive Interweave is effective perhaps because it exposes the client to any remaining or residual tension associated with the original trauma and reduction through exposure of that tension. In the use of the emotional bridge in hypnosis to find the origin of the anxiety producing tr auma, clients frequently will move back only a few years to a related trauma, and this bridging technique must be used again and again until they arrive at th e original anxiety producing tra uma. These "screen memories, " as it were, must be peeled back like the layers of an onion until one arrives at the h eart of the problem. In some cases, in fact in many cases, clients ar e able to move from the present situ ation by th e bridging technique immediately to the original causation situation. I find a very close parallel in th at client who, when using EMDR, must often work his or her way through screen ing trauma u ntil he or she arrives at the original cause of this anxiety. Again , in some cases in the use of EMDR, th e client goes immediately from the present situation to the original trauma. In th ese cases, however , as is true for my own technique, I have often found it necessary to deal with the traumatic incidents which a r e related a t each level they occur . However, in some cases, both in EMDR and exposure th er apy, it is necessary only to r emove th e origin al tr auma , and all subsequent episodes of this anxiety seem to be stripped of their emotional con ten t a nd th er efore of their effectiveness. Given the foregoing, it is most impor- 10 tant, I feel, for therapists who lll'e using EMDR to recognize that clients are individuals, with individual techniques and patterns for responding to the anxieties in their lives and to their own repressive processes. It is inappropriate to conclude that EMD R does not work or that the client is unable to make use of this method simply because he or she does not respond immediately or with apparent effect. In several cases I have found that clients who got "stuck" with the normal 20-23 eye movements respond immediately and effectively when eye movements are increased to 60 or 70. That, of course, leads us to further speculation of the possibility that it is not the eye movement itself, but the fatiguing of the muscles involved which is relevant in the decay of th e repressing mechanism. I cannot overstate my excitement at the possibilities which EMDR has opened for exploration. Nor can I over state my gratitude to Francine, not only for discovering this method, but for fostering controlled exploration into its possibilities. EMDR treats distress primarily by uncovering and r esolving th e false beliefs that empower painful memories. The goal of an EMDR session is to reduce the distress associated with the memory a nd to replace the negative cognition with a positive on e. The session ideally ends wh en the SUDs has been r educed to O or I and the positive cognition is "completely true" (VoC of 7). I would like to describe a n addition to the EMDR protocol that I have found valua ble. This interven tion is per formed at the end of a session, and is �EMDR Network Newsletter Fall/Wlnter 1993 mOS1teffective when an issue has been resolved clearly. However, some benefit ~an be gained even when this goal has not been reached. Onee the traumatic memory has been resolved and the positive cognition installed , the client is requested to close his or her eyes and to look inside himself or herself, and is asked an open-ended question such as "Now what do you see?" or "What is it like?" The answer usually is tentative and noncommittal--for example , "I see me," or "I don't mow." This is not unex· pectedsince the question is intention· ally v ague. Its purpose is not to elicit information, but to create a distract· ing senseofuncertainty which puzzles the u sual defenses. In actuality, this question is a set-up for a follow-up question , which is completely unambiguous: "Do you like what you see?" ff the session bas r eached a good con· clusion, most people will answer "Yes," and seem truly to enjoy a sense of well-being. (When the answer to the · question is "No," th e client is asked, "What stops you from liking your· self'?" That answer is used as the leading edge for additional work, ei· ther at that time or later.) Once clients say that they like themselves, · probe further, "What do you like about yourself?" For each positive answer, ask "Are you sure?" If the answer is "Yes," do a short set of saccades to install it. ff the answer is "No," ask "What is stopping you from being sure?" and use this answer to unmask additional negative cognitions. Continue asking ''What else do you like about yourself?" until there is a gen· eralization effect. That is, once sev· eralpositive traits have been affirmed, the client seems to lose patience with particulars and attempts to clarify the issue for the therapist: "I just like myself, that's all" Again , work with this: "Are you sure?" "Do you really like yourself?" "Are you really a nice guy?" If the answer is an unequivocal "Yes," in stall it. If there is any doubt, try to identify the source and work with the negative cognition using the regular protocol. The final set of sac· cades should install the most gen eral positive statement that the person can make about himself or herself. Even when clients are unable to make broad, positive statements about them· selves, identifying a single positive trait can be quite helpful. Acutely depressed patients often have diffi. culty generalizing positive insights. They do note small improvements, however, and the reprocessing con· tinues between sessions. I have the impression that patients go through a learning curve during which they fig. ure out how to use EMDR most effec· tively. Part of the evolution of EMDR has been in the way sessions are closed down. Progressively greater empha· sis has been placed on ways to "accent the positive," with the use of visual· ization and other relaxation tech· niques. The procedure described h ere can complement any of these other procedures. Additionally, clients re· port having a newfound "sense of di· rection," and it is my impression that they utilize the insights obtained during the main part of the EMDR ses· sion more effectively when the ses· sion ends on a positive note. Like so many other aspects of EMDR, a definitive answer as to whether this technique really makes a difference can be provided only by controlled studies, but my own experience has been encouraging. An international update should con· tain information from a variety of individuals, so I would appreciate it if you sent in reports of any state, re· gional, national, or international confer ence presentations. Integrating EMDR into panels on the treatment 11 of clinical populations (e.g., phobia, trauma, depression, etc.) can assist in increasing the-visibility and accept· ability of the method. We have now trained over 4500 clinicians, but with approximately 126,000 licensed men· tal health professionals in the United States alone, there is a long way to go. In addition, writing up case reports and articles for psychological associa· tion n ewsletters and presenting at local meetings can assist in dissemi· nating information about EMDR. Please check the contents of the ar· tide packets for examples. Journal articles from trained clinicians are also vitally n eeded. Two presentations about EMDR wer e accepted for the 1993 annual confer· ence of the Association for the AdvancementofBehavior Therapy. One is a panel on compliance issues in· eluding myself; Steven C. Hayes, Ph.D.; Joseph Wolpe, M.D. ; and Ron Kaufman, Ph .D. The other is a clini· cal roundtable on research problems and issues th at I am chairing with Ron Kleinknecht, Ph.D. , and Gary Fulcher, M.A The state of EMDR research is pres· ently in great n eed of improvement. Of the two controlled studies in print (besides my own), the r esearchers were not trained in EMDR (Sanderson and Carpen ter, 1992) in one, and in the other, the psychometrics used were globalmeasuresthatcouldnotchange if only one memory was reprocessed (Boudewyns, et. al., 1993). All known studies (besides mine) entail compo· nent analysis (i.e., EMDR or EMD with and without eye movements). In essence, EMDR competes against it· self. In anotherstudy(Pittman, etal., 1993) that was presented at the American Psychiatric Association (APA) , the principle investigator neglected to pro· vide a full disclosure of the control , and it was reported as eye fixation when it also included hand-tapping and a hand-waving movemen t. In other words, three major components of the eye movements were used as �EMDR Network Newsletter Fall/Winter 1993 the ontrol. In addition, although we kno~thathand-tappingcan giveposi· tive c linical results, the research result;.swere dismissei'as akin to placebo effects. ltis tssential that researchers under· stand the nature of EMDR treatment effects before attempting to interpret results. This is particularly problematic, a.s in the APA case cited above, when the principle investigator was not trained in EMDR and had not used it clinically. While it may prove that having the client do a forced eye· focus is clinically effective in some cases, it should be remembered that forced eye-focus has many factors in comlllon with the eye movement (e.g., dual attention, parallel processing, comJ)eting response, rhythmical neu· ronal bursts), as well as possible engagement oftheparasympathetic ner· vous system and hippocampal activa · tion. !tis interesting that researchers neglect these characteristics in their assessments. Hopefully, the report will be rectified, and full disclosure and a more thorough evaluation will be provided in future presentations. The primary aspect of the Accelerated Information Processing model is the activation of the information process· ing system. This can obviously be accomplished in many ways. How· ever, clearly we can only make appropriate judgments if researchers are adequately forthcoming regarding the controls actually used in their experiments. In addition, as we all know, there is a great deal more to EMDR than just the eye movement. "The Continued Phenomena of Subjective Science" As with a variety of other new methods, EMDR provides a projectiv e screen for many aspects of our profession. At times, it slips from "projective" to "projectile" ··as most recently found in new letters from the Behavior Therapist included in this packet. While one is clearly a personal opin ion (Denicola, 1993), the second one (Mueser and Herbert, 1993) becom es more problematic because it cites an article addressing methodological flaws in research that in actuality do not necessarily exist. I have decided to address their statements directly because it is highly likely that readers of the EMDR Newsletter may still harbor the same illusions I had about the "guaranteed" factual rendition of any published research or research critiques. The article they cite and authored (JBTEP, Herbert and Meuser [HIM], 1992) contained in a previous packet makes statements that offer an apparently inadequate reading of my study, (JTS, 1989) as follows: 1) "All assessments were based on verbal reports of the patient to the therapist (author), suggesting that demand characteristics could have played a role in the observed improvements" (p.170). In actuality, all changes in pronounced sympomatology (e.g., nightmares, flashbacks, intrusions) were corroborated by spouse, parent, or primary therapist in all but four cases. The chances of demand characteristics causing subjects to fake changes over a three month period appear to be very slight. 2) "EMD procedure was conducted in such a way that all patients were required to demonstrate significant reduction in SUDS ratings and improvements in VCS [VoC] ratings before treatment was terminated" (p.1 70). This implies that the reduc· tion was forced upon the client. How· ever, the initial article clearly states in the section devoted to possible "Experimenter Bias and Subject Expect· ancy" that: a) Expectation of effect was countermanded, and "No prior description or rationale for the success of either the treatm ent or the control procedure was given. However, except for three subjects (one Treatment and two Control) who took two trials to begin desensitization , all subjects began to show effects after on etrial oftheEMDprocedure." (Shapiro, 1989, p. 217); b) Complete desensitization in all but one subj ect took place in 10-40 minutes. The veteran 12 discussed in the Level I training (ie., illustrating blocked beliefs) took 90minutes to desensitize three memories. This amount of time would not seem to overly tax the subjects into demanding conformity. (Clinicians should please remember that only anxiety was being assessed and a full therapeutic intervention should include all dysfunctional emotions.); c) The Control Group was conducted for a comparable period of time with a placebo response occurring in only one subject. In most cases in the Control Group, the amount of disturbance increased dramatically during this period which appeared equivalent to the effects of a modified flooding procedure; and d) The purpose of the two groups was to control for the effects of exposure to the memory for a comparable period·- not for a component analysis. 3) It is suggested that the monitoring of heart-rate may have been a differential factor. However, heartrate was taken only at the beginning of the procedure. No client approached conditions warranting further moni· toring during the procedure. 4) It is stated that the VoC was taken after each set which would in· crease the pressure to change. How· ever, the VoC was taken only at the onset and installation phase. 5) HIM state that neither objective, nor standardized assessments were made of the symptomatology. However, in regards to this matter, diagnosis was made independently by the primary therapist and the primary intrusive symptom was directly assessed (e.g., mean number of flashbacks pre-treatment was 3 per week). This was sufficient to address the written goal of the study. The initial study used an inclusion criteria of a traumatic memory (e.g. , abuse, combat) and a PTSD symptom (such as nightmare, flashback, or intrusion) of over one year duration. The article states that the "aim of the study was to determine the effective- �EMDR Network Newsletter Fall/Winter 1993 ness of the .. procedure on traumatic mernory symptomatology". While HJ Mare certainly entitled to their opin· ion, the study accomplished this goal to the satisfaction of the reviewers of the Journal of Traumatic Stress--a peer reviewed journal, edited by Charles Figley, Ph.D. who is thesenior editor of the Brunner/Maze! psychosocial stress series. In addition, a summary of the study in a subsequent article was requested by Joseph Wolpe,M.D. , notonlytheorigi· nator of systematic desensitization, but a past president of Association for the Advancement of B ehavior Therapy. The article subsequently won the Pergamon award for the best article published in that journal in 1989. Other statements in the HIM article not grounded in fact : 1) While they state that training op· portunities have become widespread in nine countries, workshop series have been offered only in Israel in 1989, and the US and Australia more recently. However , clinician s from over a dozen countries have flown into the US to be trained. 2) While they state that we "certify" professionals in the method and the "Certificate of Completion" indicates "competence", all trained professionals know this to be inaccurate. Cer· tificates are awarded to indicate attendance or completion of the course only. 3) The Newsletter is cited as a way to "promote" El\1DR to clinicians, whereas it is an organ of the EMDR Network which is a non-profit corpo· ration, open by member ship on]y to clinicians who h ave attended train· ings to offer on-going education and professional support . In regards to their citation of th e Boudewyn s, et al. study, (tBT, 1993) th ey fail to note that the psychological measures used would not show great improvement wh en only one of a dozen problem atic combat memories i s treated. Further, in addition to men - tioning the possibility of a placebo effect, the research article stated that: 1) Both subjects and therapists rated EMDR as affording significantly better treatment effects than the control groups. 2) The reasons given by researchers for lack of response on standardized and physiological measures included a) inappropriateness of using the original script in audio taped form as a testing probe b) tendency for this population "to over r eport symptoms and negative appraisals ... on psycho· logical tests" c) the use of "a small sample of chronic, difficult subjects" d) small number of sessions for this population 3) The researchers stated that "we feel that these results are encouraging enough to support the need to carry out controlled outcome studies of EMD (EMD-R) in the future." The positive results of this pilot were sufficienttowarrantlarge scale VAfund· ing for a controlled study now in progress. This study is being done with Howard Lipke as the consultant to offer fidelity ch ecks (i.e. , (i.e. , how well the method is carried out) which was not done in the pilot. All of the above is simply to assure New sletter r eaders that "saying doesn' t make it so." That goes for the HIM critique, along with my, or anyone else's research or evaluation. It will only be the accumulation of clinical experience and studies over the next decade that will hopefully be able to sort through to a semblance of the "Truth". In the meanwhile, the following criteria for studies would seem to be appropriate: 1) Researchers should be adequately trained in EMDR (Level I and II) and use actual clinical protocols. Validity checks should be done by competent EMDR clinicians to check the fidelity of the researcher's use of the method. 2) Appropriate psychometrics that are capable of ch ange when a memory is successfully reprocessed should be 13 used. 3) Standard replication to establish efficacy should be done comparing EMDR to other conventionally used methods before component analysis is attempted. As far as studies currently underway, or submitted for publication: 1) Dave Wilson's study of PTSD victims using physiological measures has replicated the findings ofmy study e.g., full desensitization in one session and physiological measures correlating with SUDs and VoC). 2) Steve Silver has done a retro· spective analysis of his in-patient PTSD program and compared veterans receiving EMD R, biofeedback, and relaxation training. The EMDR con· dition was vastly superior across seven out of nine measures. 3) Howard Lipke's survey ofEMDR trained clinicians reports on approxi· mately 400 responders who have treated over 10,000 clients with EMDR. Approximately 74% found EMDR to offer greater ben eficial therapeutic effects than other meth· ods used. Only 4% found less r esults. 4) Two studies of treatment with Hurricane Andrew victims are show· ing highly significant results. 5) Studies with promising preliminary results are currently underway in Colorado (Sandra Wilson) , Wash· ington (Roger Solomon), and Temple University (Alan Goldstein). While these studies wend their way through the publication maze , it is important for EMDR practitioners to r emember that while there is not suf· ficient research to fully validate the method, th er e is enough to warrant judicious clinical exploration. In fact, while recently doing r esearch review, I discover ed that at th e time that EMDR was launched in 1989, th ere were no controlled studies validating flooding . However, it was being used widespread throughout th e VA sys· tern on th e basis of case reports. �EMDR Network Newsletter Fall/Winter 1993 In the meanwhile, you provide your own best experiment in comparing clinical results pre· and post-use of EMDR. If you could start using the Impact of Event scale as measures, we may be able to pool vast amounts of data at some time in the future. I highly suggest its use, regardless, as a clinical tool. Finding an elevated score after an EMDR treatment can indicate new memories or perspectives that need to be addressed. It has been included in this packet for those of you who do not have it in your manual. Frank Putnam's Dissociative Experience Scale is also available from the EMDRoffice for your clinical use. It is now being handed out during the trainings to encourage the screening of every client before at· tempting EMDR. The research committee, headed by John Thompson, M.A., is presently formulating a position paper on proposed research that will be distributed to the Network and all interested researchers. In addition, any previously established (i.e., published) researcher interested in doing quality outcome studies can be invited to the EMDR training as a guest. Please have them contact the office. However, what is needed at the present time are quality replication studies (i.e., EMDR compared to another known method)--not component analyses. "Other Phenomena" While research is lagging, the use of EMDR in clinical practice appears to be growing, as do reports of it in the literature. For example, Linda Cohn, MFCC, has a chapter included in a book entitled California Art Therapy Trends; the Family Therapy Networker magazine is devoting its November issue to EMD R; and Treatin~ Abuse Today is publishing a twopart interview with me on a variety of clinical issues and applications. This interview was conducted by Sheryll Thomson , MFCC, who also helped to coordinate the Florida hurricane response team. This widespread indica- tion of clinical acceptance and publicity is dovetailing nicely with the wider availability of EMDR workshops. Over the last nine months, I have trained and supeIVised ten additional trainers. When selected for training, they had used EMDR for over two years and worked as facilitators for at least one-and-a- half years. They will be conducting the standardizedEMDR workshops with supervised practica at a number of new locations. Please call the office if you are interested in sponsoring a local training. I am also attempting to finish a text- book on EMDR which will be published by Guilford Press. My deadline is January of 1994, so that it can be available for the fall semester. A number of trained clinicians with university positions have indicated a desire to include courses on EMDR. I do not consider the book a substitute for supervised practica, but an augmentation with a comprehensive descrip· tion of model, protocols, and procedures. To date, we have heard of three new eye movement techniques--two from Oregon and one from Colorado. In addition, there is another workshop purporting to teach "EMD ." The tech· niques are NLP or "New Age" flavored and, in one case, are taught in three hours, and in another, one hour. Unfortunately, clinicians are leaving these trainings and reporting "I've learned the eye-movement thing." Therefore, it is important that any of your clinical colleagues who have gone to these trainings be informed that what they have learned is not the same method that is garnering the successful r esults throughout the country. A number of misleading statements have been made by some trainers of these other workshops-including that I have collaborated with them. lhave notdoneso. Whenlfirst la unch ed EMDR, Emmett Miller, M.D. , warned me that there would be three stages. First it would be ignored, th en it would be attacked, then it would be imitated. I think we are in a mixture of stages two and three. Because of this problem, we h ave had 14 the logo trademarked and it will ap· pear on the fliers of all EMDR trainings--both basic and specialized--reviewed and approved by me or one of theEMDRNetwork'sprofessionalsupport committees. We are trying to strengthen a policy of quality control by reviewing credentials and workshop presentations before they are offered. Please check for the logo, EMDR Institute or EMDR Network, and the Pacific Grove address. No other trainings are recommended·· regardless of the claims of the proposed workshop presenters or sponsors. No claims of past or present affiliation or collaboration are warranted to indicate present approval or support of competence without the designations listed above. "Professional & Clinical Support" We are presently arranging the pro· gram for the 1994 EMDR Conference the first weekend of March. Currently scheduled are presentations by Richard Fisch, M.D. , Walter Young, M.D., Catherine Fine, Ph.D., and David Calof. There will be a choice of five day-long workshops on the first day, including, among others, one on treatmentofOCD, one on dissociative disorders, one on depression, one on HIV/AIDs, and another on the inter· face between EMDR and the MRI Brief Therapy model that will be presented by one of its founders. Additional presentations will include the treatment ofsubstance abuse, somatic disorders, motor vehicle trauma, vet· erans, critical incident, children, sexual abuse, and a variety of research reports. Other presenters and topics are under consideration, so please contact the office with written proposals or requests. We are expecting a sizable international attendance. I have approved a proposal for case and group consultation by some EMDR facilitators that is being coordinated by Landry Wildwind, L. C.S .W. These consultations are formatted as a bridge between Level I and II or for additional work postLevel II. While we are disseminating �EMDR Network Newsletter Fall/Winter 1993 the i:llformation as a service to partici· pants in need of additional support, finaocial and logistical arrangements are c ompletely between consultants and )larticipants. I would also like to specifically recom · mend the publications Treatin~Abuse '.I:rulaland The Healin~ Woman News· ~ . We have included subscription inforlllation as I consider them to be extremely valuable resources for the trauoia specialist. I know the editors of both publications and believe them to be of the highest integrity, with a dedication to the alleviation of client suffering. Both have recently published articles on "false memory" which further indicate the need for enligl1tened professional support. Bibliography Boudewyns, P . A , Stwertka, S. A, Hyer, L. A , Albrecht, J . W., & Sperr, E. V. (1993) Eye movement desensiti· zation for PTSD of combat; a treat· mentoutcome pilotstudy. The Behavior Therapist (2), 29-33. Pittman, R. K. , Porr, S. , Altman, B. , Longpre, R. E. , Poire, R. E. , & Lasko, N. B. (1993, May). A controlled study of eye movement desensitization/re· processing--EMDR--treatment for post-traumatic stress disorder. Paper presented at the annual meeting of the American Psychiatric Association , Washington , D. C. Sanderson , A Carpenter, R. (1992). EyeMovement Desensitization Versus Image Confrontation : A SingleSession Crossover Study of 58 Phobic Subj ects. Journal of Behavioral Therapy and Experimental Psychiatry, 23(4), 269-275. Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatmen t of traumatic memories. Journal of Traumatic Stress. 2, 199-223. Now you might ask what is theEMDR Research Training Center? Where is it located? What does it do? Might I be interested in its activities? The EMDR Research!l'raining Centeris directed by CliffordLevin, Ph.D., and is located at the MRI, 555 Middlefield Ave., Palo Alto, CA 94301. Lois Allen-Byrd, Ph.D., and A J . Popky, MFCC Trainee, are full-time staff members. Francine Shapiro, Ph.D., will be special consultant to the Center and attend approximately every second or third meeting. The Center meets every Tuesday afternoon from 1:00 pm. to approximately 4:00 pm in the well known MRI Brief Therapy observation rooms (that's right, the ones with the one-way mir· rors and wonderful audio-visual equip· ment). The primary purpose of the Center is to conduct quality EMDR research and publish its findings in the professional literature. At present, we are in the preliminary stages of planning a formal outcome study of PTSD in Vietnam veterans, rape survivors, and incest survivors utilizing a multi-session protocol comparing EMDR to an alternative treatment (yet to be determined) and a no treatment control group. The EMDR Researchtrraining Center opened its doors in July, 1993. However , at this time, we are not offering programs for the EMDR trained public. (When we begin to do so, the MRI will charge a fee for participation commensurate with other similar programs.) We are beginning to see clients in the center so that we may learn to properly use the equipment and develop cohesion as a r esearch and teaching team. Lois and I, as r epr esentatives of the Center , are also involved in th e data analysis and write-up of two EMDR studies conducted in South Florida in the after· math of hurricane Andrew. The first 15 study provided data on SUDs and Impact of Events Scale (JES) mea· surements on over 100 disaster survivors who were givenfreeEMDR treatment as part of a humanitarian effort sponsored by EMDR practitioners. Although this effort was not planned as a research study per se (thus, the results are not generalizable to other disaster survivor populations), as an evaluation study, EMDR was demonstrated to be efficacious in the reliefof certain PTSD symptoms with treat· ment effects holding at one and three month follow-up. In August, 1993, I acted as Principal Investigator for a formal outcome study conducted in South Florida. The design for this study allowed for three groups--Experimental Group (EMDR) Alternative Treatment Group (a criti· cal incident type debriefing), and a no treatment Control Group--with approximately 15 subjects in each group . Outcome variables measured are the SCL-90 (Symptom Check List) , IES, and SUDs. In addition to these out come variables, we collected information on the details of the sessions and a wide variety of demographic and questionnaire data. We anticipate that the results of this study will be ready for write up in early 1994 and the initial results look quite favorable for EMDR. Participation in these two South Florida research efforts have helped us to foresee some of the diffi. culties we will no doubt encounter in the EMDR Research!l'raining Center and hopefully bypass them. Might you be interested in participation with the EMDR Center team sometime in the future? Possibly. We have identified four categories ofpractitioner s for whom our services will be particularly well suited. 1) Dissertation Students - the laboratory setting is ideal for conducting dissertation quality research. Dr . Levin has participated as statistician for a variety of research projects and is facile with SPSS for Windows, a com puterizedstatisticalpackage. The student would have the opportunity �EMDR Network Newsletter Fall/Wlnter 1993 to a~t as a true principal investigator in tliat he or she could oversee the clinical work of experienced EMDR clinicians and not have to provide all of the "grunt work" him or herself. 2) Research Neophytes · how many of you have always wanted to participate in research so that you might learn the skills to design and conduct yourown research studies? Or, how many of you realize that at least minim urn research skills will become man· datory to substantiate our effectiveness to the managed health care companies of the future? The EMDR Researchrfraining Center will pro· vide tutorial services in statistics and research design as needed to suit your rese arch r equirements. 3) Experienced Researcher s · par· ticipate in the Center and learn the latest EMDR innovations and proto· cols. Statistical consultation will also be available. 4) Clinicians looking for advanced · EMDR training · the Center will al· ways be looking t:o develop new EMD R methods. In addition , you will have the opportunity to be supervised di· r ectly by Francine (who has promised to attend from one-third to one-half of the meetings) and the rest of the Cen· t er staff. We will also make time at each meeting for consultation on current cases in your pr ivate practice. All clinical work will be conducted one-to-one in an office with the remainder of the team observing from behind the on e-way glass. If you think you know wh at nervous is, try p rac ticing EMDR with F rancine watching your every move. It is in timidating, yes, but also incr edibly stimulating and educational. At this t ime, I would like to h ear from people who migh t have in terest in participating in such a project in the future. Ifyou wouldlike furth erinfor· mation , or ifyou wouldjus tlike to talk about your ideas, please give me a call at (41 5) 326-6465 . I look forward to h earing from you. There are several ways to help clients gain access to the resources necessary for successful processing when it does notoccurspontaneously. Forexample, when two or three sets of eye move· men ts occur with no progress, I occasionally use a "premature" positive installation. By doing so, the source of r emaining discomfort may come into sharper focus, revealing an appro· priate target for continued process· ing. Alternatively, the installation may have positive impact, giving the client more freedom from the habitual negative stance, and perhaps addi· tional strength with which to face whatever discomfort still remains. With either outcome, this strategy can be helpful in getting th e process back on track. (However , sometimes it does not work, perhaps because th e available positive cognition does not have sufficient power to overcome the block.) Borrowing from my work wi th children's nightmar es (Gr een wald, 1993), I have r ecently experimented with the "premature" installation of visual images at times when the pro· cess has bogged down. I say some· thing like this: 'Tm going to ask you to do something a little differ ent now. Imagine that this whole event was a dream. If this was a dream , and you were in it, what would you need to be safe?" If ther e is no immediate re· sponse, I will promp t as follows: "Re· member , in a dream , you can use magic, wh atever it is that you need. "Typically, an answer readily occurs and I proceed to install it in whatever manner is most appropriate. I have tried this several times, with excel· lent results. Two case examples follow. A woman who was processin g a child· hood memory of facing an oncoming tornado was not able t:o gain a sense of 16 safety or relief and was resisting a variety of strategies. Asked what she would need "in this dream" to feel safe, she immediately answered, "some protective white light ." She was asked to visualize her t argeted image, but with the white light pro· tecting her, and this was installed. She reported that during installation, she extended this visualization so that she absorbed the light in addition to being surrounded by it. The session progressed quite wellfrom that point. Afterwards, it was suggested that she practice visualizing the light as a relaxation exercise. An older woman had been haunted by a childhood memory of brutal moles· tation which had greatly affected h er whole life. Despite strong motivation and thorough preparation, she was quite afraid of facing this memory in the EMDR process (although sh e agreed to try it). The first set was brief and served to increase the vividness of the memory. After the second set, sh e reported losing th e image and associated feelings. A sense of numbness was present, which served as the next target. After the third set, even the numbness was gone, and sh e ap· peared quite withdrawn . At this point she was asked "the dream question," and answered immediately, "I would need to be stronger ." (Incidentally, strength was not her primary positive cognit ion.) The th er apist then asked, "What image do you have of strength ? If I can be an animal, a person , an idea, a place . . . what best represents str en gth for you?" Sh e immediately named her favorite animal and, with animation , described its "strength behavior" in som e detail. She was asked to visualize h er self "becomin g" the animal (as described in Martinez, 1991), and th is was installed. She th en repor ted feeling exp an sive , strong, and ver y happy. On returning to th e original tr aumatic image, she was able to pr oceed with the pro· cessing, and the session was quite pr oductive. In th e latter case, without this interven tion at my disposal, I would h ave �==c.:..:......:....:...=..:-'-==-=....:..,.~-t=s=le=t=t=e=-r Fall/Winter 1993 had to modify the treatment (e.g., mov:ing to a lower SUDs memory, • postj)Oning EMDR until the client coul«ldevelop more trust in her ability to tolerate discomfort, etc.). The delay ?"O have been frustrating and, uld aftec all, unnecessary. I vie"'I' the premature positive installatio:11 as a means of empowering the client to face his or her fears. It is important to introduce the dream context, so that image selection is not bound by reality demands and is not bound by reality demands. Spontaneous s election should be encouraged over "rational" consideration. The symbol which the client produces may enconipass much more meaning and potency than a verbal cognition. For tJie client, major trauma work is analogous to what Campbell (1949) called, the guest of the hero, involving the symbolic facing of death in order to acJiieve a rebirth , or integrative healing, experience. To succeed on this quest, the h ero must acquire magical tools, or allies with special powers, which, on a psychological level, represent emotional resources previously inaccessible to consciousness. By installing the image which the client spontaneously selects, we can enhance access to the needed inner resource; the magical sword with which the dragon may finally be slain. References Campbell, J . (1949). The hero with a thousand faces , Princeton, NJ: Princeton University Press. Greenwald , R. (1993). Treating children's nightmares with EMDR. EMDR Network Newsletter, .3(1), pp. 7-9. Martinez, R. (1991) . Innovative uses. EMDR Network Newsletter, 1(1), pp. 5-6. EMDR Newsletter Staff Editor: Lois Allen-Byrd, Ph.D. Publisher: A. J. Popky , CHT that she took a professional/observer role toward the experience (in addition to that of a client), and that she felt some concern as to her performance at tracking. I recently worked with a woman in her early forties who, for the better part of our sessions, could not track my moving fingers. She presented as highly distraught and reported that her husband of 14 years had just left the marriage the week before our session. This woman, who has been a therapist for nearly two decades, wandered distractedly about my office, touching things, and barely able to speak. She has no known medical problems, other than myopia, and takes no medications. I had used EMDR with her six months earlier on her fear of flying with no noticeable (to me) tracking difficulty, although she commented on how difficult track· ing was for her then. We had three EMDR sessions of one or more hours each on three consecutive days. I used long sets of movements with only occasional rest breaks--a practice I adopted while working with hurricane victims because of time constraints, and because the repressed material emerged so readily that interruptions based on numbers of saccades rather than thematic material seemed inappropriate. My impression was that as her work progressed to more intense issues , she was increasingly less able to track, as if the ability to track was a function of issue intensity. Less intense issues seemed to cause less difficulty tracking. (She agreed with this impression.) There was no indication of dissociation, and she seemed present and focused. She felt, when asked later, that she was focused internally on her work during the difficult track· ing times. Her eyes appeared not to move at all for long periods of time, although if I looked very carefully, I cou ld detect minute movements. She inquired periodically as to whether or not she was tracking and reported that she was unable to discern her own eye motion. She also mentioned 17 In the first session, I added kneetapping to the finger motions, con> cerned that the lack of eye movements would stall the work. In the second session, I devised a number of unusual hand variations to encourage tracking. In the third session, weary of working so hard and mindful of a recent EMDR experiment at Harvard (in which the subjects in the alternative treatment group stared at a fixed point while the finger moved-the assumption presumably being that the client's eyes were not moving), I decided to do nothing extraordinary to encourage tracking. I began to notice that new material surfaced periodically in the client's verbal account of her experience, suggesting that despite the lack of obvious eye movement, she was nonetheless processing. Finally, she described her visual image as retreating into the distance and ultimately disappearing. On follow-up, her distress was dramatically reduced, and she was extremely pleased with the outcome. The rapid surfacing of new material, the reduction and loss of the visual image, and a positive outcome despite the lack of obvious tracking during EMDR work suggest that processing was nonetheless occurring. Although this is only an n of 1, the results give rise to a number of interesting possibilities. For example, it may be that the finger saccade registers on the retina whether or not the eyes appear to move. Once it registers on the sides of the retina, signals may be sent to each side of the brain, again in spite of the lack of eye movement. This may be th e activating phenomenon and not the eye movements themselves. Or perhaps eye movement and retinal impulses work in concert. It is also possible that minuscule eye movements may be sufficien t, obviating the need to generate a wide saccade in our clients' eye movements, thus sparing the therapist some physical effort. �EMDR Network Newsletter Fall/Winter 1993 TheJe may also be a wide variation among clieots in the minimum number of sac· cades needed for processing. This client's min"'1teeye movements may have accomplislled the task. And.Iew Sweet, Psy.D., shared some oh· seIVations on this case. He pointed out that he is not aware of any literature to support the retinal signal model men· tionEd above. Whatever is occurring is cleaily not yet completely understood and needs investigation. He believed that this client may have been dissociat· ing mildly or not attending, which seems tome like a good clinical supposition. It It may be that we do not have 'to foregoEMDR with clients who have difficulty tracking because process· · ing may be occurring. We do, how· ever, need to consider the possibility of health deficits or criteria that might contraindicate the use ofEMDR with these clients. Con· sultation with theclient'sophthal· mologist or other specialist would be appropriate. Well-designed studies focusing on these points are needed to answer these questions. is a possibility that I have considered in spite of my alternative impression that she was not dissociative. It re· minds me that dissociation and atten· tion are perhaps best thought of as continua rather than either/or states. Andrew also speculated that eye move· ments may be useful in bringing up repressed material, but may become irrelevant as the client focuses inter· nally. Finally, he believed that per· haps the most important point to be learned from this case is that creative adaptation to unusual client presentations is the key to utilizing the method. Consent Below you will find an example of the types of things that we think clients should know in order to have informed consent before initiating EMDR treatment. This sample format is not meant to be the definitive answer for an EMDR informed consent, nor is it endorsed by EMDR Network, Inc. ; rather, it is offered here as one example of what can be included in such a document. Because the laws governing the use and effect of such documents vary from state to state, itis IMPERATIVE THAT YOU OBTAIN A LEGAL CONSULT BEFORE USING ANY SUCH DOCUMENT. CONSENT FOR EYE MOVEMENT DESENSITIZATION AND REPROCESSING TREATMENT advised and understand that 11 e Movement Des p . I have and in ave als ldataas tion and Reprocessing (EMDR) is a ne .. 1 de I have also been specifically adv (a) Distressing, unresolved m (b) Some clients have experie tering clinician may have (c) Subsequent to the treatme n, ocessing memories, flashbacks , feelings, etc. , may surface. ule n 1 n n io er R procedure. at neither they nor the adminis- h ysical sensations. ay continue, and other dreams, ve obtained whatever D t dby r influ Each state has its own ws gov r'ffing the use and effect of documents attempting to limit the liability of professionals, such as this CONSENT. Consult with an attorney regarding the laws applicable in your state BEFORE using any such document. This SAMPLE FORMAT is provided for your information only. EMDR NETWORK, INC. does not warrant or rep resent the suitability of this document, and disclaims any liab ility stemming from its use. EMDR NETIVORK, INC. is not, engaged in the practice of law and does not render legal services or give legal advice. 18 �EMDR Network Newsletter Fa11JW1nter 1993 node, process as follows. Soooafter I took the Level I training, I read an EMDR Newsletter article by Ron Jfartinez (August, 1991), in which Ron described having clients touch and))ress the area of their body where they were feeling emotion. (He said that he got this idea from his familiar· ity with therapeutic body-work.) Ron reported that 70% of the clients ob· tainEd a picture or memory, which they then processed. Ron~~ article inspired me to try his suggestion and, based on my own fa. miliarity with therapeutic body-work and interest in the mind/body connec· tion, I have tried other things as well, with some interesting results. I.In addition to having the client focus attention on the body sensation during saccades, have the client touch the place on his or her body where the sensation is and process till there is no more sensation. Touch only during the saccades (in all descriptions fol· lowing, assume touch or pressure dur· ing saccades and cessation of touch or pressure between saccades). 2.Have the client assume a posture associated with the situation and pro· cess in that posture until the SUDs levels off. Level C Work below the surface of the body. This seems to increase the emergence of information and emotion compared to touch on the surface, and seems to change the SUDs more than touch on the surface. I now think of the body as a full partner with the picture and cogni· tion in the EMDR process. As such, I go into detail about body sensations and experiences with clients, much as we have been trained to do with pie· tures and cognitions. I have put to· gether a tentative framework to help guide practitioners in more fully uti· lizing body centered phenomena as part of EMDR. 1. Gently apply pressure to the mus· culature where a sensation occurs, slowly increase, and process until there is no more sensation (feels neu· tral) or it feels relaxed. 2. When sensation occurs in the throat area, touch the front of the windpipe gently and process any area of sensitivity until there is no more sensation. 3.In the solar plexus, gently push inwards and process until there is no more sensation or it feels relaxed. Level A Level D Toucli or focus on the body brings more information, which is then processed. Processing a pattern of response in the body with little or no use of picture or cognition. 1. Touch brings out new informa tion (Martinez, 1991). 2.Posture can h elp clients get in touch with pictures or memories when the client just has a vague feeling and nothing else. Ask the client, "What posture goes with the experience you are having?" Having the client as· sume the posture often brings up more information. I was working with a client I will call Tom on his chronic anger and easily provoked rage. We had processed 2 to 3 childhood memories which h ad helped reduce his anger, but h e h ad a difficult response occurring as we worked. Tom involuntarily would tense his whole body and feel like hitting with his left arm whenever he felt any degree of anger, and h e would become exhausted during the processing. As we tried to process his father grabbing Tom by the arms as a boy and screaming at Tom not to cry, Level B When treatin g a body experience as a 19 Tom's intense reactions stopped our progress. In the next session, we decided to treat Tom's body response as the target. He could readily trig· ger the 'tensing response' by think· ing of anything moderately unpleas· ant. I instructed Tom to trigger his tensing response as mildly as he could and then we processed the body sensations, whatever was most apparent at the time. We would work on each location until it was mostly relaxed or felt neutral. After 2 to 3 locations, I started asking Tom to notice where in his body the tensing response originated. He initially said his shoul· ders. We then processed as he held his shoulders. Then he said he could tell that it originated between his shoulder blades. We then processed as he held this area. After 2 to 3 sets of saccades, Tom said he could now tell that the response originated in his solar plexus. We processed as he gently pushed into the area of his solar plexus. More emotion emerged as we processed at Tom's solar plexu s. At times, he could not control his tensing response and we would have to slow down. Processing the tension in his neck would generally allow him to relax enough to proceed with· out becoming exhausted. We pro· cessed as he held his solar plexus until the area seemed neutral. Tom then reported he felt more relaxed than ever before in his life, and that his mind was quiet for the first time in his life. The above is a summation of two· and ·a·halfsessions ofEMD R on Tom's tensing response. His response was not gone, but was greatly reduced, ·and he could usually relax enough to prevent it. Tom reported h e was much more relaxed in general and was no longer bursting out in anger as he drove in traffic. We were also then able to process the experience of his father yelling at Tom, with further positive results. I would appreci· ate comments and questions: (303) 443-5682. �EMDR Network Newsletter Fall/Winter 1993 A t~enty·four-year -old Catholic woinan who came to see me recently was suffering from severe post-abortion depression and guilt. (l'he abortion had been just one week prior to our '1isit.) Her presenting symptoms were difficulty eating, sleeping, get· ting lip to clean the house, and flashbacks of the a bortion. Although she was not conscious during the proce· dure, the flashbacks were of the doc· tor performing the abortion. She also punished herself by looking at a book of embryology and paying particular atten tion to pictures of the fetus at the stage at which it was aborted. The ltistory taking r evealed a reason. ably mentally h ealthy young woma n involved in a destructive marriage. She had three children, ages four , three, and a one-year-old baby whom she was nursing. After much discus· sion , the negative cognition she fi. nally chose was, "I'm a terrible p erson," and the positive cognition was, "I had to do it," with a VoC of 1. Upon r eflection , I realize th at 1 was too low to result in a positive outcome. However, note in the following paragraph how the client led me to h elp h er form a more appropriate positive cognition. What came up frequently during the eye movements was anger at people for not telling h er that th e abortion was wrong. We started the work with the image of the doctor performing the abortion. This image gradually faded, as did a sign saying "I have to punish myself." However , sh e did not experience complete relief and the original positive cognition remained at 1. I then suggested a new positive cognition: "It was wrong. I did it because I felt desp er a te." She immediately accepted this and added "l thought I was going lo go crazy," ~nd gave the entire new cognition a VoCof 7. She then had a visual picture of herself at home, pregnant, with a one· year-old baby and two small children, no husband to help her, and feeling as if she was going crazy. She was unable to visualize the abortion when she held the new positive cognition in her mind. We ended the session with her seeing her three little children happy. When I saw her for the second time, all presenting symptoms were gone. However, she did not come in enthusiastically reporting this. I h ad to question her on each symptom and learned that although she was eating and sleeping well, was busy around the house, had no flashbacks, and did not look through the embryology book, she did not seem to connect EMDR with these improvements. She was still planning to contact a priest, saying she wanted someone to tell her If any EMDR trained therapists are flu ent in a second language, please contact the EMDR office at ( 408) 3723900. If you are an EMDR trained clinician and have had any books published, please contact the EMDR office at (408) 372-3900. RESEARCH WITH ADULT WOMEN WHO HAVE HAD A HISTORY OF SEXUAL ABUSE. Assistance desired on research project from EMDR trained therapists to participate in a comparative outcome study between female AMAC clients treated with EMDR and those treated with conventional therapy alone. Contact: Nadine Zatlin, MFCC, 6 70 Brooks St., Laguna Beach, CA 92651; (714) 494-0233. 20 she was wrong. She also had initiated counseling with a Christian group who uses the Bible for post· abortion counseling. Although on the surface, selecting a positive cognition such as "It was wrong" seems to be antithetical to what we are trying to achieve, I believe that it would have been impossible to achieve these quick and positive results without putting it in to the positive cognition, as anything else would have come into direct conflict with this client's value system. Thus, it seems clear that it is essential when formulating the positive cogni~ tion, to take into account the client's value system. This means that the therapist needs to be aware of and sensitive to ethnic, religious, and social values-·not only of the group, but of the client's own unique interpretation of these values. The EMDR Research!I'raining Center at MRI is looking for smok er s th at wan t to take part in a research project to quit smoking. Anyone who has clients interested in participating, please call Cliff Levin at (415) 326-6465 or A. J. Popky at (408) 3958541. EMDR trained clinicians who are interested in Peak Performance, I want to exch ange ideas. Please con· tact Dr. Mark Huthaite, 27 No rth Cottages, Napsbury Hospital, London Colony, St. Albans, AL2 JAW. If you are interested in sponsoring a training for small groups in your area, please contact Robbie Dunton at (408) 372-3900. �CENTURY CITY/SANTA MONICA PALO ALTO RobErt Goldblatt (213) 917-2277 Ferol Larsen (415) 326-6896 Coo.-dinating a new group 90067, 90401 zip area for West L.A. Meets 1st Wed. lOam in MRI conference room. Case discussion. CUPERTINO REDDING Ger.-y Bauer (408) 973-1001 Dave Wilson (916) 223-2777 Mee.ts 2nd Wed. 2 :00 - 3:00 pm. Case consultation. Open Meets once monthly at the Frisbee Mansion on East St reet in DOWNEY Redding. Discussions, case presentations, videos, role playing, Pauline Hume troubleshooting. (213) 869-0055 Coordinating a. new group . Open SACRAMENTO EAST BAY Barbar a Parrett (916) 737-1789 Edit'h Anke rsmit (510) 526-5297 Coordinating new group. Meets on 2nd Fri. l-3pm. Mee1s 3rd Fri. 7:30pm . Case discussion only. Group is closed SAN DIEGO to new members, but willing to coordinate a new E. Bay group . Marcee Sherrill (619) 233-0460 EAST BAY/ALBANY Meets 4th Fri. from 9:00-10:30am. Primarily case discussi on . Sandra Dibble-Hope (510) 843-1396x48 Call regarding availability. Mee1:s 1st Mon . 8-9:30pm, 1035 San Pablo Ave ., Ste. 8 . SAN FRANCISCO Stan Yantis (415) 241-5601 EAST BAY/OAKLAND Sylvia Mills (415) 22 1-3030 Hanl Ormond (510) 832-2525 Meets 1st Wed. 8-l Opm., 180 Beaumont St. Please call to Meets one Fri. a. mo. Call for time & d ay. Ope n confirm. Case discussion and group process. Open . FRESNO Open Darrell Dunkel (209) 435-7849 SAN MATEO/BURLINGAME/REDWOOD CITY Meets I st Fri. a t Fresno VAMC. Primary case discussions. Open Pat Grabinsky (415) 6 92-4658 HUNTINGTON BEACH (415) 593-7175 Florence Radin Jocelyne Shiromoto (714) 764-3419 Open. Call fo r time. Coordinating a new group. Con t act Flor e nce. SANTAANA LOS ALTOS/PALO ALTO Charles Wilkerson (714) 543-8251 John Marquis (41 5) 965-2422 (714) 841-2296 Mee t s ad ho c at Pacific Gr adua te School of P sychology in Palo Judy L. Albert Meet s 2nd and 4th Thu rs. ofmo. 8 :30-10:300.m at 1633 E . 4th Alto. Primarily case discussion. Op en St. #206 . Primarily case discussion . Open LOS GATOS/SARATOGA/CAMPBELL SANTACRUZ J ean Bitter-Moore (408) 354-4048) (408) 475-2849 Meet s the 3rd Thurs. 12:00-l:30pm at Mission Oaks Hospital, Linda Neider Meets every month on a Fri. 7:00pm. P rimarily case discussi on . Conference Room l , Los Ga tos . Ope n SARATOGA/W. SAN JOSE MANHATTAN/REDONDO BEACH Dwight Goodwin (408) 241 -0198 Randall Jost (213) 539-3682 Meet s Fri. lOam-12:30. Op en Coor din ating a n ew group. SOLANO/ NAPA COUNTY MARIN COUNTY Micah Altma n (707) 747-9178 Steve Bodia n (41 5) 454-6149 Willing to coordinate new group . Call if inter ested . Coordinating a n ew group . Open SONOMA COUNTY MONTEREY Kay Caldwell (707) 525-0911 Glenn Leon off (408) 373-6042 Meets in Santa Rosa a t Kay 's office t h e 4t h Tues .12:30- 2:00pm. Robbie Dunton (408) 3 72-3900 Primarily case disc ussion, videos a nd "troublesh ooting." Op en Coordinating a. new group . Open TORRANCE NAPA James Pre.tty (800) 767-7264 Margu erite McCorkle (707) 226-5056 Coordinating a n ew group . Op e n Op en . WEST LOS ANGELES NEVADA C ITY/GRASS VALLEY (31 0) 202-7445 Stephanie Zack (916) 2 72-6738 g::~ ~~~e (3 10)4 79-6368 Call for time . Open ORA N GE COU NTY/FULLERTON Coordina ting a new group. Open (714) 680 0663 UKIAH Curtis Rouanzoin · Gar ry A. Flint (707) 468-0418 (714) 764 3419 J ocelyne Shirom oto Meetsth e l astFri. ofm o. from lOam to 12 n oonat 101 W. Church Meets 2nd Tue. from 9:30 - 11 :30 AM. Open St. #lO. Open PALMDALE /LAN CASTER W OODLAND HILLS/NORTH RID GE/WESTWOOD 1 805 272 8880 ~i;!:t;ti: , ~:ew group. Op e n < ) Ronkin~octor/Ginger Gilson . (81 8) 907-7506 ,. ,,, >,. ,,·, ,.·, ····.· • • ....,., .•.. ·• ,.· ··... , • • , , < • , ,, , . ~ee . g ~e~.me~be~~- Con tact.(}mg. r. ~ f!/iJ'PU intere~(ed in coordi~~.ting''a n~~ Stl!,~Y .., are. . i:i-gup J~Joyfre~ion}~Z Jt#:~;,n,o 'J , Jffj;; ···po ·Box51010, Pacific Grbvet'C,A.939~<Hi010 (408)\;372--a9Q(ri ~ (4Q ij41i . F 8)E 21 �EXDR lws generated a tremendous amount of enthusiasm among practitioners and all of us are anxious to read about the latest developments in, and/or experiences with, this exciting method. Because of this enthusiasm and desire to acquire more knowledge, I believe that it is important to produce a publication that provides a forum for articles that are more formal (e.g., research, prowcols, etc.), as well as for those that are less formal (e.g., case studies, innovative ideas, etc.). T<i this end, the following represent the guidelines for submissions to the Newsletter: Send articles t,o Lois Allen-Byrd, Ph.D., Editor, EMDR Newsletter. 555MiddlefieldRoad, Palo Alto, CA, 94301. Please include home and business telephone numbers, professional degree, location of practice (city and state only), professional affiliation (if applicable--university, if a lecturer or teacher, and/or institute, if an associate). E:xampk: John Smith, Ph.D., John Doe University, Johnson, WA. If possible, please submit articles on a diskette, IBM format . ARTICLES SHOULD BE DOUBLE SPACED WITH WIDE MARGINS. APA S'l'ANDARD AND STYLE-BOTH TEXT AND REFERENCES SHOULD BE IN ACCORDANCE WITH APA STANDARDS. ALL SUBMISSIONS ARE SUBJECT TO EDITORIAL REVISIONS. Proofreading of material is suggested before submission. Authors submitting a manuscript do so with the understanding that, if it is selected for publication, copyright of the article is assigned to the Newsletter. Because the Newsletter depends on you, the members of the network, I welcome any suggestions or comments that you may have. If there are any questions regarding the above, I can be reached at (415) 326-6465. 1994 EMDR CONFERENCE Sexual Abuse HIV/AIDS Somatic Disorders Problems & Pitfalls Smoking Critical Incidents Research Motor Vehicle Trauma Self Harm Sexuality 22 Substance Abuse Children Chronic Pain Art The arpy Obsessive Compulsive Diso rder �EMDR Network Newsletter Fall/Wlnter 1993 • Presented by Francine Shapiro, Ph.D. Local Sponsor ~ J .-ii. 14/15 Fri/Sat. Lo• Angeles, CA Sheraton L.A. Airport Hotel (818) 885-2827 Ron Doctor, PhD Psych. Dept., CA State Univ., Northridge (714) 680-0663 Curt Rouanzoin, PhD Chair, Dept. of Psychology Pacific Christian College, Fullerton Feb. 11/12 FrilSat. San Jose, CA Sunnyvale Hilton Robbie Dunton, MA Coordinator, EMDR (408) 372-3900 M.-~. 19/20 FriJSat. New York, NY Loews NY Hotel William Zangwill, PhD Gerald Puk, PhD (212) 663-2989 (914) 635-1300 Ap r. 8/9 Fri./S at. San Jose, CA Red Lion Inn Robbie Dunton, MA Coordinator, EMDR (408) 372-3900 Apr. 23/24 Sat./Sun. Denver, CO Sheraton Denver Tech Cntr. M.-y 15116 Sat/Sun. Honolulu, HI Kahala Hilton Sandra Paulsen, PhD Pacific Inst. of Behavioral Med. (808) 523-2990 Jun. 4/5 Sat/Sun . Chicago, IL Mariott Oakbrook Howard Lipke, PhD Dir., Stress Disorder Treatment Ctr. No. Chicago VAMC (708) 688-1900x4675 Ju11 17/18 Sat/Sun. Philadelphia, PA Radisson Hotel Airport Alan Goldstein, PhD Dir. Agoraphobia/Anxiety Trtmt . Ctr. Temple University Medical School Steve Silver, PhD Dir. , Inpatient PTSD Unit Coatesville VAMC (215) 667-6490 Location Phone (2 15) 384-77Ilx649 Aug. 6/7 Sat./Sun. Portland, OR J ean Sutton, LCSW Sheraton Portland Airport Hotel David Baldwin, PhD (503) 452-9625 (503) 686-2598 Sept. 10/ 11 Fri./Sat . San Francisco, CA Clarion Hotel Robbie Dunton , MA Coordinator, EMDR (408) 372-3900 Oct. 21122 Fri./Sat. San Jose, CA Red Lion Inn Robbie Dunton, MA Coordinator, EMDR (408) 372-3900 Presented by Francine Shapiro, Ph.D. Apr. 15/16 Fri./Sat. San Jose, CA Sunnyvalle Hilton • History-taking and specified questioning for focused identification of problem areas Jun. 24/25 Fri.IS at. San Francisco, CA Doubletree SF Airport • Closing down "incomplete" sessions Jul. 30/31 Sat./Sun. Denver, CO • Axis II applications • Integration of EMDR with cognitive therapy Oct. 15/16 Seattle, WA (Fri. -Sat.) Sunnyvale Hilton • Dissociative & other major disorders Nov. 5/6 Sat./Sun. N ew York • Abreactive responses and alternative strategies Lowes New York • Working with difficultJresistant clients Nov. 12/13 Philadelphia, PA Sat./Sun. Embassy Suites • Integr ating "self-control" techniques Dec. 2/3 Fri./Sat . San Jo!!e, CA e Trea tment of Process Phobias Hyatt Regency Denver Tech. Ctr. S unn yvalle Hilton 23 �S1rayThoughts .. ............FrancineShapiro, Ph.D....... ............................................ .................................................. . 1 · ~tgionalNetworkCoordinators ............................................................................................................................ . 2 &li!ORNetworkMeetingSchedule.. .......... .............. ................................................................. ..... ........................ .3 &l\!OR: Warts and All.. ......... ................... Elan Shapiro, MA. .................................................... .............. ... 4 ~ e taphors Describing the EMDR Process ..................Errol D.Schubot, Ph.D ......................... ... ................ 5 E~posure/EMDR: Diagnostic Use ofFeedback...................... Frank J . Schlosser, MS ................................. 7 A New Technique for ClosingOutEMDR Sessions... .................... StevenLazrove, MD................................... 10 International Update ................................ FrancineShapiro, Ph.D................................................................... .. .. 11 N'ews From the EMDR Research!I'raining Center........ Clifford Levin, Ph.D.................................................... 15 A Case Study: Paradox and EMDR with Paranoid Schizophrenia........... Edith Schultz, Ph.D .......... ....... ..... 11 :Kagicallnstallations Can Empower Clients to Slay Their Dragon........ Ricky Greenwald, MA ................... 16 C...ASE HISTORY:A Client Unable To Track.................... Judith Boore, MA ....................................................... 17 Sa111ple EMDR Consent Form........... .................................................... ......... ........................................................ 18 Innovative Uses: EMDR Body Centered Processing............... Kieth Anderson, MA................................. .... 19 TheImportance ofMatching Positive Cognition To Client Values .................. EdithAnker smit, LCSW...... 20 El\1DR Help Wanted ................. ................... ....................................................................................... ...................... 20 CaliforniaEMDRStudyGroups........................................................................................................................... 21 Submission and Deadline Information ...................................................................................................... ....... .. 22 19il4 EMDRAnn ual Conference ................................................ ............................................................................ 22 19il4 TrainingSchedule .................................. ...................................................... .................................................. 23 EMDR Net work PO Box 51010 Pacific Grove, CA 93950-6010 EMDR Network Newsletter Fall/Winter 1993 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter Newsletter Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter, 3(2), 1-23 https://d1y502jg6fpugt.cloudfront.net/13023/archive/files/e08747018ac75089fbb619819b85273d.pdf?Expires=1790208000&Signature=lHY1yPCqjDgNQnLKVaz5uF4ThNV0jBkomzzKv1ia2e5mpZtVDhnH91tFS%7EWb1oxlKkl0RxbO1d8ZhgyVx64R23bOdJP-UwdZFNHOOoJpBvAef4lfnVWA3yc3MaWQtALM8rHUW0Ld1HVKk81dPsLQ6KSGvOj2yirbw6TQu4FVtZ9GGzFwdOxjjOriKP1mbbFO5do-cg4kMOP8HWdtebgLKuHc2nYLrhduTPjy9QMlKDdHq0AFIu1oKDZfZAEiNZ3ttG-beFzQhflKt4TPhxyvAkZqYBRQnK5MOoDCiXTNVo5g0L5MN67gTmUvRy8asNDHsHtfYU%7Edykg40QlbMgikOA__&Key-Pair-Id=K6UGZS9ZTDSZM 205c93796c0cb957285bbfd48ba0af32 PDF Text Text L Winter 1993 <> G Nm IY l m INc. Vo1.3 Issue 3 N e t w o r k Newsletter EYE MOVEMENT DESENSITIZATION AND REPROCESSING Copyright O 1993 EMDR NETWORK, INC. P.O. Box 51010, Pacific Grove, CA 93950-6010 (408) 372-3900 FAX (408) 647-9881 Francine Shapiro, Ph.D. Senior Research Fellow ISSUES OF COMPLIANCE I N EMDR 1 ) THE BOUNDARIES OF THE THERAPIST'S ABILITY SHOULD NOTBE DESIGNATEDAS LIMITATIONS OF THE CLIENT Too often the limitations of the therapist's model, repertoire of interventions, or ability to interact with the client are dismissed as due to client "resistance." While client resistance and non-compliance may certainly be issues that need to be overcome, the interaction between theclient and the clinician should not be discounted as possibly contributing to the lack of the therapeutic effect. In EMDR, the therapist variables that impact upon the treatment effect include the ability to target the appropriate part of the pathology, order of targeting, and comfort with a multimodal approach. For full therapeutic effect of EMDR. the therapist must be able to: (1) establish a level of rapport t,hat allows the client to comfortably experience revivification of trauma, (2) accurately identify the appropriate targets, (3) use insight and sensitivity to asslst in the completion of processing, (4) interweave a variety of coping skills, and system's informa- tion, and (5) offer appropriate modeling when necessary. Fortunately, it is a client-centered approach that allows most of the work tobe done in the office. Therefore, non-compliance is often (of course, not always) based on inflexibility of the clinical approach and indicates the need for more appropriate targeting. 2)NON-COMPLIANCE I S PAR T OF THE PA ~ O L O Y C In EMDR, pathology is the target of therapy. Non-compliance is not under the client's conscious control and is therefore not considered an ancillary issue. With this understanding, consequences of non-compliance become part of the debriefing of the client on an on-going basis. This allows the lack of compliance to be viewed as part of the pathology that needs adjusting. We do not tell our clients to return for help when they are not so depressed-telling them to come back when they are more compliant often amounts to the same thing. 3)CO-PARTICIPA TION IN DETERMINING GOALS The therapistlclient relationship is an interaction which should incorporate the specific goals of the client. The actual effects of non-compliance should be assessed. The positive or negative effects of any therapy will be based upon an interaction ofclient, clinician, and method. Part of this interaction is the appropriate selection of goals that are agreed upon by both client and clinician. If the client is being asked to reexperience disturbing aspects of the targeted traumas, the reasons should be acceptable to the client. While there can be no guarantees, clearly the reasons for choosing to experience the discomfort of reprocessing will include the possibility of liberation from the on-going debilitating effects of the trauma. The client must recognize these potential effects in order for the discomfort generated by the processing to be acceptable. The clinician's goals should be approved ofby the client, and theclient's goals evaluated by the clinician as appropriate. For instance, never feeling angry while driving may be impossible to achieve and may be part of an inappropriate self-assessment that underlies the reason for non-compliance (e.g., inability to succeed). Noncompliance should be coached as preventing the achievement of specific goals initiated by the client, not ones foisted upon him or her by the therapist. This increases the likelihood of managing the areas of resistance. . 4) SECONDARY GAIN ISSUES Issues underlying non-complianceinclude fear of success, fear of terminating therapy, fear of failure, etc. Appropriate assessment can be made by asking the client to respond to the question, "What would happen if you are successful?" After any appropri- �EMDR N e t w o r k N e w s l e t t e r W i n t e r 1993 geted before processing the targets that underlay the primary presenting REGIONAL NETWORK COORDINATORS complaint. As with other EMDR protocols, after the memories have been I Arizona Pat Penn, Ph.D. reprocessed, the present stimuli that California (Northern) Norva Accornero, LCSW elicit the negative d e c t or behavior (Southern) CurtisRouanzoin, Ph.D. should be targeted and processed. In Colorado Laura Knutson, LPC addition, a positive template for apJana Marzano, MA I propriate action should be installed. I Connecticut SteveLazrove,MD With issues of non-compliance, the ' Georgia Pat Hammett, Ph.D. client should be asked to imagine doHawaii Sandra Paulsen, Ph.D. ing the task easily and comfortably. I Idaho Dean Funabiki, Ph.D. Targeting with EMDR allows the beI Illinois Howard Lipke, Ph.D. havioral possibilities to become more Maryland Mike Brenner, MD enhanced and allows any residualfeelMassachusetts Me1 Rabin, Ph.D. ings of discomfort to be reprocessed ' Missouri Marcia Whisman, LCSW New York William Zangwill, Ph.D. Gerald Puk, Ph.D. 1 New Mexico Peggy Moore, LSW The experiences and actual behavior Ohio Kay Werk, LISW of non-compliance can often be tarOregon Ann Iiafoury, LPC geted by EMDR. Many rehearsalscan Pennsylvania Georgia Sloane, MS be accomplished in the oifice. Texas Carol York, MSW Dan Sternberg, Ph.D. Utah In EMDR, a feedback Log is useful for Washington Roger Solomon, Ph.D. reprocessing stimuli. After a trauma Steve Riggins, MA is addressed, the client is asked to ate fears are adequately addressed, the therapeutic effect will be quesreport back on any disruptive feelings any residual feeling of tension or re- tionable. or experiences for further targeting. sistance can then be targeted with Ironically, excluding the refusal to EMDR in order to reprocess any inap- As previously stated, EMDR calls for engage in the treatment itself, this propriate fears. Fears of losing ben- directly addressing the appropriateLog is the major source of non-compliefitsshould be addressed a s a realistic ness of fears. When the fear appears ance in EMDR treatment and can be fear before investigating the possible to be based on "consensus reality" used a s an appropriate reprocessing pathogenic basis (e.g., I cannot suc- issues such as the loss of a disability target. S p e ~ ~ c a l l y , feelings of rethe ceed ifI try). Unless secondary gains check if the PTSD is handled, an acsistance to t.he task, along with any are appropriately identified and ad- tion plan for substituting a n appronegative cognition and salient memodressed, little therapeutic progress priate source of livelihood should be ries, should be addressed a s they arise can be made. inaugurated before targeting the ac- within the offlce. Results are then tual dysfunction. When appropriate reported back in vivo. 5) PRIORITlZING OF TARGETS fears are addressed through the inclusion of new information, coping In sum, in attending to issues of nonTherapeutically, fears must be ad- skills, etc., then the residual fears are compliance, the choice of treatment dressed in terms of appropriateness viewed a s appropriate targets for reshould be flexible enough to work and in the sequence of pathological processing. After these have been around the client resistance until it is blocks. addressed, the trauma targets may be resolved. This can often be accomapproached more effectively. plished with EMDR, since most of the S p e ~ ~ c a l l the EMDR model calls y, work is done during the treatment for the sequential targeting of appro- 6) GENESIS OF FEARS session. priate memories that impact upon the pathology. The order in which these Non-compliance should be evaluated targets is accessed and processed is in termsof spiritual beliefs (e.g., life is EMDRNetworkNewsletter significant (e.g., memories having to suffering), parental injunctions or Staff do with lack of worth should be tar- need toremain loyal to parents through Editor: Lois Allen-Byrd. Ph.D. geted before memories having to do parallel suffering, manipulation and Publisher: A. J. Popky, MA with fear of failure). If blocking be- power needs. Appropriate memories D a t a Entry: Sharon Lucas liefs are not appropriately addressed, underlying these factors may be tarI ������������������������������� Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter Newsletter Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter, 3(3), 1-31 https://d1y502jg6fpugt.cloudfront.net/13023/archive/files/97fad3d3cc6dc60dbeae4ff126a7bbac.pdf?Expires=1790208000&Signature=ZRrkuERWXR7drTCLnKiTzWT1oiFmQ91sQ6NOdtU89E9AI9JBidxrLMbi7wWK02L5BgpE46TuGcfTJ59035UP-eosJga%7EtwhNATipdJTAD%7E6cCXw3ChXL4FhKz8VA%7EQpxcECMu7nGWVTYMF07UnpqtkTGcgtfhKLGo2kWf49n31U0Jjy15pYoz4pHcRYetL9iBeG8hF9WWunM8gH59JsWCga5zJgp2yt1ePOPUiAZY-PHKBsGp5eOa6xIXQIsXsqud%7Em0oEHJOWHJLyIuy0W2TU94oPHS5I40Xwgk74-1F9a7BUVlMiaGU2MUJrjGtAI7VunGqGVUrtbRRJXkJ0WJxw__&Key-Pair-Id=K6UGZS9ZTDSZM a3cc14101d3f10e0054bb0d36cf77b3d PDF Text Text 1994 Issue 1 Network Newsletter EYE MOVEMENT DESENSITIZATION AND REPROCESSING Copyright @ 1994 EMDR NETWORK, INC. P.O. Box 51010, Pacific Grove, CA 93950-6010 (408) 372-3900 FAX (408) 647-9881 I thought it might be interesting to review some of the prevalent theories regarding the effectiveness ofEMDR. 1) Procedural Elements-As a quick review, any assessment of therapeutic effectiveness must take into ac· count the procedural elements in· volved in the therapy. Many aspects ofEMDR are geared to incorporate a feeling of self-efficacy. To name but a few: (a) Clients are assisted in the repeated creation and discarding oftheir traumatic imagery which may communicate to them a sense of perceived mastery in the ability to mentally circumscribe and manipulate the in· ternal disturbing stimulus. In addition, focusing attention on the disturbing material for short spans of time--while receiving reassuring therapeutic statements from the clini· cian, and becoming aware ofthe safety of the clinical context--may allow counter-conditioning to take place. At the very least, the short bursts of attention to the traumatic memories af. fords a therapeutic context that may provide the benefits of repeated exposure which is antithetical to the avoidance reactions that are part of and maintain the pathology. Stray Thoughts . .......... ...................... Francine Shapiro, Ph.D........ ...... 1 Regional Network Coordinators ........ .......................... .. ... .. ........ ... ...... 2 EMDR Network Meeting Schedule .................................... .................. 3 How does EMDR work, Anyway.. .. Steven L. Henry, Psy.D............. .. 4 Enhanced EMDR Outcome through Additional Saccades: Case Study... ............... ....................... Joann Leone, MD ......................... ..................................... Jim Dayton, MSW ....................... 5 Beyond Deficiency Motivation: EMDR Peak Experiences and Transcendence. .............. ................... Elke Maxwell .............................. 6 Trauma and Self-Trust: EMDR can Help .......... .... ..................................... ....... .... Scott Nelson, Ph.D ...................... 7 Healing the Heart: EMDR in Post-Unification MPD Therapy ................................. .. .......................... . Thomas Tudor, Ph.D ................... 8 EMDR with Panic Disorder Patients who Inhibit Anxiety Reactions .............................................................. Judith D. Wilcox, Ed.D . ..... ........ . 9 AnlnterestingObservation ............ EdithAnkersmit, LCSW ........... 10 The Therapeutic Relationship and EMDR .......... .. .................................................. Ricky Greenwald, MA ............... 10 The Positive Core ......... ..... ............... Marie Witt, Ph.D ....................... 11 Mistakes to Avoid in Using EMDR: or "Do What I Say, Not What I've Done ......... ............. .................................... .... William Zangwill, Ph.D . ............ 13 International Update ....................... Francine Shapiro, Ph.D ............ 14 EMDR Help Wanted ............................................................... .............. 16 From the Editor... .......................... ......... .............................................. 17 EMDR References .......... ............. ........... .... ..... ......................... ............. 18 California EMDR Study Groups ............ ............................................ 20 Submission and Deadline Information . ............................................ 21 1994TrainingSchedule........ .................... ........................................... 21 AudioTape Order Form 1994 Conference................................. ........ 22 EMDR Sample Consent Form.2 .......... ............................................ .... 23 (b) Clients are encouraged to remain in contact for a prescribed amount of time with the physical sen· sations that are created by the traumatic imagery. This contact may allow them to identify and separate the physiological sensory effects of the trauma from the cognitively laden, affective interpretations of these sen- 1 sations which can constitute the labeling of and identification with an emotion, such as "I am afraid," or "I am angry." Clients can identify themselves as larger than the pathological cognition by observing their own reaction. They are doing this by shifting their focus from an overwhelming feeling of fear to "I am feeling sensations �EMDR Network Newsletter 1994 Issue 1 Arizona Arkansas California (Northern) (Southern) Colorado Connecticut Georgia Hawaii Idaho Illinois Maryland Massachusetts Missouri New York New Mexico Ohio Oregon Pennsylvania Texas Utah Washington Jonathan Brooks, Ph.D. Pat Penn, Ph.D. Stephanie Zack, LCSW Norva Accornero, MSW Curtis Rouanzoin, Ph.D. Ron Doctor, Ph.D. Laura Knutson, LPC Jana Marzano, MA SteveLazrove,MD Pat Hammett, Ph.D. Silke Vogelmann-Sine, Ph.D. Dean Funabiki, Ph.D. Howard Lipke, Ph.D. Deany Laliotis, LPC Mike Brenner, MD Lorie Bollinger, MA Marcia Whisman, LCSW William Zangwill, Ph.D. Gerald Puk, Ph.D. Peggy Moore, LSW Kay Werk, LISW Ann Kafoury, LPC Georgia Sloane, MS Carol York, MSW Dan Sternberg, Ph.D. Steve Riggins, MA in my stomach which are associated with a feeling of fear. Now, I am feeling sensations in my chest which are associated with feelings offear ... " This cognitive separation allows the clients to recognize the changeability of the sensations which can increase their sense of self-awareness and self· efficacy. These short periods ofattention to sensations may afford the same benefits of counter-conditioning and exposure mentioned above. (c)Assistingclientstoidentifythe negative self-assessment regarding the trauma may allow them to perceive its irrationality. The restructuring and reframing processes inherentin formulating the positive cognitions can also assist the therapeutic process. The focused case formulation also increases in treatment efficacy. (d) The focused alignment of the primary aspects ofthe trauma through (602) 493-3110 (602) 770-7407 (501) 442-9997 (408) 356-1414 (714) 680-0663 (818) 885-2827 (303) 620-7198 (303) 220-1151 (203) 787 -0227 (404) 633-4796 (808) 232-5311 (509) 334-0677 (708) 537-7423 (301) 982-9259 (410) 771-4438 (508) 456-8623 (314) 644-1241 (212) 663-2989 (914) 635-1300 (505) 255-8682 (614) 274-7000x349 (503) 297 -0302 (215) 667-6490 (512) 343-9550 (801) 364-2779 (206) 328-5626 the image, negative cognition, and attention to physical sensation assists in the accessing of the dysfunctional in formation. This state-specific infor-· mation is then linked to emotionally corrective information through the positive cognition. (e) The instructions to "Just notice" the trauma and attendant disturbance increase the counter-conditioning and exposure benefits by preventing the client from becoming" afraid of the fear" which has contributed to the on-going distress. The ability to do this may be facilitated by the eye movements themselves. 2) Eye Movements-In my original papers, I quoted some conjectures by Pavlov, regarding general clinical effects. According to Pavlov the essence of any treatment is the restoration of a neurological balance. This view is certainly consistent with the positions of major historical figures, such as 2 Freud as well as Janet and present neurological and biochemical experts. If this assumption is valid, and clinical observations indicate that EMDR af. fords rapid and consistent positive treatment effects, by this definition , EMDR must therefore assist in a re· balancing or stimulation of the processing system. In this regard, I posited that the eye movement might have a direct effect on cortical functions. Two independent theories have been offered based upon primary re· search in the areas of neurobiology. Both posit bihemispheric involvement as a causative element. Examination of EMDR clients by means of quantitative analysis of electroencephalography (QEEG) has shown a normalization in the synchronization of slower brain wave ac· tivity in the two cortical hemispheres. Gregory Nicosia, Ph.D. , presented this data at the 1994 EMDR Conference. The normalization of depressed functioning shown in post-EMDR treatment corresponds to clinically observed memory retrieval and information processing. Nicosia posits that thephaserelationshipofthetwohemispheres is disrupted by the suppression of REM caused by the norepinephrine released during trauma. The interhemispheric asynchrony prevents integrativememoryprocessing. He suggests that the eye movements in EMDR resynchronize the activity of the two hemispheres because the rhythmic and repetitive alternation mimics the activity of pacemaker mechanisms within the cortex which existforthispurpose, but which were suppressed by the trauma. The notion of synchronized hemispheric activation producing beneficial information-processing effects is supported by independent research EMDR Network Newsletter Staff Editor: Lois Allen-Byrd, Ph.D. Publisher: Arnold J . Popky, MA Data Entry: Sharon Lucas �1994 EMDR Network Schedule Saturday,Sept.17th 9:30am to 4:00pm The Network meetings are held at the Sunnyvale Hilton, 1250 Lakeside Dnve, Sunnyvale, California (408) 738-4888. 9:30-10:00am Registration & coffee 10:00-11:30amSpecial Interest Groups (SIG) meet to share new information. 11:30-1:00pm Lunch [We suggest a second SIG meeting during lunch.] 1:00-4:00pm General meeting. Presentations by SIGs and Francine. The quarterly Network meetings have been a success as a forum for sharing new applications of EMDR, learning about the latest research results and observing talented colleagues demonstrate innovative twists with EMDR. on the differential effects of gaze manipulation on positive and nega· tiveassessments. Anumberofstud· ies have been done by Roger Drake at Western State College of Colorado (article enclosed in this mailing). The results have shown that directing the gaze of a number ofright-handed subjects to objects on the right resulted in more positive responses than directing their gaze to the left. The research was based on hypotheses involving hemisphere asymmetry in emotional processing. It was posited that the left hemisphere processes positive information, while therighthemisphereprocessesnega· tive affect. These studies provide some support for Nicosia's suggestion that alternating the activation of the hemispheres might induce integrative information processing. Just as observations ofEMDR treatments have found positive clinical effects with the use of alternating hand and audio tones, so have re· cent studies regarding lateral acti· vation of positive and negative reac·tions found predicted effects by the use of audition and physical manipulation. One conclusion that might be drawn from this research is that the type of stimulation is not as important as the attention itself. Hemispheric activation is clearly induced by simple lateral attention, whether or not any lateral motoric activity takes place. For instance, several studies in perceptual psychology have demon· strated that the initiation of a sac· cadic eye movement causes the subject to feel that it has been completed, even if the movement has not actually been made. For example, if the eye muscles are immobilized and subjects try to turn the eyes to one side, they feel as if the eyes have moved even though they have not. In short, when it comes to saccadic eye movements, we are aware of the intention, not the act. This finding is consistent with Howard Lipke's hypothesis that the orienting response alone, and not any specific movement, is necessary for the activation of information pro· cessing mechanisms. Mark Russell had also suggested that self-focused attention was needed for therapeutic effects. If alternate hemispheric activity is one of the factors in EMDR effects many more stimuli besides eye movemen ts, hand taps, and audiotones can be expected to have an effect. In fact, because the optic nerve is linked to both hemispheres, it may tum out 3 that a forced focus on a single point may induce processing shifts. Alter· natively, it may be that rhythmic stimulation alone is conducive to therapeutic effects. In either instance, the clinical objective would be to maintain the client's awareness of the trauma informa· tion while activating the processing mechanism by the continual activation from bursts of concentrated attention. Presumably, then, the best alternative stimuli would be those that allow the processing effect to occur while the clinician monitors the client's simultaneous attention to the trauma, and the present reinforcers which assist the therapeutic effect. A more integrative analysis may be in order. The most simplistic way of describing possible EMDR effects is that the trauma has remained unprocessed because the immediate biochemical responses have left it isolated in neurobiological stasis. When asking the client to follow a finger, attend to a hand tap, audiotone, or even a fixed point on a wall, active information processing is initiated to attend to the present stimuli. Regardless of the present stimulus, if the client is asked to attend simultaneously to the trauma memory, the active information-processing mechanism is linked to the target event and that can process as well. This processing mechanism is physiologically configured to take the information to an adaptive resolution. Perhaps the accelerated processing occurs because of the continued realignment and guidance to the appropriate targets by the clinician and the other procedural elements that prevent client avoidance. We have seen clinically that the amount of timenecessaryforpositivetreatment effects is less then that needed for simple exposure, so some other mechanism must be at work. However, the actual neurological con· comitants may not be discovered within this generation. �EMDR Network Newsletter 1994 Issue 1 In the meanwhile, clinical observations of EMDR effects may assist researchers in the areas of neurobiology and memory to a greater understanding of physiological processes. The rapid treatment effects afforded by EMDR offer an opportunity to observe the standard patterns of memory association and emotional/cognitive processing, as well as the differential effects of the standard procedure with long-standing and more recent memories. In many ways, EMDR may offer a window into the brain. Sleep is a busy time involving a number of mid- and hind-brain structures and mechanisms including the ascending reticular activating system (ARAS), the pons, and the locus coeruleus (LC). The ARAS is a widely connected and disorderly structure critical for wakefulness and alertness. Activated by practically any sensory stimulus, it subsequently dif. fusely activates the entire cerebral cortex. Important to REM sleep is the hind brain structure, LC. A major contribution of the LC to REM sleep is activation of another set of neurons, the Gigantocellular Tegmental Field (FTG) neurons. These are very large cells located in the general region of the LC, in the reticular formation of the pons, and may provide executive control of Dsleep. They branch diffusely so that a single FTG unit can affect large cortical and subcortical areas. The following speculations are submitted to stimulate discussion and perhaps research about some of the primary neuropsychological processes involved in Eye Movement Desensitization and Reprocessing (EMDR). The development of EMDR is rooted in problem and trauma resolution (Shapiro, 1993). The major neurotransmitter (NT) for trauma is our fight or flight substance, norepinephrine (NE) or adrenaline. Hold this thought. The superficial physical aspects of EMDR therapy seem much like a wakingversion ofrapid eye movements, or REM sleep. The phase of sleep known as REM, or D-sleep, is associated with dreaming. It seems to play a role in the integration of emotional material with memories of other experiences and allows habituation to the anxietyproducing value of the material (Carlson, 1981). The importance of the process is suggested by the results ofsleep deprivation experiments which produce a range of effects from cognitive confusion and emotional !ability to hallucinations. An important mechanism during REM sleep (at least in cats, but not yet confirmed in humans) involves a distinctive pattern of high amplitude electrical potentials in three areas: the reticular formation of the pons (P), the lateral geniculate (G) nucleus of the thalamus, and the occipital cortex (0); collectively known as PGO waves. They seem to originate in the FTG neurons of the pons and occur just before the start of REM sleep and continue during the REM period. Each PGO is synchronized with an eye movement. The conclusion is that the FTG cells drive the PGO waves and seem to generate REM sleep. Recall that REM deprivation is not completely compensated with return to uninterrupted sleep. However, there does appear to be almost complete compensation for lost PGO waves with REM periods ofextremely dense PGO activity. Interestingly, dunng REM deprivation, PGO waves emerge at non-REM sleep states and even during wakefulness and are sometimes associated with strange behaviors, such as hallucinations. It 4 seems there may be a need for a certain number of PGO waves per day. The FTG cells are activated at two times. First, they are highly active during REM sleep. Second, they are also activated when there are muscle and eye movements during wakefulness. In the LC, an almost exclusive NEbased structure, there are two types of neurons. The first type increases activity during REM sleep and results in motor inhibition. The other kind greatlydecreases activity, presumably associated with dysinhibition of the FTG cells. Just prior to sleep, the second type of cells in the LC decrease function, remove inhibition from the FTG, leading to REM. At the end of REM sleep, the second type increase their function and FTG cells decrease activity (Kalat, 1984). Given the involvement of the ARAS it seems reasonable to assume that other sensory channels may activate the FTG/PGO activity and stimulate information integration in the cortical areas. In a sense, REM is analogous with the blinking LED on a computer hard drive: a sign that the process is working, but not the process itself. Biochemically, the shift to REM sleep is interrupted by increasing the amount of adrenaline, as with amphetamines. The presence or increase of NE tends to inhibit REM sleep. Now back to our thought that has been "on hold." High stress and/or trauma levels increase the presence of NE, perhaps to a veritable flood. As this occurs, FTG and PGO activity decreases, or perhaps fails in more extreme cases, and REM sleep is inactive, or insufficiently active, along with the information processing of the emotional material Hence, events are "stuck" in the neural system. Along comes EMDR which produces waking eye movement (or bilateral auditory or kinesthetic stimulation), �EMDR Network Newsletter 1994 Issue 1 activating FTG/PGO waves throughout cortical areas. With directed at· tention using targets, selective infor· mation storage areas throughout cor· tical .regions are activated via the ARAS, quite possibly involving hip· pocampal activity, and the informa· tion reprocessed. Lesions or dysfunction in orbital fron tal or inferotemporal areas adjacent to the hippocampus may interfere with EMDR effects. As we learn about the monoaminergic genetic variants present in a high percentage of PTSD (Cummings, 1993), we can predict significant individual differences in the capacity to process emotional ma· terial, specifically to habituate to anxi· ety and so in responsiveness to EMDR stimulation. As mentioned, these are quite preliminary speculations based on a small clinical sampling and a cursory re· view of the literature (by a busy clinician). I welcome responses and chal· lenges to increase our understanding of this process. References Carlson, N. R. (1981). Physiology of behavior (2nd ed.). Boston, MA: Allyn & Bacon, Inc. Cummings, D. (1993). Genetics and pathological gambling. Paper presented at the National Gambling Con· ference: CONN. Kalat, J. W. (1984). Biological psychology (2nd ed.). Belmont, CA: Wadsworth Publishing Co. Shapiro, F. (1993). Manual: Eye move· ment desensitization and reprocess· in - Level I & IL San Jose, CA: EMDR. traumatic memory out of his head. "You've saved my life" was the follow· ing statement. EM> The feeling in the client's chest expanded to a bright warm light throughout his entire body. A 47-year-old, self-employed businessman, referred for treatment after a near fatal heart attack, was treated with EMDR 6 months after the trauma, and 4 months following his introduction to psychotherapy. Although financially successful, he con· tinued to be "driven" toward seeking acclamation from his colleagues. The physician who made the referral did so on the assumption that tis client required a significant life style change to decrease stress and workaholic be· havior. The presenting EMDR target was his emergency room experience following the heart attack. He saw himself on a gurney with four intravenous lines inserted in his arm. He saw the physicians and the nurses shaking their heads as if medical interven· tions were hopeless. The negative cognition was, "I'mdead," the desired cognition was, "I have been given another chance to live." The VoC was 4 and the SUDs was 6. The base emo· tions were fear and terror, and were felt as a constriction in the chest. The following is a summary of the client's experience with EMDR. EM (Eye Movements)> The client viewed the medical staff as they at· tempted to make a decision for intervention. He reported feeling a warming of his chest. EM> Even though processing was con· tinuing by lateral movement, the therapist changed to circular direction. This was done to facilitate the client's involvement in the procedure. The client stated, "This is weird" and reported envisioning the therapist's fingers going through his eyes and through the brain layers to pull the 5 EM> The radiating feeling drained out through his extremities. The SUDs level was reported at O and the VoC increased to 7. After completing the body scan, he reported a feeling of total relaxation and heaviness. EM> The client reported sinking in the chair and having a sense of total well being. He discussed his previous reservations about treatment and how he now realized that treatment had been a totally satisfying experience. He expressed concern that the therapist should lose weight so as not to experience a heart attack or have medi· cal problems. EM> The client reported nothing from the body scan and that the SUDsNoC were at optimum treatment levels. At this point, the psychiatrist and social worker directing the EMDR treat· ment continued a series of eye move· ments to reinforce the progress in the session and to orient toward future goals and progress. EM> The client saw his body develop· ing and strengthening in a manner to prevent future heart attacks. EM> He saw himself on a road with many curves without being able to see the end. EM> He saw that it was not important to see the end (symbolic of the representation of goals), that life should be enjoyed, and that every curve was the opportunity to view life. During this set of eye movements, words and phrases the client said during the EMDR procedure (e.g., God has given me another chance-I'm doing all the doctors asked. I've changed my diet and life style.) were woven in by the therapists. This appeared to validate �EMDR Network Newsletter 1994 Issue 1 the client's perception and reprocessing. EM> The client reported feelings of complete well being and satisfaction. Session ended. The authors noticed that the additional sets ofeye movements (after the clientattainedaSUDsofO, a VoCof7, and the acceptable body scan), along with the orientation toward future goals and progress, seemed to enhance the outcome of treatment for this client. When I initially heard ofEMDR, I was totally uninterested. I was happy with my repertoire ofskills and simply could not be bothered. However, the reports of colleagues who had the training were so exceptional I thought it was time to have a look. I still was not prepared to waste my precious hours on a training, and my way around this was to experience EMDR myself. I had genuine difficulties isolating a problem since I was at a particularly fulfilling stage of my life; however, I finally settled on a minor irritation that I was having with one of my clients. That session, plus two others, movedmeveryrapidlytoadecision to move into private practice, to implementingthatdecision, and tocurrently experiencing a life of ease, gentle pacing, and tranquility that I had no previous vision of being possible. In fact, there has been a total life style transformation. I now work only three days a week, have time to follow the joyous explorations of my toddler for hours, am writing a novel, and am experiencing considerable relaxation of the Puritan work ethic. The start· ing point had been a life style I had previously perceived as fulfilling and perfectly fine. My experiences duringmyown EMDR work involved reliving personal trau · mas, witnessing the traumas of oth· ers, and reliving personal life stages and life dilemmas. In addition, I had what Maslow called "peak experiences." Iacceptedforthefirsttimelife exactly as it was with all of its pain and horrors, without minimizing that pain, and even appreciating the place ofpain in my life. I accepted that each person needs both the experience of pain and healing and that everything has its rightful purpose and place in the universe. The beauty and inten· sity of this experience is difficult to verbalize, but its impact was that everything is alright as it is, in a mysterious and profound way. Since my own work, I have completed both Level I and Level II trainings and have used EMDR with a self-actualizing population. All ofthe participants were adjusted personalities who continued to lead responsible lives. How· ever, as a result of the EMDR experi· ences, their lives had been upgraded, qualitatively, several notches. Many of them experienced similar, though uniquely personal, peak experiences, such as: 1. The interconnectedness and right· ness of everything that had happened in their lives (even events they had previously classified as mistakes or slack or resistance) accompanied by such statements as, "I see now why I hadtodosuch-and-such." Thiswasan understanding ofthe unique meaning of their lives. 2. Experiences centering around their personal creativity (eg., its extent and depth), how it had been unacknowledged (even discounted), and sorrow at this. Such experiences were followed by the actual resurgence of creativity in their lives. 6 3. Changes in their understanding of love and peace and experiencing these concepts on a new level as total emo· tional, conceptual, physical experi· ences. 4. Novel, creative work-related insights. One woman had the experience during EMDR that EMDR worked because it unified right brain and left brain consciousness. 5. Intense abreactions about clients resulting in more relaxed and effective counseling. These results suggest that some changes may be necessary in the way we think about therapeutic goals and the end of therapy (e.g., where adjust· ment to current social expectations is seen as sufficient, or relief from deficiency is accepted as the therapeutic goal). There appears to be a push to terminate counseling as if counseling implies a deficiency and that client independence is the triumph over such deficiency. My observations suggest that perhaps we shortchange ourselves of considerable potential expansion with this point of termination, possibly in reaction to the undercurrent of social shame around counseling. Perhaps so much more is possible than we think. (Case studies ofthe particular EMDR treatments are available on request. Ifyou are interested in this extension of EMDR, have questions, or would like to talk about this, do not hesitate to contact me at: 23/26 Homsey Rd., Homebush, NSW 2140.) �EMDR Network Newsletter 1994 Issue 1 Self-trust and trust of others are core issues that emerge time and time again in individual and relationship therapy. In the broadest sense, trust implies instinctive, unquestioning belief and reliance upon something or someone. We require some measure ofthis trust to function even minimally. Specifi· cally, and in terms of our everyday experience, self-trust at least encom· passes the ability to: l)Trust awareness of external real· ity (people, places, things, degree of safety, etc.). 2)Trust awareness of internal real· ity (visual images, feelings, motives, thoughts, body sensations). 3)Trust personal control of expres· sion, actions, thoughts, motives, body experience, impulses. 4)Trust ability to sustain/meet per· sonal needs. 5)Trust our knowledge of past and present events. There are many factors that contribute to the difficulty oftrusting self and others in the aftermath of trauma. Each of the following factors can be directly affected by EMDR treatment. False or distorted reality presented by socialization agents to the victim, par· ticularly young children under conditions of duress, can be introjected as "true" and lead to dysfunctional iden· tity formation and reality testing. In this situation, the individual has a distorted perspective which, when it collides with more accurate reality representations, can further create a sense of reality which is not trustworthy. The genuine response that a victim of trauma experiences is often dystonic with the wishes of the perpetrator. In such circumstance, the perpetrator may actively deny or invalidate children's thoughts and feelings with such expressions as, "Don't cry. You should be happy I'm giving you this attention." This denial and invalida· tion is, of course, hammered home with threats of loss of love of the par· ent through abandonment, rejection and shaming, orthreatofbodily harm. Simultaneous to whatever pain a vie· tim may experience as the direct re· suit ofphysical and emotional trauma, is the profoundly disturbing feeling of being out of control of his or her life situation. One response to the stress ofbeingoutofcontrolistoyolitionally. inappropriately attribute blame for the trauma to one's self, thereby main· taining a sense, albeit false, that one is in control. In working with adult survivors of childhood trauma, the decision to accept this culpability is often lost in time, leaving the indi· vidual simply feeling perpetually guilty for his or her own traumatiza· tion. This belief contributes further to his or her inability to trust him/ herself because: 1) such action is contra-survival and 2) it is a false foundation for a labyrinth of self-de· fining thoughts and feelings that have played out since the traumatic events occurred. Another obvious way in which trauma victims become confused about their ability to trust themselves is through the use of amnesiac and distorting defensive strategies to psychologically protect themselves during and after the traumatic events. Dissociation, repression, and denial all lead to large chunks of lost self-awareness (and awarenessofother). Also, what might be considered "strategic" emotions such as depression. confusion. and projected anger can lead to a decrease of self-awareness. Given that self· awareness is a cornerstone of self· trust, such defensive strategies are directly linked to a decrease in the ability for self-trust. Another aspect of the traumatic expe· rience is that, due to strong desires for "everything to be OK," victims of trauma repeatedly place themselves in a position of danger. Thus, they 7 develop a history for failure in judg· ment. Linked to the defensive strate· gies, these anti-survival and unsafe actions lead survivors to maintain an enduring distrust for their own ability to "do what is right" for themselves. Each ofthese common assaults to self· trust are related to many of the nega· tive cognitions and affects which are regularly the targets of EMDR inter· ventions. When the negative cogni· tions and affects are reprocessed, the general effect can be seen as an in· crease in the patient's ability to trust his or her own sensory and cognitive awareness. In part, this increase in the ability to trust one's self in the process of desensitizing traumatic ex· periences may explain the generalizability of EMDR interven· tions. Take, for example, a situation in which the patient reprocesses a negative cognition that he or she failed to adequately protect him or herself at the time of the assault. If he or she acquires the alternate positive belief that he or she did the best he or she could do, this will no doubt go a long way towards increasing the overarching "sense" of trust in him or herself in the present and future. Case Example The following case example illustrates the usefulness ofEMDR in the resto· ration of trust of self long lost in the aftermath of childhood sexual and physical abuse. Tina, a 38-year-old woman, came for treatment because she was afraid that innocent, but annoying, behaviors of her young son would "open the flood· gates of rage and make me hurt him." Severely sexually and physically abused by her uncle as a child, Tina developed an extreme mistrust ofher· self and others. Tina's inability to trust herself was related to three elements'ofher trau· matic childhood through young adult experience. First, when she was being assaulted by her uncle, Tina com· plained to her parents. They invali· �EMDR Network Newsletter 1994 Issue 1 dated her feelings and thoughts by telling her not to complain because her uncle was having more difficult problems than hers. Second, as the trauma intensified and included threats against herself and her sister, she defended herself by dissociating. As a result, Tina has significant parts of her experience "missing." When asked to report her experience, she often says "I'm not sure how I feltandijustcan'ttell what I'm going to feel next." Finally, as she approached young adulthood, Tina began to feel intense anger at what had happened to her; simultaneously, she began using her anger as a way of protecting herself. Eventually she was unable to distin· guish between appropriate, situation specific anger, and the anger she felt as a protection against a perceived threat. "Anger allowed me to survive-it is now difficult for me not to be angry-anger is connected with self protection. If someone even slights me in a minor way, it gets blown into a major issue of betrayal." EMDR was used to desensitize and reprocess her experience ofinitial fear, her negative cognition of "I must be bad," her intensified fear (which led to dissociation from aspects of herself), and, as the assaults became more violent, her belief that she had to remain angryand on the defensive in order to be safe in adulthood. Finally, her fear that she would be harmful to her son disappeared with the increase in her self-trust and self-esteem. In a follow-up discussion, Tina said that the EMDR sessions improved her ability to assess and set reason· able, situation appropriate boundaries for herself and her son. This bound· ary definition, in tum, increased her sense of self-trust or safety with her internal self. In that a "sense" ofbasictrustinone's self and in others is the foundation to living comfortably in the world, interventions that lead to greater ability to trust self are sorely needed. The use ofEMDR in the case ofTina and many others has proven of great benefit in restoring greater trust in self via the reprocessing of self-depreciating cognitions and clarification of heretofore distorted memory and affects. the lack ofher having to hold a job, the opportunity to meet two times per week, her lack of an Axis II diagnosis, the absence of any family of origin contact, and a therapist experienced in the treatmentofMPD. In a 5-year period, there were only two crisis ses· sions, rare inter-session telephone contact, no need for medication, no hospi· talizations, and no suicidal or self· mutilation behavior. Thirty-one al· ters were identified, worked with intensively, and systematically fused. A history of sadistic sexual, physical, and psychological abuse had been revealed, with the primary abuser being her stepfather. The abuse had occurred between the ages of 3 and her early 20s. Multiple Personality Disorder (MPD) represents the most··severe form of the Dissociative Disorders. The pre· dominant symptoms are disturbances in the normally integrative functions. of identity and memory (American . Psychiatric Association, 1987). There has been an explosion of interest in the disorder since about 1984 (Putnam, 1989; Ross, 1989), with many articles focusing upon phenomena, diagnosis, and treatment. The treatment articles have focused primarily upon the challenging issues that have to be dealt with prior to the eventual unification ofthe mind, as represented by the fusions of the various. alter personalities. Relatively little has been written about the post-unification phase of treatment, except that treatment does not end with unifica· tion (Kluft, 1988). After 3 1/2 years of therapy, what tentatively was thought to be the final alter was fused. Therapy became more supportive in nature as various iissues regarding integration and life without dissociation were addressed. Eleven months later, another minor alter was discovered, and was fused after 5 more months of work. Two months after this fusion, Sally re· ported that life was going quite well. In fact, despite the discovery of the most recent alter, she had been re· porting considerable contentment for about 1 1/2 years. She was feeling increasingly assertive, her self-esteem seemed high, and she was writing her first novel with eagerness. From all outward appearances, she was thriving. The following is a discussion of a case in which EMDR was used in the postunification phase of MPD therapy. Sally is a 34-year-old, Caucasian fe· male, who has been in therapy with me for 5 years. She had been in therapy in another state for 2 years and had begun to consider the diagnosis of MPD by the time she, her husband, and young daughter moved to my area. The diagnosis of MPD was confirmed. Her therapy went exceedingly well, due partly to a stable marriage, her high level of intelligence, 8 At this point, I asked her if, after all of the therapy work, there were any memories that still haunted her. She affirmed that there was one that stood out. When she was about 10, she and her family were vacationing at a lake with some friends of the family. Her stepfather became incensed over some aspect of her behavior, so he took her alone into the woods and, after viciously verbally assaulting her, proceeded to sodomize her as a further and explicit punishment. I proposed the idea of using EMDR to address that memory, and she agreed. Her Negative Cognition was, "I am stupid, �I made a mistake, I deserved it, I am dirty and contaminated." Her Positive Cognition was, "I am clean, smart, pretty, and don't deserve to be hurt." The VoCwas2, theSUDswas6.5, the emotion was fear, and her body sensations were pain in the rectum, tingling feelings in the cheeks and forehead, and a knot in the stomach. Associations during eye movements rather quickly proceeded to a level of fear, shame, and dirtiness unsuspected by this therapist. Statements included, "I didn't want to exist. I don't deserve to exist now either. I have to keep his secret and my secret. I won't be able to get away from him. I must always be prepared for a lunatic. I won't ever have anything good. I'm ruined, nobody ever will want to touch or love me." After these bleak statements, more positive associations began, and some limited cognitive interweave was used. By the end of the EMDR session, she felt absolved of her guilt and shame, thought that she mattered as a person, felt that she was a moral, lovable person, and that it was now safe. Her final VoC was 6, her SUDs was .5, and her body was relaxed and without pain. The next two sessions subsequent to her EMDR session revealed a quantum leap in her self-esteem, as manifested by feelings of pride, spontaneous and non-laborious assertiveness, less reactivity to other people's "garbage," and an increased awareness of certain marital issues that needed addressing (to which she had been oblivious). She stated that before EMDR, she had resigned herself to a certain level of lingering emotional and self-esteem problems. Now she realized that she did not have to feel badly at all about what others had done to her. She reported a deeper feeling of choice in her life than ever before, and an increased ability to take care of herself emotionally. What surprised this therapist was the amount of fear, shame, and feeling of contamination that lingered just below the surface in this highly function - EMDR Network Newsletter 1994 Issue 1 ingpatient whose therapy had gone so plied: "After I realized what my diagunusually well. Even after the memo- nosis was, I knew that my mind could ries of abuse had been uncovered and be fixed, but I also knew that my heart carefully worked through, yet another could not." Now she has changed her level existed. EMDR proved highly mind and her heart. effective in uncovering this level and quickly facilitated its resolution. PerReferences haps if EMDR had been used in the pre-unification phase of her therapy, American Psychiatric Association . these issues would have come to the (1987). Diagnostic and statistical surfaceandbeendealtwithmorefully. manual of mental disorders: DSMIIIR. Washington, DC: Author. After the above issues were resolved, I asked Sally what else still might be Kluft, R. P. (1988). Thepostunification bothering her. She responded that treatment of multiple personality disshe felt ashamed about having been a order: First findings. American Jourmultiple. Again I was surprised, given nal of Clinical Psychiatry, 42, 212her level of sophistication and that for 228. 5 years I had been directly, and by implication, giving her the message Putnam, R. W. (1989). Diagnosisand that her dissociative response to her treatment of multiple personality distraumatic childhood was a considera- order. New York: The Guilford Press. ble accomplishment of coping. .Apparently, my message had not been inter- Ross, C. A (1989). Multiple personalnalized. ity disorder: Diagnosis. clinical features and treatment. New York:Wiley. She agreed to the use of EMDR regarding this issue. Her Negative Cognition was, "I was weak, I should have been stronger." Her Positive Cognition was, "I was sane and strong as I responded to an insane situation." Within one session, her SUDs fell from 6to 0, her VoC rose from 2to 7, and she gained considerable insight regarding why she dissociated and how dissociation allowed her to retain her personal integrity while living among abusive people. No cognitive interweave was used during the EMDR. She reported Introducing EMDR to panic disorder being stunned by her own insights, patients who have been educated in saying she never could have arrived at methods that reduce anxiety resuch awareness by merely thinking sponses can pose some interesting challenges. Several patients who had about it on her own. been in therapy with me for a year or I submit that EMDR may prove useful more had learned quite well the skills in the post-unification phase of MPD of using deep breathing, relaxation, therapy. In this case, it offered a way and .cognitive pattern interruption to address feelings that lingered even techniques to inhibit their anxiety after the standard abreaction and reactions. I discovered how well they therapeutic techniques had been ap- internalized these strategies as we plied. It also helped this client resolve began the EMDR work in our ata more general self-esteem issue re- tempts to clear the root causes of their garding herformermultiplicity. When panic disorder. I asked Sally why she had never brought up in therapy her lingering With twopatients in particular, a patfeelings of shame and fear, she re- tern began to emerge. We would begin 9 �EMDR Network Newsletter 1994 Issue 1 with the disturbing memories, some minimal cognitive and emotional processing would take place, and then they would report "nothing'' coming up. Their nonverbal cues prior to this included some mild agitation and then stillness. Initially, I began to suspect that they were going through a dissociative reaction phase in their processing so I just kept going with them, only to discover that, unlike other pa· tients who would dissociate and move through this phase into deeper memory processing, these panic disorder patients would continue to report "nothing'' happening. They would then become bored and discouraged and feel like they were failing in the process. The phenomenon was quite puzzling until I began to question them more specifically about what they were experiencingpriortothe "nothing" expe· rience. One woman finally solved the puzzle. She said quite simply, "Oh, well, when I start to feel anxious, I just tell myself to relax and the anxious feelings and thoughts go away." With this answer in mind, I have now begun to request that panic disorder patients trained in relaxation responses and cognitive pattern interruption techniques consciously choose not to access these responses while doing EMDR work. I explain to them theneedtoexperiencethefullrangeof thoughts, emotions, and physical sensations that can arise in the process of clearing disturbing thoughts and memories. This seems to work well with these patients who can then successfully process the traumatic material that precipitated their panic disorder, significantly decrease the frequency of their panic attacks and agoraphobic reactions, expand their range of activities, and increase their selfesteem over a relatively short period of time. 1991 SUBMISSIONS ,JULY 28 Rem em OCTOBERI8 ber, su bm i ssion s shou Id be in APA format. client's (guided) internal processing, or is it somehow dependent upon the quality of the therapeutic relationship, or is it both. Toward the end of a powerful session, my client closed her eyes and laid her hands lightly on her lap. Immediately, they began a fluttering, spontaneous movement: left hand, right hand While this was occurring, my client was mostly silent and was processing some very important material. The cognition she ended up with was that she had a right to be scared and desperate as a child. Not surprisingly, this new way of thinking was very important to her. She told me that the hand movements were entirely involuntary, and that they felt much the same as the eye movements. Somehow, it seems, her body and mind took over with my just silently being present with her. I present this information with no conclusions, but with simply the desire to share it with my peers. I wonder if others have had similar experiences. Given the diversity of the therapists who are interested in EMDR, an old debate may be fruitfully revived. Does therapy consist of task-oriented collaborative consultation and guidance, or is the negotiation of the therapeutic relationship itselftheprimarytask? To the extent that EMDR may constitute a new treatment context, the role of the therapeutic relationship in EMDR treatment is of particular in· terest. How much ofEMDR is inside the client, and how much is between the client and the therapist? Is suc· cessful EMDR simply a function of the 10 While keeping the above in mind, this discussion will pertain to the brief, focusedtreatmentoftraumaticmemories in which EMDR is the featured modality. Rather than arguing for the primacy of either the internal processing or the therapeutic relationship elements of EMDR treatment, the intent here is to explore the interplay between them. It would be useful to be able to recognize when reliance upon the client's internal processing may be insufficient and additional relational interventions are necessary. The client's "prevailing sense of safety"-that is, the client's sense of safety in the moment-will be proposed as the key to determining the extent to which the quality of the therapeutic relationship may become a more important factor. Examples that follow are from actual cases known to the author which have been altered to protect confidentiality. It seems that when the work ofEMDR is primarily internal, a basic, collaborative therapeutic alliance should be sufficient for success, assuming client motivation and therapist competence. The primary job of the EMDR therapist is to guide the client; a view which is often expressed with comments like, "I feel like I'm not doing anything but getting out of the way." The facilitating effect of EMDR on internal processing appears to be so robust that it may be successful even when the therapist fails to "get out of the way." One client whose therapist was overly intrusive (incessant commen· tary during eye movements) made the following observation: Ihadtokindofblockoutwhatshe [the therapist] was saying, and just stay with what was going on inside of me. I kept wishing she' djust shut up. I got alotoutofit [the EMDR], but I had to ignore her to do it. �EMDR Network Newsletter 1994 Issue 1 Doubtless many clients have benefited from EMDR treatment despite imperfect therapist/client relations. On the other hand, sometimes relationship factors do seem to preclude successful processing. For example, a colleague attending an EMDR Level I training reported the following: On the first day I did my practicum with people I really didn't connect with. When it was my tum to experience EMDR as a client, nothing much happened. I was kind of disillusioned. The next day I got in a group with people I liked and did some really good work with an upsetting memory. I guess I just didn't feel that comfortable "opening up" in the first group. Relationship factors may also affect the client's willingness to continue when the discomfort level increases, or when additional upsetting memories spontaneously emerge. It would seem that the relationship can function as a gate keeper to internal processing-that is, whetherEMDRcontinues or is even initiated. However, short of failure or refusal, more subtle forms of non-participation may also occur. For example, a colleague who had a successful EMDR experience in the Level I training, and then engaged a therapist for an additional EMDR session, reported the following: with the processing since the therapist was perceived to be uncaring, and therefore, of potential harm to the client(basedonthethemeofhismemories). In this case, the material being processed was not addressed because ofthe relationship dynamics that were occurring. (Clients may often rely on the meta-messages conveyed by the therapist, or even purposefully test the therapist, in deciding whether to present sensitive material.) Given the focus on internal processing that characterizes EMDR, it might be tempting to overlook the importance of the role of the therapeutic relationship , especially in brief treatment. The numerous single-session successes reported (e.g. , Boore, 1993; Shapiro, 1989; Solomon, 1993) in the EMDRtreatmentofmotivatedclients with identified traumatic memories have even led one writer to the conclusion that "clinical rapport was not a necessity" (Boore, 1993, p. 42) in such cases. However, it should be considered that relationship factors such as rapport and sense of safety are probably equally necessary with "easy" clients. What makes facing a traumatic memory potentially healing? One dif. ference between EMDR and the reexperiencing of a flashback or a nightmare is that with EMDR, the client not only may reexperience the event, We worked on a bunch of memories, but may also be observing it from a including my being the object of bully- safe place. From this safe place, the ing, vandalism, and robbery. The client can, perhaps for the first time, theme was, People who don't care about face the memory without feeling overmemighthurtme. TheEMDRseemed whelmed. This is what allows the to work alright, but it felt superficial working through. The therapeutic compared tomy·p rior experience with relationship must constitute such a it. I wasn't very emotional in the safe place, particularly by avoiding session, but then I went home and replication of threatening features of cried with my wife. The therapist was the targeted traumatic memory. The good, technically, but I didn't have the relative importance of the therapeufeeling that he really cared about me. tic relationship in the brief EMDR treatment context can be judged acThis client only partially participated cording to the client's prevailing sense in the treatment as evidenced by his of safety. The extent of relationshipwithholding his emotional responses .oriented interventions required to until after the session. His sense of create a safe context would be a funcvulnerability with "people who don't tion of a number of factors including care about me" may have interfered the nature of the traumatic memory, 11 therapist-client match, and perhaps the client's general sense of security or safety. (There are many safetyenhancing interventions which address the internal state rather than the therapeutic relationship , e.g., Greenwald, 1993.) While examples abound which support both the "internal processing" and the "relationship dependent" view· points, it is the integration and balanceof these elements which are most important. The desired internal processing of EMDR happens within the context of the therapeutic relationship. The targeted material will be more difficult to address if there are deficits within the treatment context. This may be especially important regarding client control of pacing, as many traumatic memories include intense feelings of helplessness. The process ofthe therapy should be guided by the demands inherent in the content, and be responsive to the client's prevailing sense of safety. References Boore, J. (1993). EMDR: Anew procedure. The California Therapist, 5(3), 40-42. Greenwald, R. (1993, Fall/Winter). Magical installations can help clients to slay their dragons. EMDR Network Newsletter, 3(2), 16-17. Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2, 199-223. Solomon, R. (1993, March). Research presentation. Presented at the 2nd Annual EMDR Conference, Sunnyvale, CA �EMDR Network Newsletter 1994 Issue 1 Since I completed the EMDR Level II training last summer, I have been, on occasion, using the technique de· scribed below. To date, (I have found that it has always "worked.") The technique involves creating what I term a "positive core." I have found that some of the very damaged people I see in practice who respond well to EMDR are left with a feeling of empti· ness. (The group ofclients with whom I have used this have had in common the fact that their parents were unre· lentingly critical or absent.) It is as if the trauma defined who they were and once it is "gone," they are not sure what is left. They arefeeling"good" or "relieved," but not "great." This tech· nique seems to clean up the loose ends and put all the positive cognitions and metabolized memories into an integrated sense of self, and leaves the clients feeling great. This is what I say to these clients: "Imagine a newborn baby. When I hold a newborn baby I see what I call a 'positive life force.' Depending on your religion or other belief system, you may call it something else. Except for the in utero and birth experiences, that child has been untouched by the external world. I believe that in order to live, the child instinctively protects the life force. If the child loses the life force, he or she dies. Therefore, every living person still has within himself or herself a posi· tive life force. As the child grows and develops, he or she experiences events that cause him or her to create de· fenses around the life force. That happens to everyone. However, the more trauma the child experiences, the stronger the defenses. The life force can also be nurtured. Some children have parents who nurture the life force, others do not. "I want you to think of a visual image to represent your life force. In other words, I want you to be able to imagine yourself with this life force inside of you. This is very personal. Some of the images others have come up with are: a sparkler, a tree trunk, a rock, a bright light. I want you to choose an image that fits for you. Think about this until our next session. This is a fun assignment. Your image should be one that makes you feel good." Obviously, if the client is having trouble with this concept, you have to walk him or her through it more gradually; however, most of the clients with whom I do this work are able to catch on pretty quickly. At the next session, we talk about the "image" he or she has chosen. If a decision has not been made, we spend some time trying to come up with an image. (I believe that having the "right" image is like having the "right" positive cognition.) I use hand tap· ping because I have found that it works more easily since there is so much visualization involved in this technique. I then say something like the following: "Imagine yourself as a newborn baby. (For women, I can start in utero; men, however, seem to have a hard time visualizing this, so I start with new· born baby.) Now imagine the positive life force inside that baby, that . .. (whatever image they have chosen). Doyouhavethatimage? 0 .K. Now I want you to imagine that baby, with that positive life force, embarking on a long journey through life. It's as though you are traveling through life on a fast moving train. The train is you and your positive life force traveling through life. The experiences you have had are the countryside the train is traveling through. Now I am going to have you close your eyes soon and begin. I will have you imagine yourself as that baby with the positive life force. The idea is to have you take that positive life force through life. I want you to recall whatever positive or negative events come to mind. Proceedslowlyandthoroughly. Ifyou 12 find yourself trying to skip an event, open your eyes so we can further ex· plore that event. If you can't get be· yond a certain event, open your eyes and we will do what needs to be done there." I then have the client close his or her eyes and I start the hand tapping. I provide some initial assistance in set· ting up the visualization to make sure he or she is "on the train." I instruct the client to open his or her eyes if he or she gets stuck somewhere or when finished(thatis, theclienthasbrought himselfor herself to the present date). The client always has permission to open his or her eyes if a ''break" is desired. Most importantly, I instruct the client to stop if there is any reason whatsoever that the "train" cannot move smoothly through his or her life. I mention physical tension as some· thing to monitor, but I do notfocus on it because I want the focus to be on the "positive life force." By this point in treatment, these clients seem to be self-monitoring-both in and out of session. I then continue hand tapping until the client opens his or her eyes. If the client opens his or her eyes before completing the process, we "go with" whatever has come up, using "standard" EMDR protocols (those using bilateral hand movements). (I use standard eye movements rather than hand tapping to separate the two processes.) For example, one 40year-old woman with whom I had worked extensively over childhood trauma memories (beginning at about age 4 and continuing to the present) was unable to get beyond the age of 2. Although she had no conscious memo· ries of herself at age 2, she was aware of some events that had happened at that time. When she tried to work through these events, she experienced some physical tension and thoughts about"whatthatmusthavebeenlike." We were then able to use standard EMDR and then put her "back on the train." (When we stop like that, I have the client start the train at least one year prior to the point at which he or she stopped.) �EMDR Network Newsletter 1994 Issue 1 Sometimes this process of"creating a positive core" can be done in one ses· sion, sometimes in more than one, depending on the scheduling circumstances and the amount of material to be covered. I have only used this technique with clients who lack a sense of "positive core" or say they do not know "who they are" now that they are not preoccupied with their trauma. Every client who has gone through this process has spontaneously said he or she felt great afterwards. I tell them that nothing has changed, only their viewpoint. Instead of seeing themselves as their present-day self going back and working through past painful experiences, they can now see themselves as an infant growing and developing into adulthood, surviving the traumatic experiences with theirpositive life force intact. This technique seems to neatly wrap up the EMDR work in that it cleans up any missed pieces, brings out many positive memories that might not have been triggered by the standard EMDR work, and leaves the client with a positive sense of "self," "identity," or whatever other term we tend to use for that feeling of being an "OK person," rather than a person who has "survived OK." I always emphasize to clients that they have always had the inner strength they now feel. We have not created the inner strength; we have simply drawn their attention to it. Part 1: Before the Eye Movements There are a number ofpeople involved with EMDR who have specialties in various areas including children, vet- erans, sexual abuse, peak performance, smoking cessation, etc. Though I have my own areas ofclinical special· ization, when it comes to EMDR, my particular area of expertise seems to be in the area of What NOT To Do. In thisfirstofa two-part article, I want to review many of the mistakes that I and others have made using EMDR. While this list is probably most helpful for those beginning to use EMDR, I have found it useful for experienced clinicians as well. To be successful using EMDR (or any therapeutic procedure), you must know your patient well, establish a good relationship, and thoroughly know the procedure that you are using. What follows is my compilation of important issues that need to be addressed to give you and your patients the best chance of succeeding with EMDR. Prior to Using EMDR Insufficient history taking. When I first began using EMDR, I was so excited about the method that I often tried to use it too soon in my work with patients. By too soon I mean using it before I thoroughly knew my patients and their circumstances. Until you understand your patients, the issues they face currently, and the schemas and themes that have been operating throughout their lives, do not use EMDR. Ifyou cannot literally picture the problems they are having, when they are likely to occur, with what people, and in what situations, keep asking questions (e.g., Have they had major traumas and what were they? Are there any memory gaps? What schemas and themes have been and continue to operate in their lives?). This knowledge will help you make educated guesses as to what issues to pursue and to which situations patients are most likely to be sensitive. Proceeding prior to establishing a good therapeutic relationship. Establishing a good therapeutic relationship is obviously important in any therapy, but especially so in EMDR. EMDR 13 hasworkedbestwithmypatientswhen they have been able to "let go." Sev· eral patients who initially had trouble letting go used the image of Pandora's Box to explain this reluctance, this fear that if they open the door to their fears and emotions, they will never be able to close it again. As many of us have experienced, the initial flood of feelings and physical sensations that can erupt when a memory is triggered can be overwhelming. The more our patients trust us and feel that we both care for them and know what we are doing, the easier it will be for them to benefit from EMDR. Patients need to feel that if they open Pandora's Box, you will be able to help them close it. Insufficient explanation and rationale for EMDR. Most therapies (and religions) share a number of common elements. Two ofthe most important are the story of creation and an explanation ofhow the world works. An expla· nation and rationale that explains the method and how it addresses your patient's problems is crucial. It provides a cognitive structure that can help patients better understand their experiences; perhaps view their past and current reactions to situations in a less punitive light; and increase their ability to generalize the gains they make. Once you have addressed the issues above, there are several other aspects prior to beginning the eye movements where therapists often stumble. These are discussed below. Incomplete initial set-up. Most clinicians are good at getting their patients to focus on a specific issue and a representative picture or scene. However, problems often develop in obtaining clear cognitions. Two of these problem areas are: 1) lack of proper focus on the Negative Coiroi· tion and 2) a vague or inappropriate Positive Cognition. When a patient has chosen a disturbing image or issue, it is important to help him or her discover the residue that remains in the form of a negative self-state· ment(s). How is he or she criticizing �himselfor herself now? In what areas does he or she feel lacking? The negative cognition should be in present tense, specific, and concrete. Once a clear negative cognition has been developed, make sure that you do not use a vague or inappropriate Positive Cognition. Patients need to accept that while we cannot change history, we can help them to be more fair to themselves and to change how they have evaluated a specific painful experience. As Shapiro has often stated, you want to help your patients develop positive cognitions that are realizable and specific, but also generalizable. "I learned something from the experience" is oft more realistic and obtainable than, "I'll never make a mistake again." At this point, let us assume you have obtained most of the background information that you need and the specific information related to a painful memory. Let us now move on to specific issues involved in initiating the eye movements with your patients. As you begin to arrange the chairs and work with your patient for the first time, it is important that you continue to demonstrate your concern for patient comfort and safety. Ensuring patient comfort and safety. There are a number of things to consider with respect to providing safety and comfort for your patients before initiating EMDR. First, it is very important that they are comfortable. Check the seating, the lighting, that there are tissues nearby, that you are sitting off to the side, etc. Second, you have moved your hand to let them choose the most comfortable distance, i.e., how close or far away from their faces they want your hand to be. Third, you have given them permission to .s1Qn for any reason and have agreed upon a stop signal. Patients have to know that the brakes work and that they can put their foot on the pedal anytimetheywantiftheyaregoingto feel safe. Fourth, you have established an image of a safe place. This is extremely helpful at the end of a session, but also if the patient needs to EMDR Network Newsletter 1994 Issue 1 take a break during an EMDR session. success with any particular patient or Sometimes, sadly, you will have pa- any particular issue, addressing these tients who cannot come up with an issues will help you and your patients image ofany place or person that feels avoid mistakes that might hinder your safe. Clearly, this is a message to take progress. If you carefully collect the extra time to meet their needs for information you need on your patient's safety and to explore their current history and current functioning, esresources before continuing. Fifth, tablish a good therapeutic relationwith these patients in particular, but ship, and prepare the patient for the also in general, I now take extra care EMDR procedure with care and consideration, you will be ready to worry to make sure that patients have adeguate relaxation skills before pro- about the issues I raise in my next ceeding. Whether it be in the form of article: mistakes we make during the meditation or using a tape that you eye movements and the closing porhave given them, it is important that tions of an EMDR session. patients have some way of handling the stresses that might develop be- Thanks to: Howard Lipke, Francine Shapiro, Landry Wildwind, and Eirin tween sessions. Gould for their helpful comments and suggestions. Advantages and disadvantages of beginning with an issue that has a high SUDs level. Having been trained behaviorally, I would start with an issue at a 4 to 5 SUDs level, assuming that it would be easier for patients to proceed to more difficult material later. However, Shapiro raised a concern about this approach. "What happens," she asked, "if you start with something the patient feels is at a 4 to 5 SUDs level and it suddenly increases to a 9 or 10 SUDs level, or shifts to a differentissueatamuchhigherSUDs The Annual EMDR Conference in level?'' If that happened, the patient March was an exhilarating experimight feel overwhelmed, out of con- ence. The feedback from the particitrol, etc. Now, I discuss this issue (i.e., pants was exceptional and univerthat the SUDs level may change or sally positive regarding the calibre of different issues may arise) with my the presentations. In addition, I was patients and let them choose which very pleased to present a number of issue, atwhichSUDslevel, theywould awards. Joseph Wolpe, M.D., accepted like to work with first. This discussion the Ron A Martinez Memorial Award has the obvious advantage of giving foroutstandingcontribution toEMDR patients the utmost control while pre- (which I discussed in the last Network paring them for the fact that things Newsletter}. Donald Weston, Ph.D., may get more intense than they had received the Debra P. Shapiro Memoexpected. By preparing them for the rial Award for research in the area of worst (or at least the most intense), psychophysiology. He is doing some patients seem less distressed when wonderful clinical studies on the efthey experience the initial material at feet of EMDR treatment with clients a higher level than they had expected. with HIV/AIDS. His proposal, based on his research, was accepted for preSummary sentation atthe Psychology ofHealth, Immunity and Disease Conference in I have listed the most common mis- Hilton Head Island, South Carolina takes that clinicians make in the ini- this December. I gave this research tial stage of using EMDR. While fol- award in memory of my sister who lowing the above does not guarantee died at age nine from a disease we 14 �EMDR Network Newsletter 1994 Issue 1 would now view as stress-related. I hope that we can always remember that research is not about subjects, or about "populations," but rather about the hope of helping to alleviate human suffering. Special research awards were also presented for outstanding contributions in the way of consultation and research assistance to Sandra Foster, Ph.D., Gary Fulcher, Ph.D., Howard Lipke,Ph.D.,andStevenSilver,Ph.D. They have all put in countless hours he]pingresearchers design studies and write up their results and their efforts are greatly cherished. A research awards was also presented to Sandra Wilson whose dissertation research will make a major contribution to EMDR. She coordinated the study of 80 trauma subjects and the efforts of five clinicians : Michael Galvin, Ph.D., John Hartung, Ph.D., Jim Knipe, Ph.D., Laura Knutson, M.S.W., Beverly Schoninger, M.A, Bob Tinker, Ph.D., and two researchers, Lee Becker, Ph.D., and Craig Gillete Ph.D. The research will be presented at Division 12 of APA this summer and should make a major impact. It is an extremely well controlled study that finds significance at .001 on all standard psychometrics used, including all of the subscales of the SCL-90R. Also honored was DavidWilson, Ph.D., for his excellent study of PTSD subjects using physiological measures. Its publication should be a major contribution to the literature. While excellent studies have been com· pleted, unfortunately, it takes approximately two years to get the information into print. In the meanwhile, studies by untrained researchers con· tinue to be published which call into · questionEMDR'sefficacy. Iknowthis is causing a lotofconstemation among clinicians, and rightly so. Once again, please write up your cases and submit them to professional newsletters and journals. All clinicians are already doing multiple baseline work. Take SUDs and Impact of Event scale measures on four to six unrelated memo· ries. Reprocess the first three and measure all six. Then reprocess the other three and measure them all again. Write up the results with a short introduction about EMDR and end with some ofthe clinical anecdotal material. That can be a publishable article. As a clinician, you are taking the measures and doing the reprocessing anyway. If you are in an EMDR study group, you can combine measurements and the task of writing. It can accomplish quite a bit in helping to get the word out responsibly in professional circles. Until there is an high level of saturation in the professional literature, EMDR will be subject to unwarranted attacks. The recent article in Newsweek is another example of misrepresentation. The reports of the Pittman study that compared EMDR with and without eye movement was quoted as indicating that EMDR is "snake oil." The reporter did not mention that the control included hand waving (which stimulates the retina) and hand-tapping, which we have been using clinically for years, and that the fidelity checks of treatment integrity showed a positive correlation between how well the method was done and the magnitude of treatment effects. Making EMDR sound like exposure plus eye movement is a misconception being promulgated by some behaviorists that are not trained in the method. Unfortunately, it is the state of the world. Hopefully, as EMDR gains greater acceptance through the publication of the appropriate research, we can make some needed changes in the way clinical research is uniformly done, and the way new methods are evaluated. Clearly, the field of psychology is not, presently, responsibly fulfilling its mandate. My endless gratitude goes to all of you who are attempting to do responsible research under incredible odds. Media attention has been widespread in the last few months. For a real example of "yellow journalism," take a look at the Psychology Today article. The reporter informed me at the start of the interview that "the best psychologist in the country was Oprah 15 Winfrey." I can hardly find a shred of truth in the entire article·· sol will let it speak for itself. Obviously she spoke to few clinicians actually using EMDR, and no clients. Most of the articles we have seen so far have been much more responsibly done than Newsweek and Psychology Today. To date, there are articles alreadypublishedin: New York Magazine Washington Post, (cover story), Family Therapy Networker, and the Honolulu Times. The WashinitQn £ost story was sent out on the Associate Press wire and does an excellent job of surveying the field. Sometime in July or August there will also be a segment on EMDR on 20/20 the TV News Magazine show. After the Wash: initQn Post story appeared, practi· cally every news program asked to do a show. We chose 20/20 because the producers appeared to be the most sincerely interested in doing a respon · sible job. They will not know until the week it is aired when it will actually appear, so I suggest looking at Friday TV listings, or taping all of them just in case. A presentation at the Eastern Regional Conference on Abuse and Multiple Personality was very well received. I spoke on the overview of EMDR, and Cathy Fine, Ph.D., did a magnificent job of delineating the ap· plications to dissociative disorders. Then Walter Young, M.D., and David Calof joined us for a question and answer panel. I want to thank all three of them for an excellent job and a wonderful contribution. This should help to overcome some of the misconceptions regarding EMDR as it applies to dissociative disorders. The text on EMDR thatl am authoring should be in print by Guilford Press by January 1995. It is called Eye Movement Desensitization aand Reprocessing: Basic Principle, Protocols and Procedures. We will make it available to Network members at a reduced cost and will let you know as soon as it is available. Its purpose is to act as a textbook for teaching the method and as a clinical handbook for P �EMDR Network Newsletter 1994 Issue 1 those already trained, because it ex· pands greatly on a number of topics only touched upon in the trainings. It doesnottaketheplaceoftraining, but should augment supervised practica. During the next few months we will be meeting with a number of different EMDR committees to determine how to authorize the use of the textbook throughout the universities, and men· tal health agencies. There has been a proposal to have a special training for people with academic positions who would like to include EMDR training as part of a graduate curriculum. Please contact me if you are inter· ested in this possibility for 1995. In addition, because the text will be widely available, wewillneedtomake some accommodations for expanding the role of the Network and delineat· ingcertain standards ofpractice. Any of you who have expertise or previous experience in any of these areas can certainly help formulate the policies. This is brand new territory and we want to make sure that clients remain protected while training becomes more widely available. By the time the book is published, 9, 500 clinicians will have been officially trained. This should establish an appropriate baseline of clinical practice and client success ratio. One EMDR training committee has recommended that people who have read the book, and been supervised by a trained supervisor, be given an equivalency test in order to enter the Network and advanced EMDR trainings. Other committees have rec· ommended certification programs. Please write to me if you have suggestions or expertise in regards to this area of consideration. In the meanwhile, authorized workshops are being done only by trainers selected and especially trained by me for that purpose. They are: Eirin Gould, Andrew Leeds, Howard Lipke, Barbara Parrett, Gerald Puk, Steven Silver, Roger Solomon, Kay Werk, and William Zangwill. The trainings they conduct include trained facilita· tors and cover the appropriate material regarding client safety and procedures. All of the brochures for their trainings have the EMDR Institute logo and the Pacific Grove address. The only exceptions are trainings they are doing outside the US or ones that are being included with trauma conferences; the office can give out infor· mation which those are. Any other trainings you may hear of being done by people who are not qualified to teach EMDR for a variety of reasons. Although my name may appear on their fliers, it is being done inappropriately, and without my permission. Unfortunately, as the media attention grows, these rare instances may increase and will need to be dealt with accordingly. In the meanwhile, however, it is important that you offer your colleagues the opportunity for informed consent. If you hear they are planning to attend, or have at· tended an unauthorized training, you should let them know the circumstances so they can make an informed decision about attending, or working with clients. This year there have been two legal decisions regarding the use ofEMDR. I was asked to appear as an expert witness for a case in Coleville, Wash· ington. The defense had introduced the evaluation of a psychologist who was untrained in EMDR who stated that EMDR was like hypnosis and could implant false memories. I testi· fied to the contrary armed with a .recent study by -Gregory Nicosia;. Ph.D. , whousedevaluatedEEGread· ings of EMDR clients compared to those under hypnosis. The hypnosis subjects showed a pronounced theta and alpha and the EMDREEG showed a client within the accepted parameters for a waking state. Conse· quently, according to this evaluation, EMDR is not hypnosis and does not produce the suggestibility necessary to "implant false memories." The judge's ruling supported this position. It is now a legal precedent in the United States. There is also a legal 16 ruling in Australia where the judge also decided that EMDR did not distort memory. In this present psychological climate, it is mandatory that EMDR be done properly, without trolling for memo· ries to keep it separate from the problems run into by hypnosis and "memory uncovering." There are bound to be other forensic challenges to EMDR, and we need to be prepared to meet them. This year there are EMDR presenta· tions at the annual conferences of the International Society for Traumatic Stress Studies, International Society for the Study of Multiple Personality and Dissociation, Ericksonian Foundation, International Conference of Psychoneuroimmunology, California Marriage Family Therapy, American Society of Marriage Family Therapy, Family Therapy Network, and the Society for the Exploration of Psychological Integration. However, it is important that presentations be made at many more conferences by clinicians and researchers actually trained in the method. Unfortunately, there have been reports of presentations by untrained clinicians that have mis· represented the way the method is actually used in clinical practice. Please contact the office for presenta· tion packets if you are interested in helping to responsibly disseminate the information. I know how precious time is when you are in clinical practice, but just think of the numbers of people you will be impacting. You get to be the reason that so many more clients can be helped. Please send me a listing of your name, presentation title, and the conference so we can publish a complete listing. As you may know by now, in March 1994, I was awarded the Distinguished Scientific Achievement Award by the California Psychological Association. I accepted it "on behalf of all EMDR therapists who are currently convert· ing science into practice." EMDR is where it is today because of you. �The EMDR Newsletter is in its fourth year of publication and is a wonderful forum to use to impart EMDR-related information. The primary purpose of the Newsletter is to provide EMDR-trained clinicians with the opportunity to share with, and learn from , the experiences of others . The following is a brief list of general topics that have generated interest among readers . Innovations: EMDR continues to evolve in order to meet the demands of client needs. Always welcome are suggestions of new and different ways to apply EMDR. Red Flags: This includes cautions regarding certain clinical populations, suggested safeguards, contraindications, etc. EMDR Research/Training Center The EMDR Researchtrraining Center at MRI is looking for individuals who want to take part in a research project regarding smoking cessation. Any therapists who have clients interested in participating, please call Cliff Levin, Ph.D. (415) 326-6465. Book Reviews: This includes any books that may be relevant to neurophysiology, learning theory, memory theory, PTSD, Memorable Cases etc., or any books that you think would be If you have treated any memorable of interest to practitioners of EMDR. cases we would like to hear from you. Protocols: If you have designed a proto- We are recording case histories of col for a specific population or issue, please EMDR treatment to share with each let us know . other and for possible publication. International Update: Let us know Please send 2 copies, preferably triple what is happening with EMDR interna- spaced, concise, and according to the tionally (e .g., conferences, publications, following outline: awards, etc.). Presenting problem Help Wanted: This is a column that can be used to advertise research projects, groups, etc. Tidbits: This column is for brief (one page or less) comments, ideas, suggestions, etc., about EMDR. Case Study: This is a description of a case in which EMDR was used either as the sole treatment method, or in conjunction with another modality. Theory: Francine Shapiro, Ph.D. , has developed a model based on information processing and neuropsychological activity. If you have other ideas on why/how EMDR works, please let us know. Background History Treatment Outcome Follow Up Comments Also please include your therapeutic approach (eg. Cognitive, Psychodynamic, etc.). Send to: Dr. Steve Lazrove 254 College St. Ste. 502 New Haven, CT 06510 Fax: (203) 865-7550 or call: Frankie Klaff (410) 392-6086 Research Reports: Results from research studies are vital to the continued growth and understanding of EMDR and Published? are welcome contributions to theNews- If you are an EMDR trained clinician letter. and have had any books published, Controversy: EMDR has generated some please contact the EMDR office at controversy since its inception. Bringing ( 408) 372-3900. it to the attention of our readers encourages debates which, in turn, stimulate thinking. This list is by no means exhaustive and other ideas and suggestions are welcome. 17 Fluent in a 2nd Language? If any EMDR trained therapists are fluent in a second language, please contact the EMDR office at ( 408) 3723900. Success with Schizophrenics? Anyone having success treating schizophrenia using EMDR, please contact: Carol A. Anderson, 4781 E. Gettysburg Rd., Fresno, CA 93726, (209) 445 8522 Addictions, Smoking, Weight Several therapists have contacted me regarding success in the use of my smoking protocol with other addictions. This has confirmed results I notice with many of my clients with histories of abusing heroin, crack, methamphetamine, marijuana and even food. I would appreciate receiving feedback (success and failures) from any therapist using my smoking protocol. Arnold J. Popky, MA, 17461 Pleasant ViewAve.,MonteSereno, CA 95030. Spiritual Insights Some therapists have noticed that their clients reported experiencing spiritual openings or insights during or after EMDR sessions. If you have seen this and would like to share these vignettes, please write up your case and send them to: Laurel Parnell, Ph.D. 22Von Ct. Fairfax, CA 94930 (415) 454-2084 �EMDR Network Newsletter 1994 Issue 1 The following is a list of published articles and selected presentations that may be helpful for citation purposes. I have excluded from this list all of my panels and presentations as being both too numerous and redundant. Please send all panels and presentations, upon acceptance, to the Newsletterfor future publication. In addition to new articles, we can include tliose topics not already covered in the bi ography, and mention the others in a separate section. I want to thank all of you who have taken the time and energy to help in the dissemination of EMDR. It cannot continue to flourish in mainstream psychology and eventually in the universities without your efforts. FS Baker, N. & McBride, B. (August, 1991. Cinical Applications of EMDR in a Law Enforcement Environment: Observations of the PsychologicalService Unit of the L.A County Sheriffs Department. Paper presented at the Police Psychology Division 18, Police & Public Safety Subsection) Mini-Convention at the APA annual convention, San Francisco, CA Klienknecht, R. (in press). Rapid treatment of blood and injection phobias with eye movement desensitization. Journal of Behavior Therapy and Experimental Psychiatry. Boudewyns, P.A, Stwertka, S.A, Hyer, L.E., Albrecht, J.W., & Sperr, E. V. (1993). Eye movement desensitization and reprocessing: A pilot study. Behavior Therapist, 16, 30-33 Lipke, H. (1992, October). A survey of EMDR-trained practitioners. Paper presented at the International Society for Traumatic Stress Studies Annual Confer· ence, Los Angeles, CA Butler, K. (Nov/Dec 1993). Too good to be true? Family Therapy Networker, 18-31. Lipke, H., & Botkin, A (1992). Brief case studies of eye movement desensitization and reprocessing with chronic post-traumatic stress disorder. Psychotherapy, 2a, 591-595. Cohn, L. (1993). Art psychotherapy and the new eye movement desensitization reprocessing (EMD/R) method, an integrated approach. In Evelyne Dishup (Ed.) California Art Therapy Trends. Chicago, IL: Magnolia Street Publisher Daniels, N. , Lipke, H. , Richardson, R., & Silver, S. (1992, October). Vietnam Veterans' Treatment Programs singEye Movement Desensitization and ReU processing. Symposium presented at the International Society for Traumatic Stress Studies annual convention, Los Angeles, CA Goldstein, A (August, 1992). Treatment of Panic and Agoraphobia with EMDR: Preliminary Data of the Agoraphobia and Anxiety Treatment Center. Temple University. Paper presented at the Fourth World Congress on Behavior Therapy, Queensland, Australia. Levin, C. (July/Aug. 1993). The enigma of EMDR. Family Therapy Networker, 75-83. Lohr, J.M., Kleinknecht, R.A, Conley, AT., dal Cerro, S., Schmidt, J., & Sonntag, M.E. (1992). A methodological critique of the current status of eye movement desensitization (EMD). Journal of Behavior Therapy and Experimental Psychiatry, 2.3, 159-167. Marquis, J . (1991). A report on seventy-eight cases treated by eye movement desensitization. Journal of Behavior Therapy and Experimental Psychiatry. 22, 187-192. McCann, D.L. (1992). Post-traumatic stress disorder due to devastating bums overcome by a single session of eye movement desensitization. Journal ofBehavior Therapy and Experimental Psychiatry, 23, 319-323. Goldstein, AJ., & Feske, U. (in press). EMDR treat· ment of panic disorder. Journal of Anxiety Disorders. Page, AC., & Crino, R.D. (1993). Eye-movement desensitization: A simple treatment for post-traumatic stress disorder? Australian and New Zealand Journal of Psychiatry, 27, 288-293. Herbert, J.D., & Mueser, K.T. (1992). Eye movement desensitization: A critique of the evidence. Journal of Behavior Therapy and Experimental Psychiatry, 23, 189-174. Paulsen, S., Vogelmann-Sine, S. , Lazrove, S., & Young, W. (Oct. 1993). Eye movement desensitization and reprocessing:It's role in the treatment of dissociative disorders. 10th Annual Conference of ISSMPD, Chicago. Klienknecht, R. (1992). Treatment of post-traumatic stress disorder with eye movement desensitization and reprocessing. Journal of Behavior Therapy and Experimental Psychiatry, 23, 43-50. Pellicer, X. (1993). Eye movement desensitization treatment of a child's nightmares: A case report. Journal of Behavior Therapy and Experimental Psychiatry, 24, 73.75. 18 �EMDR Network Newsletter 1994 Issue 1 Pittman, R.K., Orr, S.P., Altman, B., Longpre, R.E., Poire, R.E., & Lasko, N.B. (1993, May). A controlled study of EMPR Treatment for Post-Traumatic Stress Disorder. Paper presented at the American Psychiatric Association Annual Meeting, Washington, D.C. Puk, G. (1991). Treating traumatic memories: A case report on the eye movement desensitization procedure. Journal of Behavior Therapy and Experi149-151. mental Psychiatry, 22, Rothbaum, B.O. (1992). How does EMDR work? Behavior Therapist. 15, 34. Sanderson, A, & Carpenter, R. (1992). Eye movement desensitization versus image confrontation: A single-session crossover study of 58 phobic subjects. Journal of Behavior Therapy and Experimental Psychiatry, 23 269-275. Shapiro, F. (1989a). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress Studies, _g, 199-223. Shapiro, F. (in press) Eye Movement Desensitization and Reprocessing: Principle§. Protocols and Procefil!!:0§.. New York: Guilford. Shapiro, F., & Solomon, R. (in press) Eye movement desensitization and reprocessing: Neurocognitive information processing. In G. Everley and J. Mitchell (Eds.) Critical Incident Stress Maoaiement. Chevron Publishing: Elliot City, MD. Silver, S.M., Brooks, A, & Obenchain, J. (Jan. 1994). Eve movement de§ensitization and reproce§§ini treatment ofVietnam war veterans with PTSD: Comparative effects with biofeedback and relaxation trainini. Paper presented at the Philadelphia Society for Clinical Hypnosis. Submitted for publication. Solomon, R., & Shapiro, F. (in press). Eye movement desensitization and reprocessing: An effective therapeutic tool for trauma and grief. In C. Figley (Ed.) Death and Trauma. New York: Brunner Mazel. Spector, J., & Huthwaite, M. (1993). Eye-movement desensitization to overcome post-traumatic stress disorder. British Journal of Psychiatry, 106-108. Shapiro, F. (1989b). Eye movement desensitization: A new treatment for post-traumatic stress disorder..Joll:: nal of Behavior Therapy and Experimental Psychiatry, 20, 211-217. Thomson, S.S. (1993). Interview with Francine Shapiro, Ph.D. TreatiniAhu§e Today, 17-23. (Pt. I)~. 26-33; (Pt. 11) _a, 17-23. Shapiro, F. (1991a). Eye movement desensitization & reprocessing procedure: From EMD to EMDR-A new treatment model for anxiety and related traumata. Behavior Therapist, 14, 133-135. Wemik, U. (1993). The role of the traumatic component in the etiology ofsexual dysfunctions and its treatment with eye movement desensitization procedure. Journal of Sex Education and Therapy, .lli, 212-222. Shapiro, F. (1991b). Eye movement desensitization and reprocessing: A cautionary note. Behavior Therapist, li, 188. Wilson, D., Covi, W. , Foster, S., & Silver, S.M. (1993, April). Eve movement desensitization and reprocessin~ and ANS correlates in the treatment of PTSD. Paper presented at the California Psychological Asso· ciation Annual Convention, San Francisco. Paper submitted for publication. Shapiro, F. (1993). ThestatusofEMDRin 1992. Journal of Traumatic Stre§s. 2, 413-421. Shapiro, F. (1994). Eye movement desensitization and reprocessing: A new treatment for trauma and the whole person. Treatini Abu§e Today, 1, 5-13. Shapiro, F. (1994). Eye movement desensitization and reprocessing: A new treatment for anxiety and related trauma. In Lee Hyer (Ed.) Trauma victim: Theoretical is§ues and Practical suiiestion§. Muncie, Indiana: Accelerated Development. Shapiro, F. (in press). EMDR: In the eye of a paradigm shift. The Behavior Therapist. .a, Wilson, S.A, Tinker, R.H. , & Becker, L.A (Aug. 1994). Eye movement desensitization and reprocessini <EMDR} method in treatment oft traumatic memories. Paper accepted for presentation at the annual conference of the American Psychological Association (Clinical Psychology, Division 12), Los Angeles, CA Article being prepared for journal submission. Wolpe, J., & Abrams, J . (1991): Post-traumatic stress disorder overcome by eye movement desensitization: A case report. Journal of Behavior Jfherapy and Experimental Psychiatry, 22, 39-43. 19 �CENTURY CITY/SANTA MONICA Robert Goldblatt (213) 917-2277 Coordinating a new group 90067, 90401 zip area for West L.A. CUPERTINO Gerry Bauer (408) 973-1001 Meets 2nd Wed. 2:00 - 3:00 pm. Case consultation. Open DOWNEY (213) 869-0055 Pauline Hume Coordinating a new group. Open EAST BAY Edith Ankersmit (510) 526-5297 Meets 3rd Fri. 7:30pm. Case discussion only. Group is closed to new members, but willing to coordinate a new E. Bay group. EAST BAY/ALBANY Sandra Dibble-Hope (510) 843-1396x48 Meets 1st Mon. 8-9:30pm, 1035 San Pablo Ave., Ste. 8. EAST BAY/OAKLAND Hank Ormond (510) 832-2525 Meets one Fri. a mo. Call for time & day. Open FRESNO Darrell Dunkel (209) 435-7849 Meets 1st Fri. at Fresno VAMC. Primary case discussions. Open (209) 292-1700 James Shephard Coordinating new group. Open FULLERTON (714) 965-1550 Jocelyne Shiromoto (714 ) 680-0663 Curt Rouanzoin Meets 2nd Tues. 9:30-11:30 IRVINE Judy L . Alpert (714) 841-2296 Meets 2nd Thurs of month. Primarly case discussions. Open. Call for directions. HUNTINGTON BEACH (714) 764-3419 Jocelyne Shiromoto Open. Call for time. LOS ALTOS/PALO ALTO John Marquis (415) 965-2422 "'Meets ad hoc at Pacific Graduate School of Psychology in Palo Alto. Primarily case discussion. Open LOS GATOS/SARATOGA/CAMPBELL Jean Bitter-Moore (408) 354-4048) Meets the 3rd Thurs. 12:00-1:30pmatMission Oaks Hospital, Conference Room 1, Los Gatos. Open MANHATTAN/REDONDO BEACH (213) 539-3682 Randall Jost Coordinating a new group. MARIN COUNTY Steve Bodian (415) 454-6149 Coordinating a new group. Open MONTEREY (408) 373-6042 Glenn Leonofl' (408) 372-3900 Robbie Dunton Coordinating a new group. Open NAPA (707) 226-5056 Marguerite McCorkle Open. NEVADA CITY/GRASS VALLEY (916) 477-2857 Judith Jones Call for time. Open PALMDALFJLANCASTER (805) 272-8880 Elizabeth White Coordinating a new group . Open PALO ALTO (415) 326-6896 Ferol Larsen Meets 1st Wed. lOam in MRI conference room. Case discussion. REDDING Dave Wilson (916) 223-2777 Meets once monthly at the Frisbee Mansion on East Street in Redding. Discussions, case presentations, videos, role playing, troubleshooting. RIVERSIDFJSAN BERNADINO Byron Perkins (909) 732-2142 3rd Fri. 9:30-11:00am SACRAMENTO Bea Favre (916) 972-9408 Connie Sears (916) 483-6059 Meets 3rd Fri. 1:00-3:00 2740 Fulton St. Sacramento SAN DIEGO Jim Fox (619) 260-0414 Meets 2nd Fri. 9:30-11:00am. Primarily case discussion. Call Arthur Horvath (619) 445-0042 Mary Anderson (619) 434-4422 Meets 2nd Fri. 9:00-10:30. Case discussion. Call. Elizabeth Snyker (619) 942-6347 meets 3rd Wed. 9:00-10:30191 Calle Magdalena #230,Encenitas SAN FRANCISCO (415) 221-3030 Sylvia Mills Call. Case discussion Stan Yantis (415) 241-5601 Meets 1st Wed. 8-lOpm., 180 Beaumont St. Please call to confirm. Case discussion and group process. Open. SAN MATEO/BURLINGAMFJREDWOOD CITY Pat Grabinsky (415) 692-4658 Florence Radin (415) 593-7175 Coordinating a new group. Contact Florence. SANTA CRUZ Linda Neider (408) 475-2849 Meets every month on a Fri. 7:00pm. Primarily case discussion. SARATOGA/W. SAN JOSE Dwight Goodwin (408) 241-0198 1st. Fri. 9:30-11:30. Open SOLANO/ NAPA COUNTY Micah Altman (707) 747-9178 Willing to coordinate new group . Call if interested. SONOMA COUNTY Kay Caldwell (707) 525-0911 Meets in Santa Rosa at Kay's office the 4th Tues. 12:30- 2:00pm. Primarily case discussion, videos and "troubleshooting." Open TORRANCE James Pratty (800) 767-7264 Coordinating a new group. Open WEST LOS ANGELES Geoffry White (310) 202-7445 David Ready (310)479-6368 Coordinating a new group. Open UKIAH Garry A. Flint (707) 468-0418 Meets the last Fri. ofmo. from lOam to 12 noon at 101 W. Church St. #10. Open WOODLAND HILLS/NORTHRIDGFJWESl'WOOD Ron Doctor/Ginger Gilson (818) 907 -7506 Seeking new members. Contact Ginger. 20 �EMDR Network Newsletter 1994 Issue 1 1991 LEVEL I BASIC TRAININGS Listed below in the shaded areas are sem' ars conducted by Francine Shapiro, Ph.D. Other seminars listed will be co ducted by EMDR senior trainers. Ihm:. Location July 23/24 Sat./Sun. San Bernardino, CA Ramada Hotel Aug. Bn Sat./Sun. Portland, OR Sheraton Portland Airport Hotel lhlH. Sept. 23/24 Fri./Sat. Aug. 29/30 Mon .trues . August TBA Sept. 10/11 Sat./Sun. Oct. 7/8 Fri./Sat. Washington, DC Embassy Row Hotel Aix-en-Provence, France Hotel Pullman Roi Rene San Antonio, TX TBA Melbourne, Victoria, Australia TBA Sept. 10/11 Sat./Sun . Phoenix, AZ Sunburst Hotel Sept. 24/25 Sat./Sun. Perth, West Australia Perth Hotel Location Minneapolis, MN Radisson Hotel & Conf.Cntr. 199-t LEVEL II TRAININGS EMDR has generated a tremendous amount of enthusiasm among practitioners and all of us are anxious to read about the latest deve'lopments in, and! or experiences with, this exciting method. Because of this enthusiasm and desire to acquire more knowledge, I believe that it is important to produce a publication that provides a forum for articles that are more formal (e.g., research, protocols, etc.), as well as for those that are less formal (e.g., case studies, innovative ideas, etc.). To this end, the following represent the guidelines for submissions to the Newsletter: Send articles to Lois Allen-Byrd, Ph.D. , Editor, EMDR Newsletter, 555 Middlefield Road, Paw Alto, CA, 94301. Please include home and business telephonenumbers,professionaldegree, 'locationofpractice(cityandstateonly),professionalaffiliation(ifapplicableuniversity, ifa lecturer or teacher, and/ or institute, ifan associate). Example: John Smith, Ph.D., John Doe University, Johnson, WA. If possible, please submit articles on a diskette, IBM format. ARTICLES SHOULD BE DOUBLE SPACEDWITHWIDEMARGINS.APASTANDARDANDSTYLE-BOTHTEXTANDREFERENCESSHOULD BE IN ACCORDANCE WITH APA STANDARDS. ALL SUBMISSIONS ARE SUBJECT TO EDITORIAL REVISIONS. Proofreading ofmaterial is suggested before submission. Authors submitting a manuscript do so with the understanding that, if it is selected for publication, copyright of the article is assigned to the Newsletter. Because the Newsletter depends on you, the members of the network, I welcome any suggestions or comments that you may have. If there are any questions regarding the above, I can be reached at (415) 326-6465. 21 �EMDR Network Newsletter 1994 Issue 1 AUDIO TAPE ORDER FORM 1994 EMDR CONFERENCE Research & Clinical Applications Tapes cost $ 9.00. Full Set Price $ 430 Shipping: US & Canada $ 1.25 per tape, $ 15 Maximum International $ 2.00 per tape, $ 30 Maximum L115 L116a (4 tapes) L117a (4 tapes) L118a (4 tapes) L119a (4 tapes) Weloome & Closing MRI Brief Therapy Chronic Depression Dissociative Disorders Sexual Abuse Ll20a (4 tapes) L12la (2 tapes) Children: Traumatized Children ADHD Tourette's Disorder Peak Performance Ll22a (2 tapes) L123a (2 tapes) HIV/AIDS Research Reports of Current Studies L124a (2 tapes) L126a (2 tapes) L127a (2 tapes) Problems & Pitfalls Using EMDR Selecting Positive & Negative Cognitions Personality Disorders: Using EMDR with Difficult Agents EMDR & Structured Therapy For MPD Substance Abuse L128a (2 tapes) L129a (2 tapes) L130a (2 tapes) Obsessive Compulsive Disorder Research Design Somatic Disorders L181a (2 tapes) L132a (2 tapes) L133a (2 tapes) L134a (2 tapes) Ll35a (2 tapes) Managing Self Harm Art Therapy Critical Incident Working With Women: Midlife & Beyond Transpersonal, Hypnosis & Guided Imagery Panel: Guided Imagery & Hypnosis Veterans Seizures, Epilepsy & Meditation Ego State Disorders: DiHociative But Not Multiple Chronic Pain Motor Vehicle Trauma Smoking Protoool Research Consultation L125a (2 tapes) Ll36a (2 tapes) L137 L138 Ll39 LUO L141 L142 Name:___________________ JEAN SUTl'ON, LCSW ROBERT TINKER, Ph.D. MICHAEL ABRUZZESE, Ph.D. JENNIFER LENDL, Ph.D. I SAM FOSTER, Ph.DJ BARBARA PARRFIT, RN, MS DONALD WESTON, Ph.D. STEVE SILVER, Ph.D. I LEE HYER, Ed.D. SANDRA WILSON, LPC I CLIFFORD LEVIN, Ph.D. WILLIAM ZANGWILL, Ph.D. ANDREW LEEDS, Ph.D. PHILIP MANFIELD, Ph.D. CATHERINE FINE, Ph.D. SILKE VOOELMANN-SINE, Ph.D. LARRY SINE, Ph.D. MARCIA WHISMAN, LCSW GARY FULCHER, M.Psych. ART ANTON, Ph.D./ DEAN FUNABIKI, Ph.D. MARILYN L SPIRO, Ph.D. DAVIDCALOF LINDA COHN, ATR I MFCC ROGER SOLOMON, Ph.D. JOAN LUNDGREN, Ph.D. IRV KATZ, Ph.D. HYLA CASS, MD & JONATHAN SPEAKE, Ph.D. HOWARD LIPKE, Ph.D. SHEILA KRYSTAL, Ph.D. SANDRA PAULSEN, Ph.D. BRUCE EIMER, Ph.D. GERALD PUK, Ph.D. ARNOLD J. POPKY, MA STEVE SILVER, Ph.D. I GARY FULCHER, M.Psych. (800)-356-2834 (206) 335-5223 FAX (206) 334-7866 NBR. OF TAPES SHIPPING (SEE ABOVE) (taxed in WA) SUBTOTAL (WA Residents add 7.6% tax) Address:. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _.Zip:_ _ _ _ __ Phone: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ PU EMDR94 FRANCINE SHAPIRO, Ph.D. RICHARD FISCH, MD LANDRYWILDWIND, LCSW WALTER YOUNG, MD scarr NEIBON, Ph.D. I MARG<YI' SILK FORREST/ EIRIN GOULD, LMFT I DEBBIE KORN, Psy.D. Please mail order form & checks to: AUDIO PRODUCTIONS 8806 S. LAKE STEVENS RD. EVERETT, WA 98205 USA. Prepayment on all tape orders. please!!! No Credit Cards, please. FOR OFFICE USE ONLY: ~ TOTAL PD INV 22 SHP =$_ _ __ =$_ _ __ =$_ _ __ =$_ _ _ __ =$ ConfNum4106 �EMDR Network Newsletter 1994 Issue 1 ACKNOWLEDGMENT AND CONSENT FORM Below you will find an example of the types of things that we think clients should know in order to have informed consent before initiating EMDR treatment. This sample format is not meant to be the definitive answer for an EMDR informed consent nor is it endorsed by EMDR Network, Inc.: rather it is offered here as one example of what can be included in such a document. Because the laws governing the use and effect of such documents vary from state to state, it is IMPERATIVE THAT YOU OBTAIN A LEGAL CONSULT BEFORE USING ANY SUCH DOCUMENT. CONSENT FOR EYE MOVEMENT DESENSITIZATION AND REPROCESSING TREATMENT I have been advi~-1?$.nd understand that §re MoveIIIf,:ptmesensitization and Reprqfessing (EMDR) is ~d~~Ji~l:~«,~;:r~ ... .J!<lhl.9.#... ~~~~ !~:a~:e:!~,~~"f.fflMD.lli.....; ,.JUtfo.~1t!;~d~~Itj!ij. l~~t,;,1tt1~~~!:~1µ84.\.P ,.J~i.:1 IWA. .1-J ~~=-:e~~:;ieed~!~:t ~ ,,.·~·. . . · · · · · · ,#, . )Y g post-traumatic stress symptoms, sui!'h as intrusive thoughts, nightmares, and flashbacks . I have also been advised that, although there are currently no known serious side effects to EMDR, there is minimal data as to its efficacy or safety. I have also been specifically advised of the following: \.,:.::·:::::;::::::::,, ;.:/::.::....:i::;:.. .. (a) Distressing unresolved meIU,iri~~i m1a~ii $urfa&h~hff>,~g1%thefh~e of the EMDR procedure. (b) Some chents have experien<tfi.:f.$'adij9gg duqp/g tit 1*tffjfrn4Dt sessions that neither they nor the administering clinician may have anticipated, including a high level ofemotion or physical sensations. (c) Subsequent to the treatment session, the processing of incidents/material may continue, and other dreams, memories, flashbacks, feelings, etc., may surface. Before commencingJiMJ;>R treatment, I have thoroughly co'-fider(f alJ>fthe above, I have obtained ;;;=;~;.~:!~~1;,c;q;.;~!3r~~~tts•rc;~:a:e~thaving My signature on this Acknowledgment and Consent is free from pressure or influence from any person or entity. Date: Client Signature:._ _ _ _ _ _ _ _ _ _ __ Each state has its own laws governing the use and effect of documents attempting to limit the liability of professionals such as this CONSENT. Consult with an attorney regarding the laws applicab/,e in your stateBEFOREusinganysuchdocument. ThisSAMPLEFORMATisprovidedforyourinformationonly. EMDR NETWORK, INC. does not warrant or represent the suitability of this document and disclaims any liability stemming from its use. EMDR NETWORKS INC. is not engaged in the practice of law and does not render legal services or give legal advice. 23 � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter Newsletter Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter, 4(1), 1-23 https://d1y502jg6fpugt.cloudfront.net/13023/archive/files/e6d70f57ee36f1b421318c6031cd721a.pdf?Expires=1790208000&Signature=VjkHvPgC7Su3jlGqDwVb0effwwGw5JrRIu5-GR6-Ye7tHAM1s3JD-9LMwSu751fYYkwjPVwCZUJ1JGInO1XsSKz2Gx3cqD8y1A74UVyIhSMlkf2HKFQFg9YbJ83c%7EJkWsoJovgP7T62Noy9BidzIKtvXpkZd3HBxz3tXt2iSWE50Z18WnhObY8q%7Eb8H-x7SRjCpwFZ-AeYNaNcf%7E3L12HgS%7EpihxYWICVjU5AgzIGpHbME4bUwrHXERGpwr6VKbGcUBDnG5SV-JKzsgOsmeiRJvTRXySeTZe2Gs6yvy4o0wS8Ly2ceaje9doVsUX%7EkYdXpmz5b8CvKmJ9xd4UubDTQ__&Key-Pair-Id=K6UGZS9ZTDSZM 9ed791e95527a92e5b2d2f78c389ed43 PDF Text Text I 1994 Issue 2 e ~ e t w o r Newsletter k NETWORK, mc. EYE MOVEMENT DESENSITIZATION AND REPROCESSING Copyright (6 1994 EMDR NETWORK, INC. P.O. Box 51010, Pacific Grove, CA 93950-601 0 (408) 372-3900 FAX (408) 647-9881 The Eight Phases of EMDR Treatment EMDR consists of eight essential phases and should always be used within a comprehensive treatment plan. It is never to be attempted without appropriate preparation and the opportunity for reevaluation. The following is a quick review of the crucial phases for EMDR treatment. Stray Thoughts. ............................... Francine Shapiro, Ph.D.. .............. 1 Regional Network Coordinators.......................................................... 2 EMDR After a Terrorist Attack. ... Liliane Barr, M.D ........................ 4 "InnovativeIdeas"or Such. ............ Sonya K. Binstock, LCSW ........... . 5 EMDR: A Part of the Whole. .......... Joanne Carnes, M.A. ................ 5 Family Innovation to Enhance Child EMDR Treatment. ................ ............................................................. Ricky Greenwald ......................... . 7 International Update. ..................... Francine Shapiro, Ph.D. ............... 8 Tidbits. ........................................ Jesse Rappaport, LCSW ..............11 Submission and Deadline Information............................................... 11 EMDR Help Wanted. .............................................................................. 12 From the Editor. ................................................................................... California EMDR Study Groups. ....................... tion, so the clinician must evaluate detailed treatment plan. potentialproblems due to age or apre- Phase Two: Preparation existing respiratory or cardiac condiPhase One: Client History and tion. TreatmentPlanning I t is essential that the clinician give For clients selected for EMDR treat- the client enough information about Effective treatment with EMDR de- ment, the clinician will then take the the potential for emotionaldisturbance mands knowledge of not only how to information needed to design a treat- during and after EMDR sessions so he use it, but when to use it. Therefore, ment plan. This part of the history- or she can give truly informed conthe first phase of EMDR treatment taking will evaluate the entire clinical sent. Not only does this give clients includes an evaluation of the client picture including the dysfunctional the opportunity to make appropriate safety factors that will determine cli- behaviors, symptoms, and character- choices, but it allows them to prepare ent selection. A major criteria for istics that need to be addressed. The their work and social schedules to acjudging the suitability of clients for clinician will then determine the spe- commodate any discomfort. Clinicians EMDR is their ability to deal with the cific targets that will need tobe repro- should also be sure that clients have high levels of disturbance that may be cessed. These targets include the ini- an audio tape that includes guided precipitated by the processing of dys- tial events that set the pathology in relaxation exercises (such as "Letting functional information. This involves motion, the present triggers that Go of Stress" by Source Cassettetapes) ail evaluation ofpersonal stability and stimulate the dysfunctional informa- and that they practice these exercises life constraints, such as major dead- tion, and the kinds of positive behav- before beginning the EMDR reprolines that maybe adversely affected if iors and attitudes needed for the fu- cessing sessions. The goal is for clients the client is distracted by the ongoing ture. EMDR should only be used to to be proficient in the techniques and processing of the traumatic material. reprocess information after the clini- be able touse the tape with confidence In addition, the client should be physi- cian has completeda full evaluation of in order to deal with any betweencally able to withstand intense emo- the clinical picture and has outlined a session disturbance. �EMDR Network Newsletter 1994 I s s u e 2 Phase Three: Assessment Arizona Jonathan Brooks, Ph.D. Pat Penn, Ph.D. Arkansas Stephanie Zack, LCSW California (Northern) Norva Accornero, MSW (Southern) Curtis Rouanzoin, Ph.D. Ron Doctor, Ph.D. Colorado Laura Knutson, LPC Jana Marzano, MA Connecticut Steve Lazrove, MD Georgia Pat Hammett, Ph.D. Hawaii Sillre Vogelmann-Sine, Ph.D. Idaho Dean Funabiki, Ph.D. Illinois Howard Lipke, Ph.D. Maryland Mike Brenner, MD Eugene Schwartz, LCSW Massachusetts Lorrie Bollinger , MA Missouri Marcia Whisman, LCSW New York William Zangwill, Ph.D. Gerald Puk, Ph.D. New Mexico Peggy Moore, LSW Ohio Kay Werk, LISW Oregon Ann Kafoury, LPC Pennsylvania Georgia Sloane, MS Texas Carol York, MSW Utah Dan Sternberg, Ph.D. Washington Steve Riggins, MA Washington DC Deany Laliotis, LPC Dan Merlis, LCSW Clinicians should also use the guided visualization techniques with the client before reprocessing begins. If the client is unable to successfully eliminate moderate levels of disturbance with these techniques, the clinician should not continue EMDR. Techniques like these may be necessary to help the clinician close down an incomplete session and assist the client in dealing with new memories or unpleasant emotions that may emerge after the session. The effective use of these techniques can give clients the confidenceto deal with the high levels of disturbingmaterialthatmay emerge during the session, while an inability to handle the disturbing feelings can increase the client's level of fear and make processing even more difficult. The preparation phase also includes briefing the client on the theory of EMDR and the procedures it involves, Assessment is the thirdphase ofEMDR In it. the clinician identifies the m m p o n e k of the target. Once the memory is identified, the client selects the picture that best represents the memory. Then he or she chooses a negative cognition that expresses a dysfunctional, maladaptive self-assessment related to his or her participation in the event. Thesenegative beliefs are actually verbalizations of the disturbing affect and include statements such as, "I am useless, worthless, unlovable, dirty, bad," etc. The client then identifies a positive cognition that will be used as a replacement for the negative cognition during the installation phase of processing (Phase Five). These statements should incorporate an internal locus of control, when possible, such as, "I am worthwhile, lovable, a good person, in control" or "I can succeed." The client then assesses thevalidity of the positive cognition using the 1-to-7 Validity of Cognition (VoC) scale, where 1 equals "completely false" and 7 equals "completely true." 1 treatment. (602)493-3 10 1 (602)770-7407 (501 442-9997 ) (408)3561414 (714)680-0663 (818)885-2827 (303)620-7 198 (303)220- 1 115 (203)787-0227 (404)633-4796 (808)53 1-1232 (609)334-0677 (708)537-7243 (410)771-4438 (41 )664-572 0 1 (508)456-8623 (31 )644- 1 4 124 (212)663-2989 (914)635-1300 (505)255-8682 (614)274-7000x349 (503)29 1-9343 (215)667-6490 ( 12)343-9550 5 (801)364-2779 (206)328-5626 (301)982-9259 ( 1 ) 664-572 40 1 offering some helpful metaphors to encourage successful processing, and telling the client what he or she can realistically expect in terms of treatment effects. During the preparation phase, the clinician should also explore with the client any possible secondary gain issues. What does the client have to give up or confront if the pathology is remediated? If there are concerns, these must be addressed first, before any trauma reprocessing begins. This may include the development of an action plan to handle specific situations that may arise, such as needing to find anew job or a new place to live. If the secondary gains are fed by feelings of low self-esteem or irrational fears, they should become the first target ofprocessing. Until these fears are resolved,noother significant them peutic effects can be expectedor maintained. At this point, the picture andnegative cognition are combined to identify the emotion and the level of disturbance Subjective Units of using the 0-to-10 Disturbance (SUD) scale. A rating of 10 means the greatest level of disturbance the client can imagine, and 0 means calm or emotionally neutral. The client is asked to pick a number that indicates the intensity of his or her emotions when the memory is accessed in present time. As reprocessing commences, both the emotions and their intensity will change, with the disturbance often becoming temporarily worse. Next, the client identifies the location of the physical sensations that are stimulated when he or she concentrates on the event. The assessment stage offers a baseline of response in regards to the target memory, and the specificcomponents necessary tocomplete processing. �EMDR Network Newsletter 1994 I s s u e 2 Phase Four: Desensitization The fourth phase is called "desensitization" because it focuses on the client's negative affect as reflected in the SUDs rating. This phase of treatment encompasses all r e sponses, regardless of whether the client's distress is increasing, decreasing, or "stuck." During the desensitization phase, the clinician repeats the sets, with appropriate variations and changes of focus, until the client's SUDs levels are reduced to a 0 or 1 (when ecologically valid). This indicates that the primary dysfunction involving the targeted event has been cleared. However, the reprocessing is still incomplete and the information willneed to be further addressed in the crucial remaining phases. Remember that in many cases, the sets of eye movements or alternative forms of stimulation are not sufficient to complete processing. At least half the time, the processing will stop and the clinician will have to employvarious additional strategies and advanced EMDR procedures to restimulate the system. Phase Five: Installation The overall reprocessing effects of EMDR are manifested by changes in the picture, cognitions, emotions, andbody sensations associated with the targeted event. During a simple EMDR treatmen t session, aspects of the information shift simultaneously to a less disturbing form. Conceptually, the clinician is attempting to "clean out7'the dysfunctional information storedin the associativeneurophysiological memory network and allow it to be replaced with positiveinformztion. The fifth phase of treatment is called installation because the focus is on "installing" and increasing the strength of the positive cognition that the client has identified to replace the original negative cognition. For example, the client might begin with an im- age of her molestation and the negative cognition, "I am powerless." During this fifth phase of treatment, the positive cognition "I am now in control" might be installed. The caliber of the treatment effects (that is, how strongly the client believes the positive cognition) is then measured using the Validity of Cognition (VoC) scale. The installation phase starts once the client's levelof emotion about the target event has dropped to 1or 0 on the SUDs scale. At this point, the clinician asks the client to hold the most appropriate positive cognition in mind along with the target memory. Then he or she continues the eye movement sets until the client's rating of the positive cognition reaches a level of 6 or 7 or more on the VoC scale (where 1is "completely false" and 7 is "completely true"). Keep in mind that the client should rate the cognition based on how he or she feels at a gut level. Linking the positive cognition with the target memory allows a strengthening of the associative bond so that if the original incident is triggered, its return to consciousness will be accompanied by the new, strongly linked positive cognition, such as, "It's over, I'm safe now." As the client concentrates on the positive cognition, i t is infused into the target memory network where it can generalize to the other associatedmaterial. As discussed earlier, the positive cognition is chosen so as to generalize and reshape the perspective of the greatest amount of dysfunctionalmaterial, as well as to empower the client for present and future occurrences. Metaphorically, if the cognition gives "color" to past and present incidents (as ifthe client were seeing through rose- or dark-coloredglasses), the positive cognition acts as a different color dye that permeates the memory network. Phase Six: Body Scan After the positive cognition has been fully installed, the client is asked to hold the target event in mind, along with the positive cognition, andmentally scan his or her body from top to bottom. He or she is asked to identify any residual tension, in the form of body sensation. These body sensations are then targetedfor successive sets. Often the tension will simply dissipate, while in other cases, additional dysfunctional information will be revealed. As there appears to be a physical resonance to dysfunctional material, which may be related to the way it is physiologically stored, identifying any residual physical sensation, and targeting it in this sixth phase of EMDR treatment, can help to resolve any remnants of unprocessed information. This is an important phase and can reveal areas of tension or resistance that were previously hidden. Phase Seven: Closure The client must be returned to a state of equilibrium a t the end of each session, regardless of whether the reprocessing is complete. Techniques to close the session have been reviewed in t h e Level I and I1 trainings. In addition, it is vital that the client is given the proper instructions at the end of each session. The clinician must remind the client that the disturbing pictures, thoughts, or emotions that may arise between sessions are simply signs of additional processing. The client is instructed to keep a log or journal of negative t h o u g h t s , situations, dreams, memories-anything ofthat nature that may arise. This allows the client to cognitively distance himself or herself from emotional disturbance through the act of writing. Specifically, the client should take a "snapshot" of any disturbances so that these can be used as targets for the next session. The use of the log and the visualization techniques taught by the clinician or via a relax- �EMDR Network'Newsletter 1994 Issue 2 ation tape are extremely important to aid client stability between sessions. Unless the clinician appropriately debriefs his or her EMDR client, there can be a danger of decompensation or suicide, brought on when the client gives his or her disturbing emotions toomuch significanceor view sthem as that he Or she is permanently damaged. The clinician should give the client realistic expectations regarding the negative (and positive) responses that may both durtreatment. Thisincreases the likelihood that the client canmaintain asense ofequilibrium throughout the possible disturbance engendered by the stimulation of the dysfunctional There may be a effeet that stimulates other negative memories as the information continues to process. T:Where do you feel this death? P: [She put her hand on her stomach.] T: Stay there. P: I feel that the death is lnside of me, not outside. 0, the 18th of July, 1994, we had a terrorist attack a t a Jewish institution, a building of eight floors that was completely destroyed. M~~~than 150 people died a n d 147 were wounded. Thenextday,severalpeople with panic attacks were found walkinghthestreets. ~h~~hadnomemory of what had caused them to be so far away from their homes or work. This tragedy happened on Monday. On Saturday morning, I received a phone call from a patient in a very excited state who asked me to see her immediately. She was suffering from P h a s e Eight: Reevaluation obsessive ideas, had a fear of new attacks, was feeling "death everyThe eighth phase of treatment includes and was terrified that some. the additional targeting, reaccessing, thing could happen to her children. and review necessary to ensure o n Friday night she had gone to a plete treatment effects. After any Jewish temple to pray (she never reprocessing session, a re-evaluation goes to any temple) and when she of effects should be made a t the beginback, the telephone rang and n h g of the following session. The heard avoice telling her, "We are ask how the client going to kill YOU." She said that this feels about the previously targeted was the voice of a man who repeated material and review the 1% reports to the menacing statement three times. see if there are any reverberations of ~f~~~ that call, she could not sleep. the already processedinformation that need to be targeted or otherwise ad- This 38-year-old woman, who curdressed. The clinician should only rently is happily married with two proceed with targeting a new event children (ages 4 and 6), had been my after the previously treated traumas patient several years ago and I was are completely integrated. well aware of her past from our previous work. I believed that although Integration is determined in terms of herpresenting symptoms werecaused intrapsychic factors, as well as sys- by the current situation in our countems concerns. If the reprocessed trau- try, I was sure that it had triggered mas have resulted in new behaviors something from her past. I suggested on the part of the client, it may be that we try EMDR and she agreed. necessary to address problems that The initial target was, "I feel death arise in the family or social system. everywhere," which she rated a t a 10 The re-evaluation phase guides the SUDs level. The following is an acclinician through the various EMDR count of the material that emerged. protocols and the full treatment plan. Successful treatment can only be determined after sufficient re-evaluation of reprocessing and behavioral effects. [NowIshalldescribeonlyherwords, with the understanding that after each phrase, there was a set of EMDR.] p: I think my father wanted to kfl me when my mother became preg. nant. P: [She cries.] I know my father was a danger for me, I can now feel the danger. P: [Abreaction continues.] I know that my mother always protected me fmm hun. She means life for me. m e patient rates the SUDs as 7.1 P: I have this feeling that I am the danger. I am afraid of myself. P: I feel that 1 am my father who wants to kill me. I want my mother to do an abortion. T: NOW, speak to your father and see if you can tell him that you have the right to live. p: I know that I myself. able to protect [Her SUDS is reported to be 3.1 T: I asked if the voice on the telephone still upset her. P: Yes. T: So, you are the man who called you? P: I am full of anger and want to k l . il I hate people, I am a terrorist. [She begins to abreact.] '1 P: I see that I had this hate against my father. I never realized that it was so strong. I have carried this anger all of this time. [She feels completely calmed and wants to hug me and thank me.] The session lasted less than one hour. �EMDR N e t w o r k N e w s l e t t e r 1994 I s s u e 2 done my best, I often feel that I am a failure at much of what I do. It has been very hard not to have my Dad's verbal acknowledgment and acceptance of who I am. Mrs. O., who had suffered neck and shoulder injuries in an automobfie accident several years ago, was referred to me after an incident on her job triggered a post-traumatic stress reaction. Treatmentinitiallyconsisted of traditional talk therapy, but after having been trained in EMDR, I offered it as an option to deal with the PTSD of the accident itself. We did only 2 sessions of EMDR which were spaced w e r several months (as there were additional work-related stressors that arose and needed attention). The second and last EMDR session was so remarkable for both of us that I asked her to write her impressions . for the-N "November, 1993 "During one of my recent visits to see Toni, I had avery different experience, a kindof'outofbody' experience. We were involvedin an EMDR session focusing on the automobile accident I had several years ago. This accident has left me with neck and shoulder pain and daily headaches (an average levelofpain for these conditions would be 3 or 4 on a 10-point scale). therapy. At that time, she was 35 and in her third marriage. Except for going to work (where she was extremely competent), she stayed home and isolated in her room. Working with a psychiatrist, we put her on Prozac and started the process of working through the sexual abuse. "Aswe continued our session, one of the statements1 made was that, 'I just want my father to love me for who I am' and that, 'I have never been what my father wanted me to be, a boy.' TO Put apositive message in the negative message's place, 1 simply said, 'It's over. .. I am who I am and no matter what my father had wanted, 1 was a good and decent human being, a girl.' All of a sudden I had this very strong 'energy' sensation pulling from the left side of my head and the image of my 'little girl' swinging in the Sunshine, smiling andvery happy to be a girl! Now, wheneverIhave self-doubts, 1check in with my inner child and I can still See her swinging in the sunshine. This gives me great hope and pleasure." Ms. 0. is now living out of the state of Colorado. I got a note from her last week saying that her child is still ''swinging." "While working our way through Since I took the first EMDR training somenegativemessagesfromm~~ast, in September, 1993, I have been exI suddenly had an image of my inner ploring the outcome of EMDR as comchild, my 'little girl.' As far back as I pared to more traditional therapy, as can remember, the image had always well as how EMDR works in conjuncbeen that of a very sad, scared child tion with more traditionaltechniques. and it wasn't any different a t that The following twocases include one in moment. Although I have never which EMDR was all that was needed thought about it out loud, I have al- a t that time and one in which EMDR ways been ashamed that I am female was (and is) but apart of a longer and because females, according to my fa- more complicated process. ther, aren't really worth a lot. I have always had to try harder to be perfect First is the case of Terri, whom I first so that my father would acknowledge startedseeing in 1989,when she came my existence. I had t be prettier, in severely depressed and suicidal. o smarter, stronger. Even though I have She hadbeen severely sexually abused taken all these 'needs to be' and have as a child and had never been in Over a period of 2-112 years, we used .various therapeutic modalities. This included psychodynamics as we explored her background and linked it with present patterns and feelings. We also did child within work and cognitive therapy as we looked a t healing, self-soothing, and self-esteem. When Terri terminated therapy, she still dealt with major control issues and some depression. She had resolved many of the issues with her stepfather and her mother and was no longer isolating herself from others. She dealt with her husband in a healthier manner and had abest friend for the fwst time. ' In September, 1993, I received a call from her friend who said that Terri was again severely depressed, suicidal, and staying in her room. I called her and she came in almost immediately. Terri was agitated, tearful, and obviously depressed. She stated that she hadstruggled on and off with memories of other abuse and other abusers, but hadused her skills to handle them. However, about three monthsprior to our session, she had a memory which was unbearable. She had flashed on a scene when she was a young adult. She was lying in bed at night when her 18-year-oldbrother creptinto her room and knelt beside her bed. He fondled her and also placed her hand on his penis. Sobbing, she stated that she was the perpetrator. She was the adult and she did not stop him. That day we could get no further. Her selfdisgust and anger toward herself were alarming. She refused any medication. That week1 took the basicEMDR training. When I saw Terri a t our next session I discussed this with her, and she was more than willing tobe my first EMDR �EMDR Network N e w s l e t t e r 1994 I s s u e 2 patient. We thoroughly discussed the procedure and I also gave her an article to read. and "always angry inside." She had lost four babies late in pregnancy and she wanted a baby badly. I t was discovered that she had cervical cancer very soon after she lost her last baby, leading to the thought, "I didn't even have time to deal with the loss of my baby." I began treatment with the suggested 24 sets of eye movements. Terri was trembling and anxious, but the image was very clear. Her negative cognition was, "I didn't stop him. I am the perpetrator," and her SUDS level was 10. She also saw that she was sleeping in a bed with her mother. The memory and the intensity remained much the same for the next three sets, which I lengthened to 36. We went slowly, allowing her to stop, do some deep breathing, andfeelsafe enough tocontinue. She is from an enmeshed family and grew up with an alcoholic father who is a bright, prominent man in the community and who has been extremely critical and controlling of his two daughters (of whom Marnie is the youngest). Although she hardly remembers what her mother was like, she does like her and is close both to her mother and her sister. The three of them bonded together to protect dad from being upset--toplease him in every possible detail. They were constantly worried about what he might sayor what others (especiallyextended family) might say to him. She was often humiliated over her father's behavior. (Her father recently went to treatment and no longer drinks.) On the fifth set, she suddenlystopped, put her headin her hands, and started crying. She had moved through the memory to the place where she saw herself reaching out quietly and stopping him without awakening her mother. She remembered getting him to leave, getting up and going into the nextroom to pickup her young daughter, and making sure the child would stay safe. Marnie has many strengths: (a) her intelligence, (b) her sense ofhumor, (c) her creativity, and (d) her eagerness to work and make changes; all of which helped her deal with her issues. Her goals were: (a) tofmda way to deal with her father's control which by this time was so internalized and pervasive, that it dictated most of her waking hours; (b) to deal with her weight (she is acompulsive overeater); (c) to explore her anger; (d) to deal with her inability to say no; and (e) to deal with her growing fear of people and what they would think of her. There was an immediate and major transition in Terri's feelings and cognition. The SUDS went immediately to "0." Her cognition was, "I did stop him. I'mnot the perpetrator," and the VoC was 7. We tested the memory and all she could see was that she had stopped him. This all happened in one session. When we tested the situation at our next session, she had remained at a SUDSof 0 and a VoC of 7. She has not been depressed or isolated since then. She is reaching out and doing more new behavior--trying to relax and discover what "fun" is all about. Thisis a major breakthrough for Terri! However, since then I have discovered that it is not always that easy. This is demonstrated in the case of Marnie. Marnie is a 30-year-old, married woman, whom I startedseeing in April, 1993. She presented with severe de- pression and anxiety and stated she was on "an emotional roller coastei' I We started working with boundaries and self-talk, with choices, and with exploring her own wants and needs. This was all new to Marnie, but she caught on quickly. We also worked withvisualizationanddesensitization using scenarios in which her father acted up or was critical. At the same time, s h e s t a r t e d working on assertiveness responses. Her father's moods no longer regulated her behavior to the same extent. She was better able to stand up for herself, and her depression had lifted. However, I was quite certain we had only scratched the surface, as evidenced by: (a) her continuing reluctance to be around people, (b) her ongoing anxiety, (c) her despair over both her weight and her inability to carry a child full term, and (d) her continuing hypersensitivity to her father. In September, after my basic EMDR training, I suggested that we start EMDR and she agreed. To get a startingpoint, we took the anxiety she felt, which led to eating, and followed back with visualization until we came to a childhood memory where she felt the same way. The memory was pervasiveandchained throughawholechildhoodof: "I'm never good enough." "I'm bad." She could see her father frowningdownon her. Wefinallyfocusedon a specific memory for the purpose of EMDR. The SUDs was a 10. In the first two series, nothing happened. In the third series, Marnie broke down, sobbing. The SUDs remained the same, but there was also anger for the little girl. We did four more sets and a t that time, the cognition was, "I was just a little girl. I did the best I could." The VoC was a 6 and the SUDs was at a 2. It was time for the session to end. The next week, Marnie said t h a t not much had changed. She then proceeded to identify three different times when she dealt with her father's behavior in an entirely different way and did not become anxious or depressed. As we discussed this, she stated, "It seemed like no big deal. I had forgotten how much that kind of thing used to bother me." There were major changes after that, even to the point where Mamie set up a booth in a craft fair without her mother and sister. Dealing with her father was significantly easier which was particularly important since she worked for him. She stopped obsessing on both his behavior and what he would think. She was able to handle his criticism without feeling devastated, She started setting some boundaries and even started making �EMDR Network Newsletter 1994 I s s u e 2 humorous responses to his comments. However, the weight problem continued and the dysphoria and anxiety returned. We used hypnosis for the weight which would work for 1 to 2 weeks. The positive was the way things were going with her father, which continued to improve; as did her ability to say "no" to other people. We started exploring her despair over not being able to ever have what she wanted in life. She got in touch with the feelings and sat with them. We came to the underlying cognition, "It's nouse. I can't do anything right." "I'm never going to get there." We then took the feeling and the cognition back in time to the little girl. Marnie again started crying as she saw the picture of the little girl in a situation with her father where she felt utterly shamed and "bad." She was 6 and had written him a note asking him to buy her a dictionary. In the note she spelled "dictionary" wrong. Her father thought it was very funny and talked about it to everyone. He kept the note and showed it to friends in front of her. He never did talk to her about it. This was terribly painful, but toward the end of our time her SUDS had gone from a 10 to a 2. The positive cognition was: "I was only 6. I did pretty well just to ask for a dictionary. I would have felt better if he had talkedto me." Anothervainful memory hit her and we took the time to work it through as well. The ending positive cognition was, "I know I'm going to get there," with a VoC of 7. places because of her weight, and (d) she has conquered her fear of her father and is able to set boundaries with him. For the first time, he is making some positive comments to her and she isrecognizing these; however, she is stillnot comfortable with the change. She continues to be distressed over her weight and recognizes anxiety around the issue. Her statement is, "It's not going to happen." As she sat with this, the memories once again chain back to her father. I suggested more family of origin work. She was uncomfortable, in her new independence, coming this close to enmeshment. We startedon child within work aroundlove andnurturing. Thjs again brought sadness and tears. Mamie's therapyisnotover. We would not havegotten thisfar withoutEMDR and we may use it again. However, neither would we have come this far with only EMDR "Getting Better Might Be Risky" The first intervention directly addresses possible secondary gain issues for the child, and should be considered a s a routine component ofpreparation for EMDR. Following a careful assessment of the child and the family, individual child treatment maybe deemed appropriate. After introducing EMDR as a potentially helpful activity, the therapist can express concern regarding possible risks of successful treatment. The child may then acknowledge concern that "getting better" might lead to losing parental attentionandforfamily closeness. Once the child admits to this (sometimes only following specific questioning), the issue can be seriously discussed. Typical outcomes include: contradiction by amazed parents who assert that relationships will actually improve; a discussion of specific ways of tracking possible changes in relationships; and a family commitment to exploring this issue in therapy following individual treatment. I This intervention helps the child to Thenext weekshe cameback showing some real changes. These included making the decision to get pregnant whether she lost weight or not, starting an exercise program (which she has continued since then), and agreeing to a trip to Europe with her husband. (She also had forgotten one of t h e memories.) Some additional changes noted were: (a) much of her problem with procrastination has been conquered, (b) she has stopped obsess- Extensive clinical data suggest that EMDR can be quite rapid and effective with children under certain conditions (Greenwald, in press-a, in press-b). Desirable therapist qualities include familiarity with an adequate repertoire of child-oriented EMDR techniques, as well as the ability to develop rapport and enlist the child's coop eration and perseverance. Child qualities conducive to successful, brief treatment include a relatively limited trauma history, as well as parental support for healing. This paper will describe two simple family interventions which can help to mobi- ingon what everyone willthink ofher, lize parental support for the child's (c) she has stopped avoiding public healing. feel permission, support, and safety in attempting to relinquish symptoms. It also may serve to "hype" EMDR, with the therapist'sparadoxical worry about success leading to increased motivation. The awareness of family dynamics generated by this discussion may aiso help the family to reorganizein supportofthe child'schanges. "What a Good Boy/Girln The secondintervention addresses the child's underlying sense of "badness," and is used when the child's inner resources have been insufficient for healing with EMDR. For example, a child's memory of an angry, punishing, or upset parent may constitute irrefutable evidence of badness, and limiting progress accordingly. The therapist should introduce corrective information from the most authoritative source available. In a family session, the therapist questions the parents, who must repeatedly insist that �EMDR Network Newsletter 1994 I s s u e 2 the child is "a good boylgirl" even if he or she sometimes makes mistakes or is punished. (Some parents may need to be prepared for this.) Specific upsetting past events may be brought up, and parents asked if the child was at fault (they should say "no"). After such a session, children tend to integrate this information easily with EMDR, often leading to major behavioral breakthroughs. This intervention also tends to have multiple effects. Not only does the child acquire a needed healing resource, but the parents may become more able to distinguish their feelings about the child from their feelings about the child's behavior. The parents' inclusion here may alsohelp them to "discover" their child's goodness, and to feel empowered to continue to support their child's healing through praise and positive interaction. Greenwald, R. (in press-b). Applying eye movement desensitization and reprocessing (EMDR) to the treatment of traumatized children: Five case studies. ,4nxietvDisordersPrac&e Journal. Szapocznik, J., Rio, A , Murray, E., Cohen, R., Scopetta, M., RivasVasquez, A , Hervis, O., Posada, V., & Kurtines, W. (1989). Structural family versus psychodynamic child therapy for problematic Hispanic boys. Clinical P s v c h o l o ~D, 1-578. ~ , 57 Precautions Media Coverage Although these interventions are intended to have systemic impact as well as supporting the child's treatment, application is not appropriate with every family. For example, if the family is organized around the child's symptoms as a means of diverting parental conflict, it may be inadvisable to attempt to heal the child prematurely (e.g.,Szapocznik et al., 1989). Similarly,ifthe parents really do blame the child or believe in the child's badness, statements to the contrary will not be credible. Therefore, these interventions should only be attempted when such obstacles are not present, or have been substantially resolved. Of course, the therapist's determination that individual child treatment is appropriate probably means that the family is, indeed, in a position to support it. The general consensus is that cheers and sighsof relief went up from EMDR clinicians all over the country a t the July 29 airingof 2012Q.The episode on EMDR, entitledlWhen AllElseFails," put the concentration where it belongs,ontheclients, and was extremely favorable. Transcriptsandvideotapes of the show are available from ABC News: References Greenwald, R. (in press-a). Usine: EMDR with children: A comDenh. Pacific Grove, CA: EMDR. Tapes -800-913-3434 Transcript -800-825-5746 Give the show, segment name, and air date as listed above. Articles have recently appeared in the LA Times Ma~azine many daily and newspapen aroundthe country. There was also a report on EMDR on National Public Radio, and we have been and Preveninformed that h magazines are planning stories. You might consider sending clippings of the major newspapers to your local media. However, please make sure that no "miracle" claims accompany the coverage. It is important that the discussions are kept to the highest w e professional standards. Research Reports The August 1994annual conferenceof the American Psychological Association had three EMDR presentations. Boudewyns, Hyer, Perlame, Touze, and Kiel(1994)presentedpreliminary findings of research conducted at the Augusta, Georgia VAMedical Center. They found that EMDR with eye movement was superior to EMDR without eye movement. In addition, the full EMDR procedure was significantly better than group therapy (the standard treatment used throughout the VA).which was used as a controlcondition. A panel of EMDR papers chaired by Andrew Leeds included a report ofthe two Hurricane Andrew studies presented by C W Levin, the survey of EMDRclinicians treating over 10,000 clients presented by Howard Lipke, and a case report presented by Laurel Parnell. The audience was twice as big as the room allocated and flowed into the hall. The presentations were very well received, and hopefully others will be submitted (and accepted) . next year as well. Sandra Wilson, Bob Tinker, and Lee Becker presented their 1994 study of 80 trauma victims, and APA held a special press conference to announce it. The results are being disseminated through print media throughout the country. As usual, a critic is being asked to dispute it. The following are being cited as problems, which actually do not exist: 1.The study has limited worth because actualdiagnoses were not made. Fact: The study did not use diagnoses as a selection criteria, but an internal analysis found that more than 50% met the diagnosis of PTSD. One of the strengths of the study is the inclusion of clients evincing a full range of post-trauma responses. This self-selecting population would typically be seen by the average therapist. �EMDR Network N e w s l e t t e r 1994 I s s u e 2 In addition, a statistical analysis of those subjects meeting the criteria for post-traumatic stress disorder (over 50% of the subjects) show no difference compared to the non-PTSD subjects in the magnitude of change and subsequent indicators of treatment efficacy. There were ten standard measures of trauma sequelae used, and all showed significance at the p<.001 level. jects assigned to EMDR. While all subjects in the non-EMDR studies show only modest treatment gains, after 9-to-16 sessions, the Wilson, et al. study shows high magnitude gains with EMDR after only 3 sessions. This represents a rather dramatic difference in treatment efficacy. 2. Results may have been caused by placebo/demandcharacteristics. Fact: A review of over 300 meta-analyses (Lipsey &Wilson, 1993) appearing in the December, American Psvchologist indicated t h a t placebo effects accountedfor .19 standard deviations of change, while the Wilson et al. study indicated .50 to 2.35 standard deviations of change. Obviously this is a much greater effect than that caused by placebo alone. Furthermore, a review article by Solomon, Gurrity, and Muff in the 1992issue of the Journalof the American Medical Association states that PTSD subjects are particularly resistant to placebo effects, indicating that the dysfunction is physiologically mediated. In 1992, a review article of controlled clinical treatment outcome research in the field of post-traumatic stress disorder listed a total of eleven studies (Solomon, Gerrity, &M&, 1992). Five were drug studies and six testedclinical treatmentsfor PTSD. Few ofthese studies wouldstandup to intense scrutiny. For instance, one of the controlled studies compared 48 sessions of desensitization to no treatment. Although flooding is used extensively throughout the VAsystems as a treatment of choice, the four studies testing the methodevaluatedonly a total of 47 flooding subjects. There are still no studies on natural disaster victims, molestationvictims, accidentvictims, or children. An additional argument against the possibility of a placebo (or demand characteristic) effect appears in the Wilson, et al. study which states that 64% of the subjects had already received treatment for the disability which had persisted an average of 13.5 years. The positive treatment effects for this group of subjects indicate that the effectiveness of EMDR wasnot dependent upon the attention of a therapist or his or her demand characteristics. One would assume that paying a therapist weekly for a number of years would have caused a remediation if expectation was a major reason for change. This paucity of clinical research, the small number of subjects used, and the lack of quality as evinced by the few checks on treatment fidelity indicate the absence of scientific foundation for much of the psychotherapy currently used with PTSD. This situation is particularly disturbingbecause millions of people suffer from this disorder. In addition, it is often stated within the VA system that more Vietnamveteranshavecommittedsuicide . since Vietnam than diedin the war. A recent manual on PTSD issued by the VA National Centers quotes a lifelong prevalence of symptomsfor many veterans, and the need for more research on the methods being used. 3.The study does not establish treatment efficacy. Fact: In all of the PTSD research literature, the combinednumberofflooding subjects in all four nonEMDR studies has been 47, while in the Wilson, et al. study, there were an equalnumber of diagnosed PTSD sub- State of Post-traumatic Disorder Research State of EMDR Research At this point,, there are more positive controlled studies on EMDR than any other methodused in the treatment of trauma. Controlled studieshave been done with combat veterans, sexual abuse victims, and natural disaster victims. These seven controlled studies have been presented a t major psychological conferences and have been submitted for publication (see "Efficacy of EMDR" report in enclosed packet). Unfortunately, because of the lag time between journal submission and publication, it will be two years before they appear in print. One study that has received a great deal of media coverage is that of Pitman, Orr, Altman, Longpre, Poire, and Lasko (1993) a t the Manchester VA This study has been erroneously reported as having indicated that placebo effects are responsible for EMDR outcomes. In actuality, Pitman et al. comparedEMDR with eye movements to the same EMDR procedure with the eye movements replaced by requiring subjects to fmate a spot on the wall, and handtap rhythmically, while the researcher waveda finger in front of the subject's eyes. In other words, EMDR was compared to itself, with the obvious characteristics of the eye movements (forced fmation, rhythmical stimulation, visual stimulation) used in both conditions. The interpretation of this study can only be that other methods of stimulation can also cause EMDR effects, a fact already known and used clinically for some time. In addition, the checks of treatment fidelity of this studyprovedtobe very low, with a positive correlation between how well the procedure was performedandthemagnitude oftreatment effects. Another study, by Wilson, Covi, Foster, and Silver (1993) tested an outpatient PTSD population in conditions comparing EMDR with eye movement, handtapping alone, andnomovement. The treatment effects,includingphysiological measures, revealed a one-session desensitization effect for the eye movement group only. A recent 1993 study by Boudewyns et al. (mentioned earlier in this article) done a t the VA in Augusta, Georgia, has also shown a positive treatment effect comparing a condition of EMDR to the group �EMDR Network N e w s l e t t e r 1994 I s s u e 2 therapy traditionally used throughout the VA system. In sum, the state of EMDR research far surpasses that of any other method presently used in the treatment of PTSD. (A list of research is included in the Network packet.) Future of EMDR I have recently completed an EMDR textbook to be used in the universities. It is due out in March, 1995, and will be published by Guilford. As mentioned in the last Newsletter, we would appreciate input regarding future training practices. The EMDR Network, as a separate professional organization, should begin establishing guidelines for independent trainings and eligibility for membership once the book is released. An EPIC task force has been established, and anyone with experience or background in the professional and ethical guidelines used by comparable organizations please consider giving input. Curt Rouanzoin and Joceyln Shiromoto cochaired a meeting that took place at the September Northern California Network meeting. Please drop a note to the oEce indicating interest and you will be contacted. Please look very carefully a t the research articles included with this Newsletter. Once again, it points up the crying need for practical guidelines for publishable research. Twoof the studies were conducted by clinicians untrained in EMDR. Another study was conducted by psychology interns who took only the Level I and whodidnot practiceon clients in order to establish any comfort. They tested the method on chronic combat veterans using only two sessions and global psychometrics. They also received a fidelity check and were informed that they were not using EMDR well enough to resolve the problems. The publication of these ~ t u d i e s ' ~ o i n t s up the lack ofvalidity and reliability that clinicians have come to expect in clinical outcome research. As aprofession, we must start demandmg higher caliber investigations. No one study de- cides the fate of a method, but the principles underlying the selection of publishable research define the scientific bases, or lack of objective standards throughout our profession. of EMDR Treatment for Post-Traumatic Stress Disorder. Paper presented a t the American Psychiatric Association Annual Meeting, Washington, D.C. Additional research ispresentlybeing conducted, which willalmostcertainly make EMDR the most highly researchedmethod in the history of psychotherapy. I t is to be hoped that researchers and academicians will soon catch up to the widespread and consistent observations of clinicians of the effectiveness of EMDR. Quality research will also assist us in further refining the methodology. We need to be vocal regarding the need for high quality and objective standards. Neither science, norclients, are servedby anything less. Solomon, S.D., Gerrity, E. T. ,& Muff, A M. (1992). Efficacy of treatments for post traumatic stress disorder. Journal of the American Medcal 633-638. Association, References Boudewyns, P.A, Hyer, L.A, Perlame, L, Touze, J., & Kiel, A (1994, August) Eve movement desensitization and re~rocessirg. Paper presented a t the annual conference of the American PsychologicalAssociation, Los Angeles, CA. Grainger, R. L., Levin, C., Allen-Byrd, L. & Fulcher, G. (1994,Aug.). Treatment ~ r o l e cto evaluate the efficacv t gf evemwement desensitization and rr r e s f of a recent disaster,Presentedat the 1994annual conferenceof theAmerican Psychological Association, Los Angeles, CA Lipke, H., (1994, Aug.). A survev of EMDR-trained ~ractitionere. Paper presented a t the 1994annual conference of the American Psychological Association, Los Angeles, CA Lipsey, M.W. & Wilson, D.B. (1993, Dec.). The efficacy of psychological, educational, and behavioral treatment: Confirmation from metaanalysis. American Psvcholo~ist, 12, pp. 1181-1209. a, Pitman, R. K., Orr, S. P., Altman, B., Longpre,R. E., Poire, R.E., & Lasko, N. B. (1993, May). m, Wilson, D., Covi, W., Foster, S., & Silver, S.M. (1993,April). Evemovement desensitization and rewocessin^ and ANS correlates in the treatment of PTSD. Paper presented a t the California Psychological Association Annual Convention, San Francisco. Wilson,S. A,Tinker,R. H. andBecker, L.A (1994, Aug.). Eve movement slesensitization and re~rocessing (EMDR)methodin treatment oftraumatic memories. Paper presented at the 1994 annual convention of the American PsychologicalAssociation, Los Angeles, CA I have observed a pattern of mild reluctance or hesitant consent to undergo further EMDR sessions in clients who have had numerous prior sessions which were positive and successful. This hesitancy may stem from association of EMDR with trauma recall. An approach to mitigating the potential for EMDR becoming a stimulus for negative associations is as follows: During introduction of EMDR, and intermittently to begin later sessions, I will ask clients for their associational cues (Yvonne Dolan usage) for comfort, safety, and security; i.e., a �EMDR Network Newsletter 1994 Issue 2 beach in Mexico, home in bed with their pillow and teddy bear, etc. I will then "install"these cues using EMDR. This serves to anchor these positive associations and a linkage of comfort and security with EMDR. 1995 International EMDR Conference June 3-5, 1995 Santa Monica, CA Call for Conference Proposals are being accepted for the 1995 EMDR International Conference. Please submit a CV and topic proposal with a 250 word abstract to the EMDR office. Presentations may be 9 0 minutes or hours. Submitby January 15, 1995. EMDR has generated a tremendous amount of enthusiasm among practitioners and all of usareanxious to read about the latest developments in,and/ or experiences with, this exciting method. Because of this enthusiasm and desire to acquire more knowledge, I believe that it is important to produce a publication that provides a forum for articles that are more formal (e.g., research, protocols, etc.), as well as for those that are less formal (e.g., case studies, innovative ideas, etc.). To this end, the following represent the guidelines for submissions to the Newsletter: Send articles to Lois Allen-Byrd, Ph.D., Editor, EMDR Newslet&z, 55 Middlefield Road, Palo Alto, CA, 94301. Please include home and 5 business telephone numbers,professional akgree, location ofpractice(city and state only),professional affiliation (if applicable-university, ifa lecturer or teacher, and/or institute, i f a nassociate). Exumple: John Smith, Ph.D., John Doe University, Johnson, WA.Zfpossible,please submit articles on a diskette, ZBM format. ARTICLES SHOULD BEDOUBLE SPACED WITH WIDE MARGINS. APA STANDARD AND S'I"YLE-BOTH TEXT AND REFERENCES MUSTBE 1NACCORDANCEWITHAPASTANDARDS.ALL SUBMISSIONS ARE SUBJECT TO EDITORIAL REVISIONS. Call for Conference Research Papers Proofreading of material is suggested beforesubmission.Authors submitting a manuscript do so with the understanding that, if it is selected forpublication, copyright of the article is assigned to the Newsletter. Dwight Goodwin, Ph.D., will coordinate the selection of research presentations for the 1 9 9 5 EMDR Conference. Please send a proposal that includes a CV and a 250 word abstract by January 15, 1995, on any of the following: Because the Newsletter depends onyou, the members of the network,I welcome any suggestions or comments that you may have. If there are any questions regarding the above, I can be reached at (415) 326-6465. 1. Reports of formal controlled research investigations. 2. Case series with objective assessment suggesting protocols for the treatment o f specific disorders. 3. Theoretical papers providing an analysis of recent research. Send to EMDR INSTITUTE P 0 Box 51010 Pacific Grove, CA 93950-6010 When advertising in telephone directories, publications, or other media, list EMDR yourself as TRAINED not EMDR certified. Presently there is no EMDR certification. -EMDR Newsletter Staff Editor: Lois Allen-Byrd,Ph.D. Publisher: Arnold J. Popky, M.A. Data Entry: Sharon Lucas �EMDR Network N e w s l e t t e r 1994 I s s u e 2 FROM THE EDITOR The EMDR Newsletter is in its fourth year of publication and is a wonderful forum to use to impart EMDR-related information. The primary purpose of the Newsletter is to provide EMDR-trained clinicians with the opportunity to share with, and learn from, the experiences of others. I I The following is a brief list of general topics that have generated interest among readers. Innovations: EMDR continues to evolve in order to meet the demands of client needs. ~l~~~~ welcome are suggestions of new and different ways to apply EMDR. Red Flaes: This includes cautions regarding certain clinical populations, suggested safeguards, contraindications, etc. EMDR R e s e a r c m r a i n i n g Institute The EMDR Researchmaining Center a t MRI is looking for individuals who want to take part in two research projects; (1) Victims of natural disasters. (2) Smokingcessation. Any therapists who have clients interested in participating, please call Cliff Levin, p h , ~(415) 326-6465, , Book Reviews: This includes any books that may be relevant to neurophysiology, learning theory, memory theory, PTSD, etc., or any books that you think would be of interest to practitioners of EMDR. SpiritualInsights If you have clients who have reported experiencing spiritual openings or inProtocols: If you have designed a proto- sights during or after EMDR sessions col for a specific population or issue, please and wouldlike to share thesevignettes, let u s know. please write up these cases and send them to: Laurel Parnel, Ph.D. 22 Von International Update: Let us know Ct, F a i r f a , CA 94930. (4125) 454- what is happening with EMDR internationally (e.g., conferences, publications, awards, etc.). Help Wanted: This is a column that can be used to advertise research projects, groups, etc. Tidbits: This column is for brief (one Page or less) comments, ideas, suggestions, etc., about EMDR. . Case Stud This is a description of a case in EMDR was used either as the sole treatment method, or in conjunction with another modality. Theorw Francine Sha iro, Ph.D., has developed a model bassf on information processing and neurOpsychO1Ogical ity. If you have other ideas On why/how EMDR works, please let us know. R e s e a r c h Results from research studies are vital to the continued growth and understanding of EMDR and are welcome contributions to theNews- 2084, This list is by no means exhaustive and other ideas and suggestions are welcome. 3900. Success w i t h s c h i z o p h r e n i c ~ ? Anyonehavingsuccess treatingschizophreniausing EMDR. Please contact: CarolA. Anderson, 4781 E. Gettysburg Rd., Fresno,CA 93726, (209) 445 8522. Addictions, Smoking, Weight Several therapists have contactedme regarding success in the use of my smoking protocol with other addictions. This has confirmed results I notice with many of my clients with histories of abusing heroin, crack, methamphetamine, marijuana and even food. I would appreciate receiving feedback (success and failures) from those using the protocol. Arnold J. Popky, MA, 17461 Pleasant View Ave., Monte Sereno, CA 95030. Donate Time I am a clinical Ph.D. student at the California School of Professional Psychology in Sari Diego. I am in need of recruiting EMDR therapists who are willing to donate 4 to 8 hours of their Babies time to assist in running subjects for myresearchproject. Thesubjectswill I would like to meet or correspond include a n o n - ~ l i n i ~ a l p ~ p ~ l a t i ~ n , ith others .that have used EMDR and w the focus of treatment will be anxiety andlor other body-mind therapies to reduction. Therapists in the area of remove traumatic sequelae in babies San Diego, Orange County, or City of in their first year of life (e.g., birth Claremont can call me, Jonelle Sell- trauma, suctioning, heelsticking [for ers, collect a t (714) 631-5514, or (714) blood tests] circumcision, etc.). I am 227-5606, if they are interested in the also interested in any relevant book study. The research will begin in Sep- titles. Sheryll Thornson, 1641 Hopkin St., Berkeley, CA 94707, (510) 525- Research Project? If you are currently conducting an EMDR research project, please send Controversv EMDRhas ~ n e r a t e d s o f n e information to the EMDRoffice statsince its inception. Bring'lng ing the topic, name of principle init to the attention of Our readers encour- vestigator, and subject base. EMDR ages debates which, in turn, stimulate INSTlTUTE, INC., Pacific Grove, thinking. CA, 95060-6010. . -I F l u e n t i n a 2 n d Language? If any EMDR trained therapists are fluent in a second language, please contact the EMDR office a t (408) 372- 8031. Published? If you are an EMDR trained clinician and have had any books published, pleasecontacttheEMDRofice at (408) 372-3900. �EMDR Network Newsletter 1994 I s s u e 2 CALIFORNIA EMDR STUDY GROUPS Norva Accarmero, LCSW California Network Coardiinator (408) 5544048 CENTURY CITYISANTA MONICA Robert Goldblatt (213) 917-2277 Coordinating a new group 90067, 90401 zip area for West L.A. CERRITOSICENTRAL CITIES Pauline Hume Pat Sonnenburg Coordinating a new group. Open (213) 869-0055 (310) 924-7307 CUPERTINO Gerry Bauer (408) 973-1001 Meets 2nd Wed. 2:00 - 3:00 pm. Case consultation. Open EAST BAY Edith Ankersmit (510) 526-5297 Meets 3rd Fri. 7:30pm. Case discussion only. Group is closed to new members, willing to coordinate a new E. Bay group. EAST BAYIALBANY Sandra Dibble-Hope (510) 843-1396 x48 Meets 1st Mon. 8 - 9:30pm, 1035 San Pablo Ave., Ste. 8. EAST BAYIOAKLAND Hank Ormond (5 lo) 832-2526 Meets one Friday a month. Call for time & day. Open FRESNO Darrell Dunkel (209) 435-7849 Meets 1st Fri. a t Fresno VAMC. Primary case discussions. FULLERTON Curtis Rouanzoin Jocelyne Shiromoto Meets 2nd Tuesday from 9:30 - 11:30 AM. (714) 680-0663 IRVINE Charles Wilkerson (714) 543-8251 Lois Bregman (714) 262-3266 Meets 2nd Thursday of month. Primarily case discussion. Open. Call for directions. LOS ALTOSlPALO ALTO John Marquis (4 15) 965-2422 Meets ad hoc a t Pacific Graduate School of Psychology in Palo Alto. Primarily case discussion. Open LOS GATOSISARATOGAICAMPBELL Jean Bitter-Moore (408) 354-4048) Meets the 3rd Thurs. 12:OO-1:30pm a t Mission Oaks Hospital, Conference Room 1, Los Gatos. Open MANHATTANIREDONDO BEACH (213) 539-3682 MARIN COUNTY - (415) 454-6149 ll:30am. Call for information. MONTEREY Glenn Leonoff ilobbie Dunton Coordinating a new group. Open SACRAMENTO (909) 732-2142 - 1l:OOam. Bea Favre, Psy.D. (9 16) 972-9408 Connie Sears (9 16) 483-6059 Meets third Friday of every month 1:00 - 3:OOpm. At 2740 Fulton Ave., Sacramento, CA 96821 SAN DIEGO Jim Fox, MFCC Meets second Friday of Each Month, 9:30am (6 19) 260-0414 - 1l:OOam. Arthur Horvathl Ph.D. Call about meeting times and places. (6 19) 445-0042 (619) 434-4422 z:zs",?zay of every month from 9:OO - 10:30am Prima- rily case discussion. Call regarding availability. Elizabeth Snyker (6 19) 942-6347 Meets 3rd Wednesday of every month, 9:OOam - 10:30am. 191 Calle Magdelena St., Ste. 230, b c e n i t a s , 92024. SAN FRANCISCO (415) 221-3030 Sylvia Mills Meets Friday, call for next date. Potluck dinner and case dis- cussion. New members welcome. (415) 241-5601 Stan Yantis Meets 1st Wed. 8 - lopm., 180 Beaumont St. Please call to con- firm. Case discussion and group process. Open. SANMATEO/BURLINGAME/REDWOODCITY Pat Grabinsky Florence Radin Coordinating a new group. Contact Florence. (4 15) 692-4658 (415) 593-7175 SANTA CRUZ AREA (408) 475-2849 Linda Neider, ATR, MFC-I Meets every month on a Friday (Call for time) Case discussion. SARATOGAIW. SAN JOSE Dwight Goodwin Meets alternate Fridays, 9:30am - 1l:30am. (408) 241-0198 SOLANO/ NAPA COUNTY Micah Altman (707) 747-8178 Willing to coordinate new group. Call if interested. SONOMA COUNTY Coordinating a new group. 1 Friday per month. loam RIVERSIDWSAN BERNARDINO Byron Perkins Meets 3rd Friday of every month, 9:30am Kay Caldwell Meets in Santa Rosa at Kay's office the 4th Tues. 12:30 - 2:OOpm. Case discussion, videos and "troubleshooting." Open TORRANCE (408) 373-6042 (408) 372-3900 James Pratty Coordinating a new group. Open Marguerite McCorkle (707) 226-5056 Garry A. Flint Meets the last Friday of every month from loam 101 W. Church St. #lo. Open. Judith Jones Call for time. Open (916) 477-2867 Elizabeth White Coordinating a new group. Open (805) 272-8880 uKIAH NAPA NEVADA CITYIGRASS VALLEY PALMDALEILANCASTER PAL0 ALTO Ferol Larsen (415) 326-6896 1st Wednesday lOam in MRI conference room. Case discussion. REDDING - 12noon at WTURA Sheila McHenry Worman, MFCC Second Friday of each month, 3 - 5 pm. meetings are held a t 2443-A Portola Road, please call for more information. WEST LOS ANGELES Geoffry White David Ready Coordinating a new group. Open WOODLAND HILLS/NORTHRIDGEIWESTWOOD (916) 223-2777 Ron Doctor Meets once monthly a t the Frisbee Mansion on East Street. Dis- Ginger Gilson cussions, case presentations, videos, role playing. Seeking new members. Contact Ginger. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter Newsletter Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter, 4(2), 1-14 https://d1y502jg6fpugt.cloudfront.net/13023/archive/files/b898af8369eb1dafda1eb1d258d66d89.pdf?Expires=1790208000&Signature=fe7V5eU839xueu3tmda5XutEjoaxmM4VgEHgHZyMbfy3tye%7EUsohOkq3qP-qClgBIpITLslxJKpyiRi9UuURAoCNlIds7IlNwj%7EEho05mdchyxwF23Y5qfutTJZ6YtDFgenXFuUTz5ZMRlAFtLMXKDjlbpToXAYpki3%7EK5ED3vi98ni-Cc6zXpXsFqjy2rc1sKjE00s0jq0wRqj8x-COpWOBDnVdfTBxq6CqHTeU%7EbFe2tI2lISWonCiZWAwWYOjVX-Lqv78SA9qr7lKfMaCX0FT8jIHpDbNcvhRj37uGbnt6jbjCAlYnPI5hh-PR4mIonWWynJyuL-TGeYzJjoilg__&Key-Pair-Id=K6UGZS9ZTDSZM d06e4d1501eaff938830ee73ca21e203 PDF Text Text EMDR Network N e w s l e t t e r 1994 Issue 3 1994 Issue 3 e ~ e t w o r Newsletter k NETWORK. mc. EYE MOVEMENT DESENSITIZATION AND REPROCESSING Copyright O 1994 EMDR NETWORK, INC. P.O. Box 51 010,Pacilic Grove, CA 93950-6010 (408) 372-3900 FAX (408)647-9881 STRAY THOUGHTS Francine Shapiro, Ph.D. Senior Research Fellow Mental Research Institute Palo Alto, CA AFFECT, IMAGERY, AND MEMORY It has appeared me that plays a pivotal, and perhaps under appreciated, role in the information processing we observe in EMDR therapy. I have found that the ab&ty to achieve positive treatment effects is not based on the ability to retrieve images, but rather on the ability to tap into the network of dysfunctional ma. terial through the affect andconnected sensations. have exploredin earlier Newsletters, in the Acceler- ated Information Processing model, the dysfunctional information is typi- fiedby its storage in state-specificform, along with its inability to link up with more adaptive information character- izedby different affect. In either case, the parallelpositive ornegativecogni- tions are merely constructions which are simply verbal manifestations of the affect. These verbalizations allow thedysfunctionallystored~nformation to be more readily accessed which, in turn, stimulates physical sensations that can be both focal points for the client during processing, and indica- tions of the degree of treatment suc- cess. Many aspects of the controversy over sexual abuse memories have been Table o f Contents Stray Thoughts. ....................................... Francine Shapiro, Ph.D. ................1 Tidbits ....................................................... George Anderheggen, Ph.D. .......... 3 Submission and Deadline Information. ......................... . ...........................3 Assessind Dynamics and Expectations to Insure Positive EMDR Outcome Jim Dayton, MSW, Terry Cassity, MSW .......................................... 4 Ideas for Using EMDR with Dissociative States Audrey Cook, M.Phil. ................................................................................. 5 Recall of Near Death Experience During EMDR David Donaldson, Ph.D. ....................................................................... 6 Intermittant Use of EMDR With a Central American Trauma Survivor George Gafner, CISW .................................... .. ....................................... 7 Using EMDR with Children: Cleaning Up"Afterwards Ricky Greenwald, Psy.D. ............................. ......................................... . 8 Summary Positive Cognitions: A Protocol for Terminating EMDR Interventions.................................William Larsen, MFCC ................. 9 News from the EMDR Research Center. ........................................................ 9 Case Report: Treating a Toddler with EMDR 10 Joan Lovett, MD ........................ . . ......................................................... . Computer Metaphor for EMDR. ............Arnold (AJ) Popky, MA ..................10 I n t e r n a t i o n a l Update. ......................Francine Shapiro, Ph.D. ..........11 EMDR and Shame: a Brief Report. ....... William Zangwill, Ph.D .................13 Containers: The Use of Cognitive Interweave with Cognitions Obtained at Intake. ...................... . Elizabeth West, MA .......................13 ......... . .......................................................... 14 EMDR Help Wanted. ......................... . 15 California EMDR Study Groups................................................................... International and National Regional Network Coordinators................. 16 EMDR and the Internet. ......................... A. J . Popky ..................................... 16 troubling. Arecent court case in Pennsylvania was decided against a psychiatrist. The client came to the c h i cian charging that her parents had molested her and, after evaluating the sequalea, the psychiatrist made a diagnosis of PTSD. The client later recanted the story and the psychiatrist was found negligent for having fai1edtoinvestigatefurtherthe"truth of the charges against the parents. The legal system, therefore, seems to make clinicians responsible for the client's memories and disclosures. We have certainly all heardof cases where clinicians (some under trained in and misinformed about the meth- ods they were using) seemed to have flagrantly contaminated their client's memories. These stories have been horrifying to many clinicians who are quite capable of using hypnosis without leading their clients and who attempt to stay out of the way of their client's disclosure process. Nevertheless, regardless of the competency of the clinician, it is important to remember that clients may have been previously contaminated by faulty therapy, media exposure, a variety of misleading self-help books, or by means of vicarious trauma. It is, of course, necessary that we give unconditional support to our clients in all aspects of the therapeutic process. �EMDR N e t w o r k N e w s l e t t e r 1 9 9 4 Issue However, it is equally clear that clinicians should actively inform their clients of the falhbility of memory and for clinicians to maintain a non-judgmental stance. The court case in Pennsylvania makes the meaning of "non-judgmental"even more problematic. Balancing forensic and clinical realities appears to be one of the challenges of the 1990s. (1) Given the present controversy regarding falseldelayed memory, and all of the unfortunate polarization that has occurred within the psychological community, it has been especially unsettling to hear of some clinicians who tout the ability of EMDR to aid memory recovery. The problem is that while emotional and physical memories may be retrieved, we cannot conclude that the visual images that accompany them are anything more than cognitive constructions. The following quotation may be useful for better conceptualizing the issues: "The distinction between declarative memory a n d emotional memory is an important one. W.J. Jacobs of the University of British Columbia and Lynn Nadel of the University of Arizona have argued that we are unable to remember traumatic events that take place early in life because the hippocampus hasnot yet matured to the point of forming consciously accessible memories. The emotional memory system, which may develop earlier, clearly forms and stores its unconscious memories of these events. And for this reason, the trauma may affect mental and behavioral functions in later life, albeit through processes that remain inaccessible toconsciousness." (LeDoux, 1994, p. 57) if the details of the trauma are specified, a perpetrator "identified," and symptoms cease, then the remission of the pathology is itself proof of the accuracy of the memory. However, I would like to suggest instead that the client's construction may have served a metaphoric function for him or her and, as with traditional guided imagery techniques, the chician's use of the metaphor (whether provided by client or c h i c i a n ) may have led to the symptom remission. Certainly we know that a client can find meaning in metaphors like Milton Erickson's "tomato plants" or that a n agent of change can be imaginally specified through a n "inner helper," "angel child,"or "February Man;" allof which can assist in alleviating symptoms. Thus, it may be that the identification of a supposed abuse scenario taps into the dysfunctional affect, which offers a parallel cognitive construction, and the therapeutic effect emerges a s a function of the clinician's use of the treatment methods. In other words, why should one imagined scenario work less well than any other salient metaphoric construction? What then should we conclude if the client reports images that they believe have emerged from the first months of their Me? I believe that the most responsible stance is that although some traumatic experience may have actually occurred, t h e client's cognitive construction may or may not accurately describe it. Some I t has become increasingly clear to me over the years that imagined scenes may be merely representations of the client's feelings. For instance, one client reported a "memory" of being in diapers while cowering from h e r mother while in the living room. However, on closer examination, the image did not make sense to her because she had not lived in the house that contained that livingroom untilmuch later in life. During processing, she reported seeing herself as much older, and arguing with her mother. The image of herself in diapers appeared connected to her remembered feelings of vulnerability, rather than to an actual event. Likewise, it is reasonable to argue that images of various kinds of physical abuse may be cognitive constructions of incidents of emotional abuse. Or perhaps the image of abuse is accurate. How can we claim to know either way with certainty-and does it really matter if chicians have argued, however, that processing the affect results in the remedation of the symptoms? In other words, I believe that positions which declare that the historical accuracy of delayed reports of abuse is alwavs or never the clinical reality underlying symptoms are equally indefensible. I do not believe that sexual abuse survivors are eagerly reporting w i s h - f u I f h g fantasies. However, the image of a memory fragment should be treated with care by the clinician, and the appropriate cautions communicated toclients because of the realities of memory falhbility. Anyone who promised c h i c i a n s "a rose garden," conveniently neglected to mention the hidden thorns. ' Similarly, what do we do with clients who present us with "memories" of birth trauma? On the one hand, I would be astounded if the birth process did not leave some form of imprint on the nervous system. I believe further (as indicated by the previously quoted article) that i t is quite possible for this physiological response to establish a foundation for a variety of future perceptions. However, I also think that the birth experience is an emotional and physical response that does notbecome associated with words, beliefs, and images until later in life. Now, if a client came for therapy because h e or she was extremely anxious due to a number of achievementrelated issues, how should we treat him or her? The client might reveal a cognition such as"1 can't achieve,""I have to suffer to achieve," or even "I will &e before I can reach my goal." If the clinician helps the client to access the dysfunctional material that appears to be a t the root of the problem, it might be discovered to be comprised of childhood. experiences of failure, disappointment, sickness, hardship, etc. But what if the client remembers t h a t h e o r s h e was born almost strangled by the umbilical cord? Does this mean that this was the actual cause of the negative belief, or did the negative beliefbecome associatedwith the physiologically recorded response a t a later date? Or is the memory of the event merely acognitive construc- tion of the affect? . �EMDR Network N e w s l e t t e r 1994 I s s u e 3 A remission in symptoms as a result of processing does not prove that the event is the cause, or that it even occurred. It may simply mean that the affect and physical sensations have provided access to the network of dysfunctional material which could be imaginally represented in this way, or in any number of other ways. This phenomenon can be further illustrated by many clinicians' reports of clients who have processed targets by revealing imagery consisting almost entirely of different patterns of colors. Some of these clinicians have asked me if it was "alright" to continue EMDR. My answer is that if the information is processing--(i.e., the client is reporting more adaptive emotions, cognitions, and physical sensations, and most importantly, behaviors)-then continue; if it is not, then do something different. The point is that all we and the client have are imaginal representations that correspond to affect, sensations, andbeliefs. We can not know if they are also based in historical reality unless there is independent corroboration in the present. The good news is that we do not need to know the truth of the matter in order to help the client to heal. The bad news is that sometimes we get seduced into concluding that because the client has improved, he or she must have provided an accurate report ofthe traumatic event. The worst news is when we think we or the clients must know the truth if they are to get better. I believe that we would be much better off if during the therapeutic process, we aimed our attention more a t the client's affect and less on his or her imagery. Therefore, my usualclinical response to the client reporting the emergence of horrific images or destructive cognitions is to provide every non-verbal indicator of unconditional support I can muster, a n d to ask t h e question "Where do you feel it in your body?" (1) Treating Abuse Todav is an excellent resource for staying abreast of the legal and c h i c a l issues involved in the false/delayed memory contro- experiences with, this exciting method. Because of this enthusiasm and desire to acquire more knowledge, I believe that it is important to produce apublication that provides a forum for articles that are more formal (e.g.,research, protocols, etc.), as well as for those that are less formal (e.g.,case studies, innovative ideas, To this end, the following represent the guidelines for submissions to the Newsletter: Send articles to Lois Allen-Byrd, Ph.D., Editor, EMDR Newsletter, 555 Middlefield Road, Palo Alto, CAI 94301. Please include home and business telephone numbers, professional degree, location ofpractice (city and stateonly), professional affiliation(ifapplicable-university, i f alecturer or teacher, and/or institute, if an associate). Example: John Smith, Ph.D., John Doe University, Johnson, WA. Ifpossible, please submit articles on a diskette, IBM format. ARTICLES SHOULD BE DOUBLE SPACED WITH WIDE MARGINS. APA STANDARD AND STYLE-BOTH TEXT AND REFERENCES MUST BE IN A C CORDANCE WITH APA STANDARDS. ALL SUBMISSIONS ARE SUBJECT TO EDITORIAL REVISIONS. manuscript do so with the understanding that, i f it is selected for publication, copyright of the article is assigned to the Newsletter. Because the Newsletter depends on you, the members of the network, I welcome any suggestions or comments that you may have. If there are any questions regarding the above, I can be reached at (415) 326-6465. versy. Call 8001847-3964 for more information. Reference LeDoux, J.E. (1994, June) Emotion, memory a n d the brain. Scientific American. 50-57. After my Level I a n d Level I1 trainings, I got so involved with the desensitization component that for a few months, I skipped the reprocessing. What I learned from this serious mistake cannot be underlined too many times! After using EMDR, my clients felt much relief and were much improved, but in 4 to 6 weeks they were a bit down and depressed. Their self-esteem was being diminished by both the inner negative cognition that I had failed to take into consideration, a n d not undertaking the reprocessing with the positive cognition. I was fortunate enough to still be seeing these clients and we were able to reconstruct the target from my notes, do the positive cognition, and with some work, obtain a VoC of 7. I am not disappointed that I made this error as it taught me the importanceof taking enough time to not just get the target a n d its SUDS reduced. Additionally, I also realized the important of obtaining the negative cognition and the positive cognition and dealing with them. I hope my experience can assist �EMDR Network Hewsletter 1994 Issue 3 , you. I have now been using EMDR with great success for 6 months. It is not a cookie cutter and is not a substitute for a full knowledge of the therapeutic process, but it is a very fine tool. I have used it with MPD and Dissociative Disorders and agree with Dr. Shapiro that you know how to work with these populations before trying EMDR with them. EMDR has worked well with sexual disorders as well as with PTSD from both current and old trauma. I am very pleased and am now very comfortable with using it. An acrophobic professional requestedEMDR to enhance hisparticipation in a ropes course offered by his program for substance abusers. The presenting material was his f ~ sropes t experience during which he became paralyzed on a ladder 10 feet above the ground. He was determined to allow himself to fall off and trust his team members to lower him safely. The incongruency between this belief and his internal psychic disturbance was the target of the initial EMDR session. The presenting picture was the exact moment of paralysis. The negative cognition was that he would die, and the desired cognition was that he would complete the ropes course (VoC=2). His emotions were fear and terror, his body sensation was generalized tension, and his SUDSwas a 9. He requested that EMDR be scheduled the day before he participated in his second ropes program. He was specifically interested in testing EMDR as a treatment procedure that would be effective in resolving his own problem and in helping clientele . in his program. Using the videotape, the subject viewed his moment of hesitation and the affect was captured and then tar-. geted. We decided to forego formulating new cognitions and began immehately with eye movements. New memories emerged about his place in his family and he processed a number of fantasies which had enabled him to survive the experiences of his young Life. These fantasies appeared to have helped to establish a coping behavior and a belief that he could change his life by personal determination and professional and academic achievement. These successes and accomplishments were used in a metaphor emphasizing his present level of success and his courage and desire for self-improvement. A final series of eye movements had the subject voluntarily falling off the beam during the ropes course. His anxiety appeared to have resolved and a final body scan was free of tension. The first couple of sets of saccades produced nothing. Then the direction of the eye movements was changed and processing began. The initial picture changed to a childhood experience in which he was with younger children locked in a car outside a tavern frequented by hisparents. The necessity of comforting upset siblings and the implied responsibility was associated with additional childhood memories. The thoughts, emotions, and physical sensations of that experience were desensitized as processing continued. He explained how he used his imagination to help him detach and dissociate from the traumatic situation. At this time, the SUDS level had decreased to a 2 and the VoC increased to a 6. Further eye movements produced no additional change. It was assumed by the subject and the clinician that the reported measurements were ecological representations of the reality of the presenting material. The installation of the positive cognition and a body scan free of tension were effects of the EMDR session that would be verified the following day. 1 I 1 The subject was filmed taking the ropes course the next day and showed marked improvement and decreased physiologic arousal. I t was interesting to observe that his difficulty arose when he looked down and his eyes involuntarily produced a set of rapid eye movements accompanied by a temporary hesitation to continue the course. Instead of completing the course as planned, and walking the 30-footbeam, the subject climbed halfway down the ladder before allowing the group to suspend him with the ropes. The second EMDR session was requested to further decrease the much improved, but residual, affect experienced during the ropes course. When asked to bring up any of the original material of the previous ropes experi- ence, the subject was unable to do so. Several weeks later, thesubjectparticipated in a third ropes course and he discovered a return to the initial state of distress. At that point, the clinician and the subject began to thoroughly review the treatment sessions for possible mistakes using EMDR. The following conclusions were made regarding the experience: ' 1. The initial EMDR session used a magical desired cognition based upon the subject's old childhood fantasies and coping strategies. When this cognition was installed, the subject's &tress decreased, a s it had in the past, but only temporarily. This conclusion also demonstrated that one should not dismiss the reality of the task to be accomplished. How many persons could climb 30 feet in the air while suspended by a rope, and fall off a beam without experiencing marked anxiety and physical sensations even if there were no associations with trauma? This mistake clearly indicates seeing reality and the need for completing a thorough psychosocial assess- ment before proceedmg with EMDR. �EMDR N e t w o r k N e w s l e t t e r 1994 Issue 3 I t demonstrates the precautions in setting negative a n d positive cognitions which Dr. Leeds has addressed in his presentation, "Case Formulation of Positive a n d Negative Cognitions, EMDR Conference, 1994." Rather than jumping from "I'm going to h e " to "I'm going to complete the course." a more realistic positive cognition, i.e., "I'll do the best I can," would have been more appropriate. The session was compromised demand characteristics. by There was a n expectation that a sing1e session would change a whole set of previous experiences. Also, both participants assumed the subject would the ropes the k g day) so that when the subject a lingering sense of discomfort a few days after the second EMDR session, h e dsmissedit without reporting back for additional processing. 3. Using the videotape tap into distressing affect, while helpful in establishing a h k between the first and second session, may also have overthe subject emotionau~. and may have indicated the presence of materialhe was not ready to address a t the time. In summary, when a clinician h a s she mculty with EMDR~ make that he Or she has done a complete psychosocial assessment of the 'lien' the process unfolds~ he or she needs to determine that his or her therapeutic interventions will not reinforce the problem. References Leeds, A. (1994). Case formulation of positive and negative cognitions. EMDR Conference. EMDR Network Newsletter Staff Editor: h i s Men-Byrd, Ph.D. Publisher: Arnold J.popky, M.A. Data Entry: Sharon Lucas I havebeen usingEMDRwith many a number ofwhom had ofmy been assaulted a s a n d have suffered other childhood trauma. While it is very helpful for most clients, I have found that some, who had suffered repeated and early abuse, are overwhelmed with the material t h a t they uncovered using EMDR in its original form. I have tried a couple techniques for alter. of ingEMDR whichhavebeenvery helpful to some clients. Interestingly, many clients can return to the original version once their anxiety levels have been lowered. I use slow passes through negative cognitions and states with these cli. ents-lookingfor ustuck spots)~; either reoccurring blinking, over spots, or places where the eyes return after a series of saccades Thomson, 1993). 1encourage my to hold place their eyes in this ~~~~~y and close their eyes. Almost always their eyes blink rapidly, and I believe the processing continues. The clients report that they are getting sensations. pictures, and cognitions just a s they did with the eye movements, but they are more able to stay with the event. They are much less melyto llchainV events of abuse and become overwhelmed by the horrible movie that is playing before them. Another technique which has been very helpful for clients suffering d s sociative states is exploring the stuck spot one hemisphere a t a time. When it seems that a client is unable to name a feeling, or continually dissociates into either numbness or another state, I have been using a "one-eye-ata-time" tool. First, I find the stuck spot, then ask the client to describe the sensation or emotion with one eye covered, and then with the other eye covered. With dssociated clients, the states a r e quite different, and often contradictory. For example: the stuck spot with the left eye may be angry, while with the other eye it may be helplessness. Clients can notice the differences between eyes, a n d also that they have an "objective" third observation. This has been very helpful for indviduals with disassociated early trauma, a s well as for MPD clients. The dissociated clients report both eyes having the same response after several sets, while the MPD clients almost always continue to report different responses by eye. After the stuck spot for each eye h a s been "opened up," I continue with both eyes open until a lower SUDS level is reached. Finally, I have found a tool that has been very helpful in assisting clients to r e t u r n from dissociated states quickly when EMDR is being slowed by numbing. I ask clients to hold pencils in both hands and simultaneously w r i t e continuous figure eights. I tap one hand to signal to reverse the flow of writing, and then the other. This is a rather silly exercise which produces lots oflaughs, but it does return quickly many clients to integratedfunctioning .Obviously, lots After~erhapsacou~leoft~esesets~ the client is less likely to exhibit the of humor helps the process to be nonstuck spots, and "usual" EMDR is judgmental a n d useful. commenced. I look for stuck spots in References saccades in all directions andin circles by using the technique described by Thomson, Sheryll. (1993, Winter). Thomson (1993) of "opening up" the Eye movement "glitches" and slower stuck spot by pushing a t the edges o f the spot with circular movements. A passes: The importance of observing light stick has been very helpful f01 how the eyes move during EMDR. . this technique. �EMDR half report hellish experiences. Those reporting negative experiences do not remember them longer than 20 minutes, while memoriesof positive experiences may endure a lifetime. He speculates that dissociative mechanisms take over to suupress memories of experiences too horrible to consciously tolerate. Interest in near-death experiences has grown considerably since the publication in 1975 of Life After Life, by Raymond A Moody, Jr., M.D. b Death and Dving (Kubler Ross), pubhshed in 1969, was the first modern attempt to examine patients' reports of being out of their bodies when they were near death. Some reported encountering beings of light, dead relatives, beautiful vistas, and a sense of being unconditionally loved. Written and oral tradition on afterdeath experience goes back to the beginning of human history, including such works as The Tibetan Book of the Dead, The Bible, and speculations by Plato and Socrates. Maurice Rawlings, M.D., a cardiologist, in his book lif3tS 49 books and articles on the subject. He believes we are hearing more about this because of modern medicine's increased capacity to literally drag people back from death's door, giving us a larger pool of people whom have had near-death experiences to report. Explanations of near-death experience range all the way from speculation that it is the production of an anoxic brain to belief that survivors are reporting objectively true experiences of the realities that lie beyond this world. Popular works on neardeath experiences, such as the bestseller, Embraced bv the Lieht, by Betty Eahe, typically report beautiful positive experiences, while The Bible, The Tibetan Book of the Dead, and Medieval literature report that there are also hellish experiences. Rawlings reports that about halfof his patients' spontaneous reports given within minutes of revivification describe positive experiences, while Despite all that has been written on . near-death experiences, nowhere in the literature is it reported that neardeath experiences have been recovered later by a person who does not initially remember or even suspect having had one. It is the purpose of this paper to report such an event as a serendipitous side effect of using EMDR for entirely different therapeutic reasons. The client initially came to me for marriage counseling in 1982 and terminated after her divorce. I had not seen her for about 5 years, when a friend of hers phoned to report that she was in a coma at Denver General Hospital as the result of a bicycle accident. She had been riding on the Cherry Creek bike path in Denver when a jogger's Labrador, off leash, cut in front ofher, causing her topitch over the guardrail and land head-first in the grass 15 feet below. She remained comatose for 5 days. After 3 months of extensive rehabilitation therapy, she was discharged from Denver General Hospital and returned home to live with her teenage son. About one year after the accident, she called to ask if I could help her. She found herself blowing up at the slightest. provocation-a reaction which had not been present before the accident. The client reported that her neurologist attributed it to the brain damage she sustained from the accident. She also complained of having nightmares and not being able to sleep on the 23rd of each month (the date when the accident happened). 1 9 9 4 Issue 3 her to start by picturing herselfridmg on the bike path with her girlfriend just before the accident. After completing the first set of eye movements, she described having seen herself riding along enjoying the day with her friend when the Lab cut in front of her. During the second series, her jaw suddenly dropped and her eyes immobilized. She finally blurted, "Is that possible?" I asked, "Is what possible?" "Well, I pitch over the r a h g headfirst and hit on the grass down below by the creek. People run up to me. I m ' in a fetal position. They roll me on my back, and my friend is by the left side of my head and panicked. A guy is working on me holding my head. He has long hair and is wearing a t-shirt or sweat shirt of dark colors. But I'm above the railing looking down at myself." She went on to describe an IVbeing hooked up, being placed on a stretcher by people in white coats, and being loaded into an ambulance which was down on the path. "I go to the hospital emergency room. Sometimes I'm inside, and sometimes I'm outside the ambulance." She maintained a tone of awe throughout her narration as we alternated sets of EMDR with her narration of what she was seeing. She described seeing her family in the ER with her and being transferred to the ICU where she experienced rejoining her body. The patient said she had never heard of anyone leaving his or her body and feared she must be crazy. She appeared quite relieved when I told her that others hadreportedsimilar experiences. I began by describing and demon- One week later, using EMDR, we reviewed the bicycle accident, the trip to the ER, and seeing her family at the hospital. As the client began reporting the scene, she added details not strating EMDR to her and then asked reported in the frst session. When . �EMDR Network N e w s l e t t e r 1994 Issue 3 she revisited the ER scene, she suddenly stopped talking. "David, everything is glowing with light," she said. She reported having been in a place of inexpressible beauty, then said, "There were six other spirits with me: my two grandmothers, my grandfather, the baby my mother lost a t 7 months pregnancy, mother's father, and dad's brother (all had died previously). We all talked and it was wonderful. They were not in human form, but looked like puffy white clouds on a spring day with the light shining through. Wecommunicatedmentally. They were so loving and caring. It seemed that if I would cross over to their side, I would be in the next dimension. Then this amazing bright light appeared and engulfed me. I experienced the most increhble unconditional love and understanding. I wanted to remain there forever and be engulfed in that pure love." She said she did not want to come back. "After all, my son would be with his dad." She and the person of light then discussed whether she should stay or come back, finally decidmg to come back because her son needed her. We then went through the entire experience two more times, during which her attention shifted to her original agenda, the explosive symptoms. She reported reexperiencing the explosive feelings when thephysical therapist tilted her body as she hadbeen tilted when she waspitching over the rail. She then connected explosive f e e h g s with other situations in which she feared loss of control. She reported a SUDS of 0 to all target issues a t the end of the second session. Later, she reported by phone that the explosiveness was gone and her anger was more normal. She was free of the nightmares and resting comfortably through the night of the 23rd of each month, the anniversary of her bicycle accident. One year later, she came to see me again. Ayear ofvigorous workouts in the gym had restored most of her former ease and grace of movement. "My son is graduating from high school," she said. "I feel like I am totally starting over." She described a quality of contentment in her life she had never before felt, attributing it to the near-death experience she had recovered during EMDR. She had become a volunteer a t a hospice and described helping people and their families through the dying experience. She said she had lost all fear of death and had in fact come to see the deathbed as a sacred place. "I can share the glft of having seen the other side of dying." RossandGonsalves (1993) on the use of EMDR in their seventh session of brief therapy with a G u a t e malan who had facedpersecution and trauma prior to to the U.S. They 'pted for EMDR at that juncin because of a need to reduce the intensity of the 'lien'" symptoms. Following one Session of EMDR, which the client said was "like magic," the 42-year-old man described improved sleep, an overall decrease in PTSD symptoms, and a reframing of past political persecution. The purpose of this report is to rf?countasimilara~~lication ofEMDR within a genera1 ~ s ~ c h o t h e framework. The author will offer impressions and tionsfor working with Central American refugees. Maria Garcia (not her real name), a 35-year-old woman from Guatemala, is a client in the Refugee Clinic operated by the University of Arizona's Department of Family and Community Mehcine. The author is one of three Spanish-speakingmentalhealth practitioners who volunteer for the clinic, which is a regular rotation for medical students and residents. The client's husband disappeared and is presumed dead. She has been in the U.S. for six years, speaks little English, and works as a hotel maid. She and her 10-year-oldson reside in a house shared by three families. Maria had not had any previous mental health treatment when she was referred. She had recently been started on Welbutrin and reported improved sleep, but continued to be bothered by symptoms of avoidance and arousal and had chronic suicidal thoughts. Her general presentation was one of moderately retarded depression. She employed poor eye contact and a barely audible voice. She described herself as a social isolate, with "I don't want to be so shy" as a goal elicited in the first session. Sessions 2 through 4 were spent on shyness-examining, exploring, reframing, and beginning to alter this symptom, which was lgelong (although worse with current P T ~ D and depression). At the same time, the author attemptedhypnosis, which was unsuccessful as the client was unable t o concentrate. Attempts a t attentional absorption via several routes were u n s u c c e s s ~ u ~ ~ B~ the fifth session, the author had received Level I training and EMDR was initiated. ~ ~ target image i ~ (SUDS= 10) was the military's burning a pile of dead children with gasoline after airplanes had bombed a school. Neither a negative belief state~ ment e ~ a~ ~ ~ cognition could be a ~ nor positive elicited. Emotions were anxiety, sadness, and fear, and body sensations cited as headaches and ness in the chest. The client asked to stop after a series of 3 sets of eye movements (SEMI, resulted in no change in the gUDs. �EMDR Network N e w s l e t t e r 1 9 9 4 I s s u e 3 Maria returned to the next session 2 weeks later with a brighter mood, neater dress, and said she felt better. This time she cited, "I'm worthless" as a negative self-statement, and "I can change in my own way" as a positive cognition. Rather than start with the target image, the client was asked to concentrateonemotions and body sensations. A series of 4 SEM decreased the SUDS to a 4, and increased the VoC to a 6. Two subsequent sessions of EMDR over the next month yielded a SUDsof 3 andVoC of 5. TheVoC was installed, EMDR terminated, and "standard therapy was resumed. The client now showed broader affect and her concentration was improved. She responded well to role rehearsal and other aspects of assertive training. Trance was induced by absorbing her attention in the flame of a saint candle while she counted slowly backward from 100. As she counted, the therapist gave ego-enhancing suggestions with therapeutic stories. She learned to apply selfhypnosis to contain negative affect, and she declined further abreactive and reframing work around h e r trauma. Three months later, her SUDs was stdl a 3 and the VoC remained a 5. In using EMDR cross-culturally, Marquis (1993) stresses the importance of adapting the method to Latinos. For those with little education, shesuggests therapistshold their hands apart to suggest SUDs level. Also, she works with clients' positive , as they are more likely to have these images instead of positive cwnitions. Some of these clients believe that EMDR is magic. However, these clients are also likely to view psychotherapy or me&cal treatment in a similar light. Psychoeducational material such as informative booklets on PTSD can be helpful. Also, we can help these clients hasten their adjustment by strongly encouraging and supporting their learning English. References Ross, J., & Gonsalves, C. (1993). Brief treatment of a torture survivor. In R. Wells & V. Giannetti (Eds.), Casebook ofthe brief~svchothera~ies (pp. 27-51). New York: Plenum. the memory which had not previously been identified as &stressing, including the location of the assault and the person of the assailant. Subsequently, only minimal therapeutic preparation for the trial was necessary. Since then, when working withchildren, I have routinely "gone fishing" Marquis, P. (1993). Personal com- for other potentially &stressing aspects of the memory after the SUDs munication. has reportedly been reduced. Every so often, this pays off. Fairly quickly, one can systematically ask a series of Using EMDR With Children: questions that address thevarious elementsofthememory which are likely "Cleaning~~'!,~ft;er$ardi: to be &stressing. For example, fol&ky *..l'r'urnansburg, $2 *.,I b@,g$*"+ lowing EMDR work with the memory lVewXork%;f " " , 8% of an auto accident, I might say the following: < " * ~~i~~;u"G~g~%Tiiye I *d". 9, I . Since describing an evolving approach to using EMDR with children (Greenwald, 1993), I have become aware of a subtle problem in confirming that a child has completed the processing of a memory. This may occur whether the full adult protocol is used, or a more abbreviated imagery-focused adaptation is chosen. When you have been using EMDR with a child and he or she announces that the SUDs is "0," he or she is probably telling the truth--but use caution. With children, the usual means of gauging completion of the SUDs, the body scan, and, to a lesser extent the VoC, may be insufficient. Some children may compartmentalize aspects oftheir disturbingmemory, and be unaware that portions remain unprocessed. Furthermore, even after using EMDRsuccessfully on much of the memory, the child may still prefer to "forget about" other parts of it, and fail tomention that those parts are still hsturbing. I discovered the above by accident. After working through a memory ol an assault by a stranger, I asked a young adolescent if he was looking forward to testifying against the assailant. He blanched. It was necessary to process additional aspects of "I am going to ask you about M e r ent parts of the memory, to see if any parts of it stdlbother you. What about when you got into the car that day, think about that. Does that feel bad? What about watching your mother drive? What about when the other car hit yours? What about all that noise? The broken glass . . . going to the hospital . . . having your baseball jacket get thrown out a t the hospital. . . sleeping over a t the hospital . . . when you were alone there . . . the needles . . . what anyone said to you after. . . wondering ifit was your fault . . . What about when you get into a car now?" Using EMDR with children can be very fast-paced and confusing, and there is a risk of sloppiness. This extra "clean-up" effort a t the end can help to ensure that the job is really complete. References Greenwald, R. (1993). Using EMDR with children. Available from EMDR, P.O. Box 51010, Paclfic Grove, CA 93950-6010, with formal training. �EMDR Network N e w s l e t t e r 1994 Issue 3 client and I review in a global fashion the progress of the EMDR intervention. In my practice, EMDR is mainly utilized as a close-ended intervention of a set number of sessions. In working with so structured a n application, I have developed a specific termination protocol t h a t has proven extremely valuable in maximizing therapeutic gains. In essence, this involves a sessionby-session review of the recent intervention for the purpose of formulating a "Summary Positive Cognition" (PC). As Shapiro h a s noted in trainings, the positive cognitions that emerge in a series of EMDR sessions have a n evolutionary quality that moves ever toward a purely self-affirmative and functionally adaptive belief. As the definitive marker of the client's progress, a "Summary P C (as described below) can be seen as not only a synthesis of the previous cognitions, but as a literally new ego state arising out of both the newly completed work and the termination process itself. Also, it often reveals incipient therapeutic tasks emerging into the client's foreground. 2. I read the client's PCs in chronological order, and the client copies them in his or her journal. In this process, attention is paid to a brief reminiscence of each session focusing on the central features of that work, the evolutionary trend of the positive cognitions, and the client's present level of acceptance of each cognition. 3. The PCs are installed, in chronologicalorder, andany "glitch points" that interfere with the installation are desensitized in the same way as in the peak performance protocol. 4. At the end of this process, the client is asked to sit with her or his experience and allow a "summary positive cognition" to emerge. This is explained as a cognition that encompasses the ideal aspects of all the cognitions and summarizes the new experiential frame of the client following the series of EMDR sessions (there can be a completely new wording or a variance of an earlier cognition). I n the final session, which has been set aside for the termination protocol, the client reports as usual on journal work and what h a s emerged since the previous meeting. If something momentous h a s occurred, it is dealt with and desensitized. (On rare occasions, the new material is significant enough to warrant a full session and a delay in the termination date.) The termination protocol begins with a general overview of the client's original goals and focuses on salient issues and core themes. The following steps are then followed: What emerges as a Summary Cognition a t this point is often a formulation that is both more internal and purely positive than previous cognitions, and also announces the more refined therapeutic tasks lying ahead. "I can take care of myself' might become, "I can trust my ability to notice a n d honor my inner needs," or "I can safely feel and satisfy my longing for intimacy." That is, as with Maslow's (1970) hierarchy of needs, therapeutic growth results in issues of defense a n d survival giving way to the fulfillment of longing and creativity. Often, this new cognition is not accepted a t a level 7 VoC, with the typical reason being "I still need to practice this." I then have theclient frame a P C around his or h e r willingness and ability to do so a n d install that cognition. 1. Starting with the original therapeutic issue and target image, the The last step involves having the client imagine a situation in which she or h e is functioning a t an optimal level (whatever that may be), and complete the imagery with attention b e c t e d to the sensations of doing so. I then install this gestalt, and ask the client to sit with the experience as long a s it is pleasurable. I n s u m m a r y , formalizing t h e completion of an EMDR intervention has effectively served to augment the shift to self-afFvmative beliefs, delineate the client's present level of adaptive functionality, and identify emergent therapeutic tasks made possible by the EMDR work. EMDR is by nature an interactive process, and I gratefully acknowledge the collaborative assistance of two exceptionally sophisticated clients in the development of this protocol. There is clearly much work to be done in the area of termination procedure, and I invite comments and suggestions as to how this protocol can be modified for greater efficacy. References Maslow, A. H. (1970). Motivation and ~ersonalitv.New York: Harper & Row. The EMDR Research Center a t the MRI, Palo Alto, California, has now been in operation for over one year. At present, our senior staff is comprised of CLifford Levin, Ph.D., (director), Lois Men-Byrd, Ph.D., (assistant director), Eirin Gould, M.A., (outside consultant), and Francine Shapiro (consultant); the interns are A. J. Popky, M.A., and Amy Filiatrault. In recent months, we have been conducting single-case, repeated-measures EMDR research with survivors of natur a l disasters and other traumatic events. We are offering up to ten �EMDR Network N e w s l e t t e r 1994 Issue 3 sessions of free therapy in return for the subject's willingness to complete our rather lengthy questionnaires up to ten times (three times prior to treatment, three times during treatment, and four times post-treatment) during his or her participation in the research project. If you would like to refer a survivor of a traumatic event to this project, please feel free to give our number as Listed above. A J.Popky has developedan EMDR cessation protocol for smoking and other addictions. He and other EMDR therapists nationwide report excellent results to date, the EMDR Research Center will begin accepting referrals immediately. The treatment will last five to ten sessions and will cost $50 per session (an adjusted fee ispossible in case of financial need). A l subjects l will have to be willing to provide longterm follow-up data on the success or failure of the method. Furthermore, all prospective subjects will be screened for severe mental illness andl or severe dissociative disorder. It is the Center's belief that it would be unsafe to practice EMDR with these populations unless they were being seen within the context of long-term treatment. We a t the EMDR Research Center are constantly striving to further our understanding of the effective practiceofEMDRwith avariety oftrauma survivors. If you are interested in our work, please give me a call, a t (415) 326-6465, and schedule a visit to the center. I guarantee it will be an experience to remember. driven by the child's uncle. All of the doors of the car were temporarily jammed, and the family panicked when they could not get out. The uncle sustained some physical injuries, but did not require hospitalization. The toddler was examiried by his pediatrician and did not have any signs of a physical injury. However, for the month following the accident, the toddler awakened crying several times nightly. During the day he was irritable, cried easily, and was frequently angry. "good boy!" After this single session, lasting 45 minutes, the toddler reestablished his normal sleep pattern and resumedhis usual disposition. His pediatrician reports that h e is well six months after treatment. This toddlerhad lived with his aunt, uncle, and two cousins since he was one year old, when his parents left him in their care. His caretakers described him as a good-natured boy until the automobile accident. He knew only two words in English"good boyn-and spoke single words in Chinese. Clients andparticipants have asked for a simple explanation ofhow EMDR works. Since my previous life was in high technology electronics and computers, I devised the following metaphor for my own understanding of the process. With the growing popularity of personal computers, more people have become computer Literate and seem to understand this metaphor. I asked the boy's aunt and uncle to use toy cars to demonstrate how the accident occurred and I wrote down the sequence of events. I decided to use alternativemovements on the toddler to desensitize the car accident, Information isstored and processed and to reprocess the traumatic event in the brain in a similar way to inforby using "good boy" as the positive 1 mation in computer memory. Inforcognition. I explained EMDR to the mation comes intocomputers through boy's aunt and uncle by telling them input devices such as the keyboard, a that if their nephew could see, hear, modem, or a mouse. It then moves and feel the retelling of the accident into a type of memory called Random while being tappedon alternating sides Access Memory (RAM) and is acted on of his body, then he would feel better. or processed by the computer's central I taught the toddler to slap my hands processor or brain. The information is alternately as I repeated "good boy" processed freely in RAM, constantly ("good boy" is a fine "safe place" for a changing, andis usually combinedwith toddler-he smiled throughout). Next, additional information brought in from he sat on his aunt's lap while his uncle storage devices such as floppy or hard dramatically told the details of the disks: The information also be accident in Chinese. This is the se- sent out to the screen, printer, other quence his aunt and uncle and1 estab- output devices, or stored on disk. The lished in English and they recounted information flows freely from input in Chinese: 1) "good boy" (he happily andis processed in and through RAM. demonstrated alternate hand slapping), 2) "car ride" (he grabbed two toy There is another type of computer cars and I used a third car to tap his memory called Programmable Read knees alternately for the rest of the Only Memory (PROM). When inforsession, 3) "big boom!" (he became mation i introduced into PROM, an s anxious), 4) "scared," 5) "crying," 6) electricalcharge is appliedat the same "everything is okay," 7) "don't worry," This electrical charge causes 8) "we're all fine," 9) "go home," 10) the information to be locked in I can A 20-month-old Chinese boy was referred to me by his pediatrician because of symptoms which began immediately after an automobile accident. The accident occurred when a car spun out of control on the freeway and smashed into the side of a car m. �EMDR Network N e w s l e t t e r 1994 Issue 3 memory. It can be moved around, but cannot be easily processedor changed. Whenever that memory location is addressed or stimulated, the locked information will always appear a t the output. In order to change or reprogram PROM, new information must be held a t the input and an electrical charge introduced simultaneously. The brain shares some similarities with how information is processedand stored in computers. The brain receives information into memory (pictures, sensations, odors, and tastes) through our own input devices (eyes, ears, nose, mouth, nerve endings, etc.). The brain processes this information, sometimes combining or comparing it with previously stored information. The results can then be stored in memory or outputted through actions or speech. In normal times, information is taken in, processed, and allowed to process freely from input to memory through to output in a completely "normal" manner without beingcorrupted anddysfunctional. However, when trauma occurs, an electricalenergy locks the information associated with the event (pictures, words, smells, etc.), along with any dysfunctional beliefs in its own biochemical envelope in memory (PROM). Whenever that location in memory is stimulated (by the picture, sounds, smells, etc.), thelockedinformation (negative cognition) is accessed and the resultant output is the negative affect. For example, suppose that a young girl is raped by a fat, bald man with a red cap and a mustache. The rape experience may then be locked into memory (PROM) by the shock of the trauma, accompanied by pictures, sounds, smells, and other associated senses. The rape could then be reexperienced whenever she sees a man, a fat man, a bald man, a man with a mustache, or a man with a red hat, or any combination of the above. With EMDR, we ask the client to access the event by bringing up the pictures, negative words, feelings, and body sensations and simultaneously moving his or her eyes rapidly back and forth. These rapid eye movements cause neuronal bursts (electrical energy), allowing the negatively charged experience (negative cognition) held in memory (PROM) to be processed and replaced with a positive representation (positive cognition), thus moving from dysfunctional to functional. The most exciting news of the year is that Geoffry White of Los Angeles has been successful in his year-long quest and has managed tofmd a home for two EMDR trainings in the Balkans. Geoffry was relentless, perservering through countless interviews, false leads, and massive bureaucracy. The world would be much improved if there were more people like him. The plan is to send EMDR trainers Steven Silver, Ph.D., andGerald Puk, Ph.D., to Zagreb in Croatia early in 1995. Both Drs. Silver and Puk are donating their time and the EMDR Institute is underwriting the other costs of travel and training. We are all thrilled to be able to do something to help alleviate the terrible suffering in that part of the world. We are also hoping to provide similar trainings in other trouble spots around the globe. We are presently trying to arrange suitable locations in Russia, the MidEast, and Africa. If any of you have contacts in these areas and can assist in our outreach, please let us know. Roger Solomon, Ph.D., just finished conducting an EMDR training in Kuwait, and it is clear that there is a vital need to help not only the POWs, but those suffering from vicarious traumatization-which includes members of the helping professions. In 1994, EMDR trainings were given for the first time in France, England, Norway, the Netherlands, and China. We flew facilitators and trainers over from the United States and it was wonderful to see the camaraderie that developed through the shared desire to help alleviate clients' suffering. Except for having to be careful about certain words having slangconnotations, or metaphors that are meaningless outside the US, like "stop on a dime," the clinical issues are much the same as here, and the cross-cultural application of EMDR is apparent. It's not always comforting, however, to hscover all the world-wide common denominators. For instance, when I was explaining the "memory unfoldingphenomena" that we see in EMDR, where a victim of a boating accident may start by seeing himself go down for the third time and then, as EMDR, is initiated, the memory completes itself until he is safe on the shore, I generally caution clinicians that the aftermath of a trauma can be just as devastating as the trauma itself. For instance, "The victim of a rape may feel just as violated by the experience at the hospital or police station." I t was saddening to see the chicians in trainings throughout Europe nodwith recognition just as they do in the U.S. From all reports, the EMDR presentations a t a number of major conferences in 1994 were well received and often attendance was standing room only. Presentations presently scheduledfor 1995 include: American Psychiatric Association, American Psychological Association winter meeting (New Orleans), Family Therapy Networker, American Association of Psychotherapists, In ternational Stress conferences (Amsterdam and Paris), Anxiety Disorder Association of America, and Japan Association of Brief Psychotherapy. I would appreciate it ifpresenters sent in a list of accepted presentations to professional organizations so that we can publish a complete compilation. This will allow network members to alert their colleagues of opportunities to attendto gain usefulinformation about EMDR and decide if they want to pur- �EMDR Network N e w s l e t t e r 1994 I s s u e 3 sue further education about it. There continues to be a great need for presentations a t all levels of the professional community, from local chapter meetings and state conventions through national and international conferences. In order to assist any of you who are interested in sharing your case material and experiences in these forums, presentation packets (which include descriptions of the current state of research and publications) are available from the EMDR Institute office. More submissions to organizations such as AABT, S E P I , a s well a s t o cognitive, psychodynamic, family therapy, and t r a u m a conferences, a r e vitally needed. In adhtion, presentations to lay organizations are becoming necessary to address the proliferation of "EyeMwement Therapy" courses that have been springing up. A number of c h i c i a n s have been misled into taking these courses, which merely show people how to move their fingers. A number of lay people are also hanging MovementTheraout shingles asUEye pists." Prospective clients need to be informed that EMDR is a great deal more than just eye movement, and that it should be performed by a licensed, trained clinician. This can be done through presentations to various local clubs and charitable organizations. The potential for haphazard trainings will become even greater once the book is published, but a s I mentioned in the last Newsletter, a n EPIC task force is presently reviewing guidelines for professional standards in teaching EMDR. Once again, input is welcome from anyone with expertise in the area of the dissemination of specialty area education. There have been a number of requests for information regarding the publication date of the EMDR text and the possibility of including an EMDR course in college curricula. Gullford expects the book to be available in mid-April. We are planning on a m a h g to get the book to all past participants a t reduced price, and a s quickly as possible. The book is quite hefty, explores all the aspects of EMDR, from client selection through implementation a n d integration within a comprehensive treatment plan, and was planned as a companion to supervised practica. I intended it to be used a s a text for a full semester course, and a s a detailed handbook for the EMDR-trained clinician. In addition, I will be giving a spacelimited, three-hour workshop a t the EMDR International Conference in June for those with university affdiations who are planning to teach an EMDR course, and are interested in including information, metaphors, and examples that parallel the EMDR Institute's formal training. One of my aims over the past five years has been to create a common vocabulary and frame of reference for EMDR practitioners. Everyone who attended the EMDRInstitute training can communicate their own innovations, insights, or counter-examples aided by the shared knowledge of particular cases, and procedures. For instance, the example I gave earlier in this column regarding "memory unfolding" has been illustrated by same examples in all of the workshops. I would like to assist others who feel it is worthwhile to offer the opportunity for maintaining the continuity. The three-hour course will also explicate in greater detail my reasons for each of the aspects of the model and method. Because space is limited, please send in a request on university letterhead, stating your affiliation and the nature of the proposed course in EMDR, along with your conference registration. The meeting wdl also give us an opportunity to brainstorm ways in which we can further assist the educationalprocess. There is a good chance that the book will be published before you receive another Newsletter. I had expected to finish sooner, but was prevented from doing so by ill health. Its publication in April will mark five years since I introduced EMDR train- ing in the U.S. and will initiate a number of changes in the way EMDR information is disseminated worldwide. Therefore, I've decided to address briefly, and hopefully for the last time, some of the more t r o u b h g issues that have arisen. I hope its publication will stop many of the attacks and accusations, but that is certainly not why I wrote it. Rather, the book was written to assist c h i c i a n s that have already been trained in EMDR, and prepare the way for the widespread training of clinicians throughout the university system and by responsible members ofour profession who are qualified to teach. My reasons for being undeterred by attacks over the past years is that I could not find any that appeared to be in the interest of clients, or of science. For instance, the accusation that the training agreements have stifled research is untenable because morecontrolled research has been done on EMDR than on all of the other methods used in trauma combined. Further, we have always publicly encouraged research and even trained most investigators for free. The accusation that the training agreements created a n inappropriate "closed system has been astonishing and disappointing to me. I had thought it was obviously the course necessary to prevent misuse of the work (and, in any case, a course I was obliged to take under APAcode 1.16).Theagreements were indeed implemented to keep EMDR "closed - to lay practitioners and therapists and researchers who have been instructed incorrectly by learning it "second, third, or even fourth hand." This measure was considered especially important until standards of care within the professional community had been established. The goal to keep EMDR out of the hands of non-professionals was accomplished because it was only after the recent (unsolicited) massive media exposure that lay practitioners have actually become a problem. The attempt to safeguard the quality of . �EMDR Network N e w s l e t t e r 1994 Issue 3 research has borne mixed fruit in that, contrary to APAcodes which call for researchers to be "trained and supervised" in the method tested, much of EMDR research has been conducted by people using the early, and now out of date, 1989 articles. The good news is that the published literature can be divided between those whohave been trained and those who have not been trained. The bad news is that the existence of the latter group points to the need for the professional community to do some real soul-searching regarding the lack of adherence to its own ethics codes in both research and clinical practice. I believe that the same lack of quality control has led to the managed care and "false memory" debacles which have resulted in outside influences trying to take over that function. Finally, in regards to the claim that my motives have been entrepreneurial, I can understand the tendency for people to count the heads of participants and multiply by the workshop fee. However, I came into the field of psychology after a bout with cancer in 1979 and I do not know anyone who walks away from that hsease believing that the purpose of life is to make money. On a practical level, the actual motivation (and attendant expenses) should be obvious if you try to recall any other trainings you have attended that provide such a high ratio of facihtators to participants. I can only ask the attackers to examine their own motives. In the past five years I have had the opportunity to meet clinicians of courage and vision--people with loving hearts who have reveled in the changes they saw in their clients and who have enthusiastically done their best to make EMDR as widely available as possible. Unfortunately, I have also met clinicians who have wanted to keep EMDR a well-kept secret so they could be the only ones in their area who provided, and therefore profited from it. The bottom h e is that in every group there will be variabhty, a mixture of "light" and my eyes as well while I did the finger snapping. She asked me to do this because, "If your eyes are closed, I won't have to worry if anything really ugly comes out. You won't be able to see it." Because I have a very good relationship with this patient, and because there was absolutely no evidence of a dissociative disorder, I acceded to her request. (Subsequently, she has been able to process material both with her eyes closed and open.) "shadow". As EMDR moves into the 1 next stage of development, there will be many independent trainings, organizations, and schools of thought. I have done what my conscience dictated in trying to hsseminate EMDR responsibly and ethically. I can only hope that heart, conscience, and ethics will hold greater sway than politics and ego in the continued development of EMDR in the years to come. ~ " I do not know what your destiny will be, but one thing I know: The only ones among you who will be really happy are those who have sought and found how t o serven-Albert Schweitzer One of the most difficult issues in an EMDR session is when a patient is not able to "let go" and experience the process. There are a variety of reasons for this happening, one of which involves the shame patients sometimes feel in both reexperiencing the memories and of sharing them with us. Despite assurances that they do not have to share content, some patients have still reported difficulty in lettingpastmaterialarise tobe reprocessed because of fear of embarrassment and humiliation. When this occurred in two recent cases, I found the finger snapping procedure to be quite helpful. Thinking that if they had their eyes closed they might feel less vulnerable to shame, being judged, etc., I asked the patients if it would be easier for them if they closed their eyes while I moved my hand rapidly back and forth on either side of their head and snapped my fingers. Both said that it would be and proceeded to reprocess the mate. rial much more effectively. In fact, in one case, the patient asked me to closc In both cases, the patients reported that closing their eyes reduced the shame and fear of humiliation that they had felt when their eyes were open. They reported feeling less on the spot and less concerned with how I might react. Has anyone else had similar results? I Collecting information properly at intake is one of the most important steps we can make in preparing to use EMDR with our ~ a t i e n t s A thorough . psychosocial history and interview help to highlight many possible targets and events by which an effective course of treatment may be created. During this preliminary phase, we are also looking for the patient's selfdescribed strengths, weaknesses, goals, expectations, motivations, support systems, and limitations. It is possible, given the aforementioned areas of interest, that abreactive material may arise before the completion of intake. If this happens, what steps may be taken? In a recent intake session, a new patient introduced a series of negative cognitions regarding some current and past events. I noted these self-statements for use in a future �EMDR Network N e w s l e t t e r 1994 I s s u e 3 EMDR session. Between appointments, the patient escalated into an agitated state and began to use some self-prescribed relaxation techniques andavailable support systems to manage the flood of material. After receiving a crisis call, I attempted to introduce a positive cognition that directly opposed a negative in take cognition. I encouraged the patient to focus on the positive cognition until our next session. Afterusingcognitive interweave, the patient was better able to develop a positive cognition of her own and gradually contained the agitation until the next session. EMDR m L P WANTED "Help WmtedWis esigned toussistyou in a uariety of ways. Ifyou a r e d looking for a position, have positwm available, have an interest in research collaboration, w a n t infornatwnof specific populations o r p r o b l e m , etc., s u b m i t them to the Newsletter and includey o u r name, address, telephone, and fa numbers. EMDR ResearchfI'rainingInstitute The EMDR ResearchA'raining Center a t MRI is looking for individuals whowant totakepartin tworesearch projects; (1) Victims of natural disasters and (2) Smoking cessation. Any therapistswhohaveclientsinterested in participating, pleasecallCliffLevin, Ph.D. (415)326-6465. Research Subjects Needed Research subjects needed for PTSD outcome study, using EMDR and another proven treatment for PTSD. Potential subjects must be Kaiser Permanente Health Plan members able to receive treatment in the South Bay Area. They must meet DSM-IIIRcriteria for PTSD, be stable on mediIn this case, the positive cognition cation, not suicidal, have no litigation and cognitive interweave created a pending, no drug or alcohol abuse or temporary container for the patient's dependence, no Multiple Personality distress until it was safe to proceed Disorder or Dissociative Disorder, no with EMDR in a later session. The Babies patient also noted that it was particu- Anyone using EMDR andlor other psychosis, and must have had symplarly helpful to bring up the positive body-mind therapies to remove trau- tomsfor greater than one month. Since cognition just before sleep because it matic sequelae in babies in their first this is a randomized study, subjects reinforced her future hopes and ambi- year of life (e.g., birth trauma, may not be assigned to the EMDR tions. It may be speculated that the suctioning, heelsticking [for blood condition and therefore, it is impornatural eye movements during her tests] circumcision, etc.). Contact: tant that they are not referred with sleep state further actualized the posi- Sheryll Thornson, 1641 Hopkin St., the intention of receiving EMDR. tive cognition. Berkeley, CA 94707,(510)525-8031. Benefits to participation are that the individuals will receive careful evaluNegative and positive cognitions ation, treatment implementation and can "book-end" goals within a treatSuccess with Schizophrenics? follow-up, and will add to our knowlment map. Developing and using a Anyone havingsuccess treatingschizo- edge of treatment for PTSD. Once positive cognition a s a container gives phrenia using EMDR. Please contact: again, it is important to remember the client a sense ofcontrol over his or CarolA. Anderson, 4781E. Gettysburg that we cannot accept subjects into her therapy while converging respon- Rd., Fresno, CA 93726,(209)4458522 the study who expect EMDR because sibility with that of the therapist. Even they may be randomized to an alterwhen a patient has difficulty graspnative therapy. AU patient referrals ing the positive cognition, the theramust be willing to receive either treatRETIEMDR pist can use a cognitive interweave to Practitionersinterestedorexperienced ment. For questions and referrals, educate the patient until actual de- in RETEMDR Please contact: please call: Linda Kolsta& a t (408) sensitization and installation are pos- Dennis Coates, 216 Avenue P South, 236-6763. sible. Saskatoon, Saskatchewan S7M 2 W 2 (306)665-2788 (306)242-6847 or Spiritual Insights Fluent in a 2nd Language? If you have clients who have reported Any EMDR trained therapists fluent Public Education experiencing spiritual openings or inin a second language, please contact and Awareness Committee sights during or after EMDR sessions the EMDR office a t (408)372-3900. We are developing genericletters, bro- andwouldlike to share thesevignettes, chures, &packetsfor use by all EMDR please write up these cases and send clinicians tosend tolocalmedia (news- them to: Laurel Parnel, Ph.D. papers, radio and TV stations. If you 22 Von Ct, Fairfax, CA 94930. Published? If you are an EMDR trained clinician have developed this type of media and (415) 454-2084 and have had any books published, would care to share, please send please send, title, publication date, samples to: Donna Raposa, P O Box 724, Aptos, CA 95001. etc. to the EMDR office. �EMDR Network N e w s l e t t e r 1994 I s s u e 3 CALIFORNIA EMDR STUDY GROUPS Norva Accornero, LCSW California Network Coordinator (408) 3544048 CENTURY CITYISANTA MONICA Robert Goldblatt (213) 917-2277 Coordinating a new group 90067, 90401 zip area for West L.A. CERRITOSICENTRAL CITIES Pauline Hume (213) 869-0055 (3 10) 924-7307 Pat Sonnenburg Coordinating a new group. Open CUPERTINO Gerry Bauer (408) 973-1001 Meets 2nd Wed. 2:00 - 3:00 pm. Case consultation. Open EAST BAY Edith Ankersmit (510) 526-5297 Meets 3rd Fri. 7:30pm. Case discussion only. Group is closed to new members, willing to coordinate a new E. Bay group. EAST BAYIALBANY Sandra Dibble-Hope (510) 843-1396 x48 Meets 1st Mon. 8 - 9:30pm, 1035 San Pablo Ave., Ste. 8. EAST BAYIOAKLAND Hank Ormond (510) 832-2525 Meets one Friday a month. Call for time & day. Open FRESNO Darrell Dunkel (209) 435-7849 Meets 1st Fri, a t Fresno VAMC. Primary case discussions. REDDING Dave Wilson (916) 223-2777 Meets monthly a t the Frisbee Mansion on East Street Discussions, case presentations, videos, role playing, troubleshooting. RIVERSIDEISAN BERNARDINO Byron Perkins (909) 732-2142 Meets 3rd Friday of every month, 9:30am - 11:OOam. SACRAMENTO Bea Favre, Psy.D. (916) 972-9408 Connie Sears (9 16) 483-6059 Meets third Friday of every month 1:00 - 3:OOpm. At 2740 Fulton Ave., Sacramento, CA 95821 SAN DIEGO Jim Fox, MFCC (619) 260-0414 Meets second Friday of Each Month, 9:30am - 11.00am Nancy Stark, MFCC (209) 292-1700 James Shepard, MFCC Meets every other Friday Call for information. FULLERTON Curtis Rouanzoin (7 14) 680-0663 Jocelyne Shiromoto (714) 965-1550 Meets 2nd Tuesday from 9:30 - 11:30 AM. HUNTINGTON BEACH Jocelyne Shiromoto (714) 965-1550 Open. Call for time. IRVINE Charles Wilkerson (714) 543-8251 Meets 2nd Thursday of month. Primarily case discussion Open Call for directions. LOS ALTOSIPALO ALTO John Marquis (4 15) 965-2422 Meets a d hoc a t Pacific Graduate School of Psychology in Palo Alto. Primarily case discussion. Open LOS GATOSISARATOGAICAMPBELL Jean Bitter-Moore (408) 354-4048) Meets the 3rd Thurs. 12:OO-1:30pma t Mission Oaks Hospital, Conference Room 1, Los Gatos. Open MANHATTANIREDONDO BEACH Randall Jost (213) 539-3682 Coordinating a new group MARIN COUNTY (415) 472-2766 Gilda Meyers Steve Bodian (415) 454-6149 1 Friday per month. loam - 1 l:30am. Call for information. MONTEREY Glenn Leonoff (408) 373-6042 Robbie Dunton (408) 372-3900 Coordinating a new group. Open NAPA Marguerite McCorkle (707) 226-5056 NEVADA CITYIGRASS VALLEY Judith Jones (916) 477-2857 Call for time. Open PALMDALELANCASTER Elizabeth White (805) 272-8880 Coordinating a new group. Open P A L 0 ALTO Ferol Larsen (415) 326-6896 1st Wednesday lOam in MRI conference room. Case discussion Elizabeth Snyker (619) 942-6347 Meets 3rd Wednesday of every month, 9:OOam - 10:30am. 191 Calle Magdelena St., Ste. 230, Encenitas, 92024. SAN FRANCISCO Sylvia Mills (415) 221-3030 Meets Friday, call for next date. Potluck dinner and case discussion. New members welcome. Arthur T. Horvath, Ph.D. Call about meeting times and places. (619) 455-0042 Mary Anderson (619) 434-4422 Meets 2nd Friday of every month from 9:00 - 10:30am. Primarily case discussion. Call regarding availability. Stan Yantis (415) 241-5601 Meets 1st Wed. 8 - lopm., 180 Beaumont St. Please call to confirm. Case discussion and group process. Open. SAN LUIS OBISPO Marilyn Rice, Ph.D. (805) 438-3850 Meets fourth Sunday of each month. Call for details. SAN MATEOIBURLINGAMEIREDWOOD CITY P a t Grabinsky (4 15) 692-4658 (415) 593-7175 Florence Radin Coordinating a new group. Contact Florence SANTA CRUZ AREA (408) 475-2849 Linda Neider, MA, ATR, MFCC Meets every month on a Friday (Call for time) Case discussion. SARATOGAIW. SAN JOSE Dwight Goodwin (408) 241-0198 Meets alternate Fridays, 9:30am - 1 l:30am. SOLANOI NAPA COUNTY Micah Altman (707) 747-9178 Willing to coordinate new group. Call if interested. SONOMA COUNTY Kay Caldwell (707) 525-0911 Meets in Santa Rosa a t Kay's office the 4th Tues. 12:30 2:OOpm. Case discussion, videos and "troubleshooting." Open TORRANCE James Pratty (800) 767-7264 Coordinating a new group. Open WEST LOS ANGELES Geoffry White (3 10) 202-7445 David Ready (3 10) 479-6368 Coordinating a new group. Open WOODLAND HILLS/NORTHRIDGE/WESTWOOD Ron Doctor (818) 342-6370 Ginger Gilson (818) 342-6370 Seeking new members. Contact Ginger. If you are interested in coordinating a new study group in your mgion, please notify the EMDR office at: PO Box 61010, Pacific Grove, CA 93960-6010 (408) 372-3900 Fax (408) 647-9881 �EMDR Network N e w s l e t t e r 1 9 9 4 Issue 3 - REGIONAL NETWORK COORDINATORS USA National Coordinator: Norva Accornem, MSW (408) 366-1414 Arizona We are in the process of registering a domain name for EMDR with zNET as the provider. The domain name, when assigned, will be emdr.org. As soon as registration is completed, we will begin working on the design of a home page for the world wide web. Initial hcussions include; providing gateways to information and discussions based various levels 1) accessabilityto information tothe general public, 2) trained EMDR therapists, and 3) Network members. We also plan to have specialty areas for on line discussions between therapists. This is the ground floor of the planning and design phase of EMDRavailability in the internet, and we would U e your ideas on form and content to include. Please address your suggestions to me at: qjpopky@net.com. I will begin to assemble a phone book of email addresses of network members. When our domain name is registered and assigned. I will notify you of our new email address at that time. AUSTRALIA CANADA ENGLAND FRANCE GERMANY ISRAEL NETHERLANDS NORWAY SOUTH AFRICA UKRAINE California (Northern) California (Southern) Colorado Connecticut DC Georgia Hawaii Idaho Illinois Maryland Massachusetts Missouri New York New Mexico Ohio Oregon Pennsylvania Texas Jonathan Brooks, Ph.D. Pat Penn, Ph.D. (602) 493-3 110 (602) 770-7407 Norva Accornero, MSW (408) 356- 1414 Curtis Rouanzoin, Ph.D. (7 14) 680-0663 Ron Doctor, Ph.D. (818) 885-2827 Laura Knutson, LPC (303) 620-7198 Jana Marzano, MA (303) 220- 1151 Steve Lazrove, MD (203)787-0227 David Russell, Ph.D. (203) 231-9191 (301) 982-9259 Deany Laliotis, LPC Dan Merlis, LCSW-C (301) 982-9259 Pat Hammett, Ph.D. (404) 633-4796 Silke Vogelmann-Sine, Ph.D. (808) 531-1232 Dean Funabiki, Ph.D. (509) 334-0677 HowardLipke, Ph.D. (708) 537-7243 Mike Brenner, MD (410) 77 1-4438 (410) 889-8338 Eugene Schwartz, LCSW-C Lorie Bollinger, MA (508) 456-8623 Marcia Whisman, LCSW (3 14) 644- 1241 WilliamZangwil1,Ph.D. (212)663-2989 Gerald Puk, Ph.D. (914) 635-1300 Peggy Moore, LSW (505) 255-8682 Kay Werk, LISW (614) 274-7000x349 Ann Kafoury, LPC (503) 291-9343 Georgia Sloane, MS (2 15) 667-6490 Carol York, MSW (5 12) 343-9550 Dan Sternberg, Ph.D. (801) 364-2779 Steve Riggins, MA (206) 328-5626 Raquel Solvey, MD Gary Fulcher, Ph.D. Sheldon Walker, MS Marchall Wilensky, Ph.D., R. Psych. John Spector, Consultant, Clin. Psych. Francois Bonnel, MD Arne Hofmann, MD Elan Shapiro, MA Ad de Jongh, Psych. Atle Dyregrov, Ph.D. Reyhana Seedat, FMT Dr. Alexander Bondarenko Buenos Aires Burwood, NSW Calgary, ALB Vancouver, BC London Aix En Provence Oberursel Ramat Yishay Amsterdam Soreidgrend Bergen Durban, Natal Kiev 1995 EMDR International Conference June 23,24,25 in Santa Monica, CA � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter Newsletter Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter, 4(3), 1-16 https://d1y502jg6fpugt.cloudfront.net/13023/archive/files/59cb63f0ea80b414bc3c442086359558.pdf?Expires=1790208000&Signature=D3s7Mx4Txmy6KMyy%7E5wXgFhBI49Kw1f2jk3uNofZPs-dRUTgXLb7-ZNt7Kp00oZ2V9x1xONUpDxv1L7Jz2GW8ERPnkREIvDGFq3B4WqR5SfOiLHyPSmiorgrglqDprZvV8NY1CThn3%7EUKPo6wKzavMVbwUpjaDS5Oshv-g8uSaRR39U1CBTXiqA7Xt3MqzBB91t%7Ed5N6PX1GNsVLUzHHS0XMYp1rFNQV5ao%7ElL2HQqMOGy3mdco-nxHnZ1ZSm7PFp7O8p5li5nQD1S86fbRmJb254V-sccPKEGHMLkpHfw4eLXqEousz4sOH62IvBzSzE3auovfqUcqd1Vz1N2j4-w__&Key-Pair-Id=K6UGZS9ZTDSZM 608067a55ca8f6dae0bc4e1308db6f0d PDF Text Text EMDR Network Newsletter . 1995 Issue 1 B ~ e t w o r Newsletter k ~oP&INc. EYE MOVEMENT DESENSITIZATION AND REPROCESSING Copyright O 1994 EMDR NETWORK, INC. P.O. Box 51010, Pacific Grove, CA 93950-6010 (408) 372-3900 FAX (408) 647-9881 .................................... ................................. Spiritual Transfo .......................................................... ................. .................. Cook, M.Phil. .................... 3 Slow Down ...................................................Virginia Novak, MSW ................... 5 EMDR for Thought Disorder Cliente Juliana Garza. ................................ 5 International Update. .............................. Francine Shapiro, Ph.D. ............... 6 A Case of Spontaneous EMDR in a Child ...................................................... G ................................................... ary W. Lea, P8y.D. ...................... 8 Changing Cognitions ................................ Scarlata, MA, LPC .................8 Bea The Case of a Sexually Abused Woman Re-entering her Body .. The report of the bombing in Oklahoma City was extremely painful for many of us. As I watched TV, I was struck again by the level of pain we put each other through, and the level of suffering some of us endure. It also made me think of the obligation we have as mental health professionals to the world at large. The Accelerated Information Processing model that I use as a clinical heuristic for EMDR application, explicitly states that present dysfunction (excludingthose of organiclchemical origins) are based on earlier life experiences. As I have stated in the trainings, this is not a great revelation because unless we think that pathology is caused by an alien virus visitation, clearly inappropriate reactions in the present are based on previous experiences that are being triggered. For example, the alleged perpetrator in the Oklahoma bombing is apparently a GulfWar veteran. His hometown neighbors said that when he returned from the war, he seemed to be a different person. They say that the person he became seemed to have no relation to the little boy they had known. It seems clear that had he been successfully treated for his war experiences and level of rage and pain, this tragic bombing might 9 on .......Landry Wildwind,LCSW ............... never have occurred. Some people may become caught up in the "militia rhetoric," but I think as a profession, we need to direct our attention to the psychological drivers underlying the hate. For years, clinicians have reported explosive dysfunctional reactions in veterans that were continuing to disrupt their present relationships. The spouses and children of suffering combat veterans were often victimized by the rage. It has also been reported that more combat veterans have committed suicide than died in Vietnam. Now we are witnessingfirst-handone of the experiencesmany of them went through. We are forced to hopelessly watch the effects of a military act on innocent civilians. Some of us are heartbroken a t the sight of the mangled and bloody bodies-just as many of the veterans I have treated have suffered over the past years. As a profession, we need to mobilize not only to relieve the suffering of the present victims, but to relieve the suffering of those that may be capable of committing such acts of violence and continuing the cycle of inhumanity. I was appalled to hear that during a speech at the last International Society for Traumatic Stress Studies conference, clinicians were told that there is nothing we can do for veterans after so many years. Clinicians were told to just "close them up and prepare them to live with it." As EMDR clinicians, we know that this is not true-and it is incumbent on all of us as therapists, and as citizens of the �1. EMDR Network Newsletter 1995 Issue 1 world to say, "No, this will not stand." Even if we believed that there was nothing presently available, our attention should be directed at how we can work to change the present system to learn more, to develop more, and to make healing more possible. Over ten thousand clinicians have been trained in EMDR worldwide. If each person devoted only 48 hours of the year to working for change, we could make a difference. We need to help others see the need to band together as a profession in order to integrate services and allow the wisdom of our profession to inform our organizations. For instance, we know that secondary gains prevent substantial treatment effects in combatveterans (as well as others). Therefore, we have to become vocal to change the structure of VA benefits so that compensation checks are not denied the veteran if the symptoms remit. We have to inspire the VA to inaugurate halfway houses to teach veterans the requisite skdls necessary so they can feel less fear and have greater ability to reenter the world. There are reports in the literature of World War I1 and Korean War veterans becoming nonsymptomatic when properly treated. Time is not the significant factor, but making the situation conducive to healing is. We need to become vocal within our professional organizations. We need t,o help inaugurate standing committees that set training, research, and publication standards in order to test new methods, develop already efficacious procedures, and having validated them, make them more readily known to the field. Experienced, seasoned, practicing clinicians who have been validated as competent in the various methods should have a leadingrole in thecommittees. They should not be run exclusively by academicians and researchers simply because they have the time or the organizational position. The practicing clinician is the one in the trenches and we need to get our priorities straight. If we are going tohelp our clients, and in doing so have a positive impact on humanity as a whole, we need to make sure we have delineated and clarified our standards regarding training, research, informed consent, and client practice. The official who said, "Just close them up, nothing can help" should not be the one to be heard. The practicing clinicians that know there are ways to help should be the ones to lead the way. However we must do it judiciously, and with all the rigor necessary to get the point across. We must be vocal during professional meetings, conferences, and in newsletters and journals. We must do what we can to bring forward a new standard of practice, research, and training. We must do it because, as a profession, we have taken on for ourselves the role of guardian for the world's p s y c h e a n d we can nolonger afford to be cavalier or nonchalant about slipshod or uninformed work. GeoffreyWhite, Ph.D., took the time to find organizations willing to set up an EMDR training in Croatia. It was not easy, but he saw the need. Gerry Puk, Ph.D., and Steven Silver, Ph.D., donated their time to train the clinicians in Zagreb. It was not easy, but they were determined to go. During the training, they heard guns in the distance, because fighting h a d erupted. Three psychiatrists from Sarajevo managed to get to the training by a circuitous route and arrived a t 5 AM on the day of the training. One of the psychiatrists seemed very skeptical, but participated as a client in the practicum. Steve noticed that she seemed stuck in the material she had targeted and coached the person in the therapist role. The blockopened, and she leaned back and smiled. Shoaly afterwards she asked ifSteve and Gerry would come to Sarajevo to do another training and they agreed. Later that day, in speaking about it, they told the host, 'We'll go wherever we're asked. We'd even go to Serbia." Even though the Serbs were the mortal enemy, the host said, "Good, you should go there. This fighting won't stop until we all get past the pain." Can we all take that message toheart? The world's suffering will not stop until individual people get past the pain. This is our goal: thousands of therapists throughout the world helping people to open to a greater sense of community and interconnectedness. Thousands of therapists setting the kinds of standards that make clients safe and our profession strong enough to fulfill its mandate. Thousands of therapists vocal enough and loud enough that elective deafness and cognitive dissonance and misguided ideology in our presently divided profession do not stand a chance. And isn't this goal possible if every clinician devoted just 48 hours a year to being an advocate for change? Isn't it possible if you arejust willing tostand up and try? The client is a 27-year-old woman known to me from her first psychiatric hospitalization 2 112 years ago, during which she was diagnosed with Major Depression with psychotic features. She also had dissociative syrnptoms including well-defined "parts," though she did not experience time loss. She had tried about 20 M e r e n t psychoactive medications prior to her first EMDR session, and had also received outpatient electroconvulsive therapy (ECT) 18 months earlier. During ECT, she maintained a straight-Aaveragein her course work to obtain a second degree in nursmg. Although she experienced a brief remission of symptoms during the course of ECT, shortly thereafter, she found herself unable to eat or drive, was experiencing severe anxiety and shaking, and ". . . felt like a weird thing was telling me to kdl myself." She was laid off from her job as volunteer coordinator at a social services agency, went on disabihty, and in a virtually catatonic state, returned to �EMDR Network Newsletter 1996 Issue 1 ' live with her parents for 6 months. She felt that her "brain was across the room," she had trouble with spatial relationships, and she half believed there had been a nuclear holocaust and she was the last person left alive. She also felt a compulsion to kill both of her parents andlor herself, but the fact that she was unable to get out of bed helped to control this urge. Upon her return to Nashville, she wentback into therapy with heroriginal outpatient therapist, with whom I work in tandem. The following is an account of her third EMDR session, during which time she was unable to trust in any decision-makingability. She described her depression as ". . . holding me down and choking me" and she related this to a dream in which she had crashed her car into a "rib joint" where other people were able to eat and enjoy food, while she was ". . . not able to swallow even the things that wouldfill a hunger." This was the negative cognition, and the positive cognition was, "I can take care of myself without hurting myself." She immediately had an image of ".. . abratty kidscrearningandbreaking things." She associated this with her childhood history of running around the house so frantically that she would be unable to stop unless she hurled herself into the furniture. In the first few passes, "the kid" was raging and stomping,breaking glass, cutting and clawing herself, and screaming incomprehensible gibberish. I instructed her to ask the child what she wanted and what shehad to say, andin her first attempt she yelled, "Whatthe fuck is wrong?" and did not get much of a response. When she was able to try a calmer, less insulting approach, a dialogue ensued. The child let her know that, "I have to keep running because when I stop, it all comes crashing in. She's crying and says she's so tired, but I can't sleep because ofthe nightmares. Even crying sucks and there's no way out. M D R &&y~wrk J -P Submission h f o m t i o n EMDR has generated a tremendous amount of enthusiasm a m n g practitioners and d l of us are anxious to read about the latest developments in, and/or experiences with, this exciting method. Because of this enthusiasm and desire to acquire more knowledge, I believe that it is important to produceapublication thatprovides a forum for articles that are more f o r d (e.g., research, protocols, etc.), as well as for those that are less formal (e.g., case studies, innovative ideas, etc.). To this end, the following represent theguidelines for submissions to the os Newsletter: Send articles to L i Allen-Byrd, Ph.D., Editor, EMDR m, Middlefield Road, Palo Alto, CA, 94301. Please include 555 home and business telephone numbers, professiod degree, location of practice(city and state only), professional afiliution (if applicable-university, if a lecturer or teacher, and/or institute, if an associate). Example: John Smith, Ph.D., John Doe University, Johnson, WA. Ifpossible, please submit articles on a diskette, IBM format. ARTICLES SHOULD BE DOUBLE SPACED WITH WIDE MARGINS. APA STANDARD AND STYLE-BOTH TEXT AND REFERENCES MUST BE IN ACCORDANCE WITH APA STANDARDS. ALL SUBMISSIONS ARE S U B JECT TO EDITORIAL REVISIONS. Proofreading of materia,?is required before submission. Authors submitting a manuscript do so with the understanding that, if it is selected for publication, copyright of the article is assigned to the Newsletter. Because the Newsletter depends on you, the members of the network, I welcome any suggestions or comments that you may have. I f there are any questions regarding the above, I can be reached at (415) 326-6465. It seems endless." The two sat down and joined each other in an attitude of total despair. Synthroid and Sinequan. There has been continued optimism and a markedimprovement in her ability to set limits with others. In the previous session, the client had found herself on a sunny path The client now has a degree in fine "....where all the pure souls are before arts, leads a support group for teenthey were injured." I suggested that agers, and makes original jewelry. she take the child with her "on the path," and suddenly she began to laugh. She saw them eating barbecue sandwiches, surrounded by light and congenialfriends. Her awarenesswas, 'We all have to toil and struggle, but there's always a place for our best selves, where our difficulties are celebrated as parts of living." I work in an office where we do assessments and referrals, as well as Afew days later, she Saw t h e ~ h ~ s i mental health and substance abuse cian who had hospitalized her and had treatment. Client A was to administered her ECT. She felt "dis- me from our EAP colleague as a pasgusted and violated" at being told, sible candidate for EMDR. She ar"She hadchronic depression and there rived for our intake session as sched. was nothing that could be done about uled, presenting quite anxiously and it." The depression lifted, and she childlike, both verbally and in her in , made other plans to obtain her bodv ~osture. She s ~ o k e a soft. �EMDR Network Newsletter 1995 Issue wispyvoice, andher small frame folded over itself as she sat in her chair so that she seemed even smaller. As her story unfolded, she was embarrassed to be weeping and it became apparent she had been emotionally stuck a t age four, although she was reportedly a happily married woman and mother of two children, ages three and five. She had been working part-time outside of the home and her job was ending that week, for which she was "mostly relieved." The presenting problem was a n obsession with death. She had been increasingly depressed for the past few months, and it had recently escalated into constant fear and obsession around her own death, the death of someone close to her, and refusal to attend a wake or funeral, to the extent that it was starting to create tension in her family. Other symptoms included difficulty making decisions, irritability, spontaneous crying, low energy, and low self-esteem with a critical ego, plus some selfmedication with wine that was concerning her. The referral was made as she had a clearpicture in her mindofher father's death. When she was four years old (remember, her children's ages are three and five), she had been playing with her sister on the beach over the Fourth of July weekend. m e client came in for treatment in July.) Suddenly, "Everyone was running around screaming and crying." Someone told her that her father had died. Later she discovered that he had had a heart attack. She was never allowed to talk of him again; in fact, it was a long time before she understood words like "funeral" and "death." After her father's death, she experienced many years of trauma, includingbeing made tosleep with her mother before her mother's remarriage eight months later, moves to other states, losses due to older siblings refusing to live a t home, and sexual molestation. Her mother, who married her brother-in-law (thus making cousins "sisters") stated that this was a new family now. (Her mother still refuses to talk of client's biological father.) During our first meeting, a history was taken and EMDR was reviewed briefly. The client was given a book about death to read to herself and her children. The second session consisted of a more in-depth exploration of EMDR. We ended with the client experiencing a relaxation exercise with healing around the self-protection role that fear and tension had played in her life. I recommended that she continue relaxation daily. Her stated treatment goal was to be able to talk about death without crying. She had already noted some improvement after reading a n d rereading the book four to five times and a decision to return to church. The client returned for the EMDR session anxious about the process, fearful she would cry, but determined to do something to end her suffering. Her negative cognitions were, "I am confused, afraid, and angry about death and Me. I am angry a t God." Her positive cognitions were, "I accept death as a normal part of life that I do not have to fear. I can survive even an unexpected death." Her SUDs level was 10 and her VoC was 3 or lower, as she sometimes felt she would rather die than sufferany longer. She had intense physical sensations (such as tightening) in her stomach. As she progressed through the EMDR session, she abreacted extensively. At first she would cut off her crying and needed much encouragement. Soon she was wailing, shaking, and sobbing, much as a small child would. When her SUDs level would not go below a 3, she expressed her fear that if she let go of her pain, she would forget her father. She let out some long repressed anger by punching a pillow and really allowing her angry feelings to be expressed, ineluding anger a t her mother, God, and her father. A dysfunctional belief system had been to repress anger and v 1 be a nice girl. We went with her fears, embarrassment, and tightness in her stomach. As her SUDs level went to 0, she stated, "It just feels like a bubble came up from my throat and went out my mouth. I feel so relaxed." The abreactions then started again as we went through the positive cognition. Then her cognitions started shifting spontaneously. "I do not have to be a Marine and take care of everyone." "I can miss my father and not be overwhelmed." "I am a t peace.'' The client was advised to call me in two days (or before if necessary) to journal, and to continue relaxation exercises. She was also informed of the possibility of bodily or emotional reactions occurring, even the possibility of significant dreams as she adjusted to the healing she had experienced. When the client had not called within the agreed upon time, I contacted her. She stated that she had been busy and was feeling fine. When she returned one week later, sheheldherbodystraighter, appeared taller, and her voice had dropped several octaves. She confidently stated, "I am more solid, feeling powerful, more in control of myself rather than tryingtocontrolothers. Icanbreathe better. I am able to laugh out loud. I am sleeping better. I am not afraid of the dark. I have moved beyond my mother. I feel free. I t does not kdl me to remember my father." We discussed two dreams that were quite significant in their symbolism to a tremendous healing and new Me direction. Then she asked, "Something else happened thismorning that was not a dream. Do you want tohear about it?" "Of course." She then related: "As I was lying in bed this morning, I suddenly reachedmy hand up towards the sky. A hand reached down and held my hand. As I opened my eyes and looked up a t the c e h g , I could still see the hand and feel it holding mine." -. . �EMDR Network Newsletter 1995 Issue 1 I asked whose hand it was. She answered, "My father's, of course. I am finally connected to my father! I no longerneedto come in for therapy." attached emotions, and process out experiences. When I t i e d applyingthis approach with my clients, I had a number of exciting results. The clients I would have expectedto have difficultyfocusing often were able to do so when the pace was slowed. Also, clients rarely reported having many of emotions, memories, or issues come up between sessions. Even clients who had extensive histories of abuse and neglect were able to focus on relatively minor issues (e.g., relationship problems) without their entire history being raised. We discussed her husband's reaction to her transformation and the possibility that he could feel threatened andlor confused about the transformational changes of her new outlook on life. She felt confident that ak she could t l with him and was enthusiastic about leaving. She again stated that she did not want to return for treatment and asked, "Could I hug you for helping me so much?" In attempting to make EMDRmore comfortable for myself and my clients, 1have come across an approach which seems to be extremely helpful--SLOW DOWN. ~ f t attending an EMDR train a ~ ing, 1 was very excited about the possibilities, not only for my clients, but also for myself. After 8 months of using the method successfully with my clients, I was finally able to use it for my own issues. However, my mind never seemed to be able to get the hang of it. I just kept derailing or ending up at dead ends. By a slow movement, I mean as slow as 30secondsforone finger sweep or a total of 5 minutes for a set of 10 movements. Yes, these are REALLY SLOW movements, and most clients do not need it quite this slow before they are able to report concentrating. However, for a t least one client with an extensive abuse history, this speed was necessary before she was able to 1 address her feelings of anger when in an intimate relationship. I I find these results particularly interesting since I had noticed that EMDR can sometimes seem to override the mind's defense mechanisms, and that the "blocking" or topic skipping that was happening for some clients appeared to be the mind's last ditch effort to remain in control. I t seems as if slowing down the pace can help the mind keep its defense mechanisms in place while still dealing with the target material. Network Newsletter 1 11 Editor: Lois Allen-Byrd, Ph.D. Publisher: Arnold J.Popky , M. A. sharon L~~~~ Data Entry: I have been working with these clients for a number of years and know them quite well. As our agency uses the Client's Strength and Assessment Model, I have already helped the clients to identlfy their strengths. Because the onset of mental illness is itself traumatic and devastating to a person's self-esteem, I have found it important to establish a Position of Power (Popky, 1994) before attempting to process the trauma. I Rather than give up, I began experimenting on my own with a variety of eye movement patterns and speeds. Eventually, I tried slowing I am very interested in knowing if the movements down, notjust a little, other clinicians experience similar but quite a bit. Finally, my mind was able to stay on a topic, deal with the results with this approach. = I, people with whom I have been working have been diagnosed with Paranoid Schizophrenia, Personality Disorder NOS, Bipolar Mixed, SchizoaEective Disorder, Borderline Personality Disorder, Panic Disorder, Agoraphobia, and Dysthymic Disorder. AU of these people have been physically andlor sexually abused. Although we can treat thought and mood disorders with medication, the emotional memories of the trauma remain and can exacerbate the illness. I have found that EMDR is a useful therapy in the treatment of persons with a major mental illness. The I To start the procedure, I ask clients to identify a successful event or accomplishment. I help them toidentify an event that is real and significant to them, although it may seem insignificant to anyone else. With one client, it was the birth of her child; with another, it was her first paycheck; a third client identified a basketball game where she made the winning basket. I then ask them to remember that feeling of success, that experience of "YES," or "I did it." 1ask the client to visualize the event and use the eye movements to install the experience of success. I can see from their expressions t h a t they are reexperiencing or getting in touch with their feelings of success. I then use Popky's protocol for Creating a Position of Power to create a Successful State. I anchor it into their physiology with a touch on their hand. When they feel insecure, they can recall that feeling of success by touching the spot on their hand where we anchored the successful state. I then continue with the standard EMDR protocol. To demonstrate how this �EMDR Network Newsletter 1996 Issue 1 has been useful, I will review one case out of the five with whom I have been working using EMDR. Maria (name has been changed for confidentiality) is a 31-year-old, divorced, Mexican female, who has been in treatment with this agency since 1987. Maria has had three psychiatric hospitalizations occurring in 1980, 1984, and 1989. Her diagnosis is Paranoid Schizophrenia. Maria has been on psychiatric medication since 1981 and has been maintained on Prolixin Decanoate for the past several years. This summer, her medication was changed to Risparadol, 3 mg twice a day, because of concerns about t h e potential long-term effects of Prolixin. She says that the Risparadol is more effective than the Prolixin and that she feels more alert and has feelings. Maria stated that when she has been "sick in the past, she becomesveryparanoid and hallucinates. She also displays a lot of bizarre behaviors such as wearing clothes that are four sizes too small, thinking that a stranger is really her ex-husband in another body, and being sexuallypromiscuous. Maria has been stable for the past three years; stable enough, in fact, to complete a year of college prep courses offered by our local community college. s h e was beginning regular college courses and was afraid that she could not make it because of insecure feelings that began when she had to return to school after her first psychotic episode a t the age of 16. She related to me that she had been experiencingnightmares and fear that her father was going to come and hurt her. In August 1994, we began the procedure by installing the Position of Power. She remembered when she made the winning basket in high school before the onset of her mental Illness. When she became fully aware of the memory, I could see the change in her body. She sat up in her chair, her eyes widened, she smiled, and she looked "proud." She also reported that she could that experience of success. She also was able to disclose to me her memory of physical and sexual abuse, which she has never had the courage to talk about before. She reports that the nightmares have ceased and that she is no longer experiencing the fear that her father is going to beat her up again. I am using EMDR to work on these traumas and others that are beginning to surface. I think that I was able touse EMDR because Maria was stable and her fears were based on reality. The feelings of fear that she described were different from the paranoia that she experienced before Risparadol treatment. She knows she has a mental illness and wants to make changes in her life. I have not used EMDR with chents who both have thought disorders and are in denial of their mental illness or who are not being treated with medication. I would be interested in hearing from other therapists who are using EMDR with thought disordered clients. References Popky, A J. (1994). Smoking Cessation (Addiction) Protocol. (From obervations of Robbie Dunton's work with children). The EMDR training in Croatia took place in Zagreb in March and 40 clinicians attended. The work of Geoffrey White, Ph.D., in arranging it, and the dedication of Steven Silver, Ph.D., and Gerald Puk, Ph.D., in donating their time to teach cannot be overemphasized. As a result of the reports by three Sarajevo psychiatrists that attended (traveling a t riskof their lives), we have been requested by Catholic Relief Services in Bosnia to put on another training in Sarajevo during the summer. The same teaching team, and anumber ofother clinicians, have already volunteered to go. The Oklahoma City bombing took its toll with 167 people dead and thousands who are emotionally devastated. After a call from a representative of the FBI that requested EMDR clinicians to help in the relief effort, Judy Albert, MFCC, left for Oklahoma City to start setting up facilities and contacts for therapy. Virginia Denman, LCSW, an EMDR c h i c i a n and resident of Oklahoma City, has been a wonderful host and networking resource, along with EMDR facilitator Karin Kleiner, MFCC, who, as a past residentof Oklahoma, flew in to assist the effort. So far, two offices, appointmentstaffs, telephones, and an apartment have been donated for the use of EMDR clinicians. Judy has already met with 6 EMDR clinicians who are residents of Oklahoma and provided them with some additional training and refreshers. She used the recent trauma protocol and tapes of the Hurricane Andrew interventions she &d during that disaster response. Steven Lazrove, MD, is coordinating a possible interface between the EMDR project and other orgqnizations, such a s Operation Healing directed by Charles Figley, Ph.D., and CISD directed by Jeff Mitchell, Ph.D. Level I1 trained EMDR clinicians (critical incident experience may be useful) are requested to help in a relief effort. The plan is to have cohorts of EMDR c h i cians rotate in every week. Sandra Wilson, Ph.D., andLee Becker, Ph.D., will simultaneously be coordinating research to docum-ent the effects of EMDR treatment. The primary goal, however, is to help relieve the suffering. Judy Albert and Sandra Wilson are attempting to organize on-site financial backing for travel and lodging. If you are able to donate time, please send the questionnaire included in this Network packet to: Judy Albert, MFCC 1 7610 Beach Blvd. #38 Huntington Beach, CA 92647 or fait to: 714-846-0646(ring once, hang up and then fm) . �EMDR Network Newsletter 1995 Issue 1 For those of you who would like to help, and would like critical incident training, if you are planning to attend the annual EMDR conference, you can learn from experts Jeffrey Mitchell, Ph.D., and Roger Solomon, Ph.D., who will be giving an all day workshop on the topic. In order to be better prepared for the next crisis, we would like to have an EMDR Disaster Response team already organized. The EMDR Network, which is a non-profit organization, will collect tax-deductible donations earmarked specifically for that purpose. The donations will be used to provide travel expenses for the firstline team of providers that in the past has had to pay their own way. If you are unable to donate your time to the project, please consider making a financial donation. It will be used exclusively for clinical work to provide clinical relief for disaster victims. Please send donations to the Pacific Grove office at the address listed on this Newsletter. The EMDR annual conference will alsosee the inauguration of the EMDR International Association. The association will function as a professional organization and help to set EMDR training and practice standards for other organizations that will be conducting EMDR trainings now that the textbook has been published. The plan is for it to take on many, ifnot all, of the EMDR Network functions as of 1996.The EMDRNetwork would then become the equivalent of an alumni association for the EMDR Institute and a service organization. Donations would be solicited to fund the disaster reliefproject; the assistanceprograms, such as the free trainings in Croatia; scholarships and research grants. Alternatives will be discussed a t the annual EMDR conference and a vote will be taken a t that time. Please think about it in the meanwhile and feel free to send me any suggestions. There have been a number of articles in professional newsletters throughout the country that are con- in professional journals. In addition tinuing the myth that there is no EMDR research. At this point, there are ten completed controlled studies, making EMDR by far the most widely studied method in the treatment of trauma. Please consider writing your own articles and referencing the studies reviewed in the EMDR publications and research list included in this packet and in my textbook. Managed care companies throughout the country are apt to be swayed by the misguided rhetoric and ignorance. Please help the professional and public community be more aware of the actual situation. In addition, let us continue to encourage well-designed research by well-trainedscience-practitioners. The best news in the EMDR research world is that the controlled study of 80 trauma victims implementedby Sandra Wilson, Ph.D., Lee Becker, Ph.D., andBobTinker, Ph.D., has been accepted for publication in the c The journal is the most respected research journal in the country and only accepts 10% of the manuscripts submitted. Drs. Wilson, Becker, and Tinker did a magnificent job in writing up their results. They, and the Colorado clinicians who donated their time to do the therapy, have done a great service to EMDR. Once the article is published, it should be impossiblefor any reasonable professional to question the existence of well-designed research validating EMDR effects. to sending copies of EMDR articles to the office, please send them to David Baldwin, Ph.D., PO Box 11148, Eugene, Oregon 97440. Dr. Baldwin has agreed to supplement the author's abstract with information that would be particularly relevant to the EMDR clinician. We will continue to send out some of the articles, but as you saw from last year's financial report, we need to cut back on the amount of paper being duplicated and sent or raise the dues. Many of you suggested this solution and I thank you for taking the time to do so. , 1 1 1 I have also been informed that another well-designed,randomized, controlled, comparative study has been superiority to the controls. We are looking forward to its presentation, hopefully at the annual conference. The EMDR Network will be send- ing out selected articles this year along with a list of published material and abstracts of those articles that appear Once again, we wouldlike to be able to extend the assistance programs by financing free EMDR trainings in third world and/or war torn countries and by sending clinicians to help in disaster areas. Please consider making a donation to the Network, or offering your time as an on-site clinician. An interview with Geoffrey White (whoset up the Croatian EMDR training) quoted him as saying, "As a father, I was very disturbed by media coverage of the brutality of war, repeatedly depicting how snipers around Sarajevo, for example, would deliberately kill children in the arms of their mothers as a way of demoralizing the civilian population. I read about the rape camps where young girls (my daughter's age) were deliberately impregnated as a part of the policy of 'ethnic cleansing.' When my children are old enough to read about the former Yugoslavia, I want to have something to say when they look a t me and ask, "Dad, what did you do to help?' There's y take a hand. �EMDR Network Newsletter 1995 Issue 1 up a great deal of sadness for her, as she visualized many dead child parts inside. A CASE OF SPONTANEOUS EMDR IN A CHILD Gary W. tea, Psy.D. Kelowna, BC; Canada Clinicians trained in Eye Movement Desensitization and Reprocessing WMDR) are well aware of the oft cited report of Dr. Shapiro's discovery of Eye Movement Desensitization. The following is a brief account of an 8year-oldmale sexual abusevictim who spontaneously discovered eye movement desensitization. In August 1994, I began providing counseling services to the boy's parents who were in a blended family. The teenage daughter (the father's offspring from a previous marriage), herself a sexual abuse victim, was discovered sexually assaulting her half-brother. This discovery put significant strain on the spousal relationship and was a threat to the mother's day care. For a period of time, I provided services only to the parents, while the daughter was placed in foster care and the son received psychotherapy from a child care counselor. The parents mentioned to me that their son had been havingnightmares and fears, butthat he had spontaneously learned to reduce his anxiety by rapid eye movements. Surprised to hear of this, I asked to interview the boy in January, 1995. When I met with him, he presented as a bright youngster who readily talked about the molestation and his fear that "she [his half-sister] could come and get me." When I asked him how he had been coping with this, he told me that while lying prone in his bed, he would move his eyes from one side to the other of his window in a lateral, then a horizontal, and finally, a diagonal fashion. Sometimes he would move his eyes in a "star" fashion. He found that when he did this, his anxiety abated and he was able to sleep, although he found it necessaryto repeat the procedure most nights. I am now working with him in a structured fashion and assume that he will enjoy permanent benefit from EMDR in short order. Linda (not her real name) is a 40year-old professional woman whose avocation is healing and who is proficient in several of the touch therapies. She has a Dissociative Disorder with well-defined "parts," but she has not experienced time loss. She is not on medication and although she is often depressed, she is able b function fairly well most of the time. As a child, she was emotionally and sexually abused by her father for approximately ten years. He is bedridden now, but she is still subject to his verbal abuse when she visits him once a week. He has never acknowledged his abuse, nor has she confronted him about it (although she has told her mother). She said she will not feel totally safe until he is dead. We have had ten sessions together. EMDR was used in most of our sessions during which she processed specific incidents of abuse that were very traumatic for her. She believes that she has many dissociated infant and child parts-each of whom hold a memory of one of the abusive incidents she experienced. During our last session, Linda wanted to work on her reluctance to accept payment for her work as an energy healer, even though she knows that her work is excellent. I asked if she had ever been reluctant to receive payment before and she said yes. Her preliminary negative cognition was, "It is the duty of the child to give, the child cannot expect to receive,"which evolved to, "It's safer to give than receive, it's not safe to receive," with an image of being .forced to receive oral sex a t the age of three, feeling frightened, suffocated, and helpless. The chosen negative cognition was, "I am not safe; I am going to die." I usedher fatheis first name (rather than calling him "Daddy" or "Father") to ask if he had ever given her anything she wanted. Linda said that he gave her a camera one Christmas, but that most of his gifts to her involved something she did not want (which was also true of his grftsto her mother). He favored her brother and she was taught that because females are inferior, they are supposedto servemales. Linda's next negative cognition was, "I will never get what I ask for, I am not worth giving to." This brought up a lot of anger, which she was never allowed to express. She saw her inner child parts angry and upset and concluded that, "It's bad to be angry, so they deserved what they got." During a cognitive interweave, I said, "The fight or flight syndrome is a normal response to danger, an automatic built-in mechanism by the Creator that helps assure the survival of the human race. Anger is an appropriate response to fear of suffocation and death, and no one deserves to be raped--especially not an innocent child. Children deserve to be protected, nurtured, and loved unconditionally by their parents." (Linda has a daughter, so she knows fxsthand that this statement is true.) After severalsets of saccades,Linda said, "Receiving can be deadly." After several more she said, "When you're She said that the children inside were listening to my cognitive interweave and beginning to feel better. I continued and said that the perpetrator was no longer a danger to them or to anyone, that they were safe now. Our goal that day was to honor their efforts on Linda's behalf to contain the abuse she sustained during her childhood,to enable her togo to school, play with friends, and continue living an otherwise normal life-during the times when she was not being putdown, humiliated, andlor raped. I told the children to design a perfect good to Daddy you can live, but some- playroom for themselves, a playroom times it's not worth it." This brought that was 100% safe-a large, sunny, , �EMDR Network Newsletter 1995 Issue 1 beautiful, bright, colorful room with all their favorite toys, their favorite playmates, pets and music, and everything they had ever requested and been denied. They seemed to respond positively and Linda's face softened. During my next interweave, I told them to let go of any thoughts or feelings they had about being bad or inferior. They were very, very good, and exceptionally grfted; in truth, they were perfect. They were beautiful, bright, innocent, brave, creative, self-sacrificing little children who had saved Linda's life many times, often a t the expense of their own lives. As the set ended, Linda told me that the children inside liked what I said and when I was speaking, they all gathered around a huge blanket that was spread on the ground and curled up a t the edges like a bowl. Then they pulled out "gunky," black stufffrom their heart-space and threw it on the blanket. As the blanket u l this becamef l , stufflooked like thick, black oil. Linda said she thought the angels would come and gather up the blanket and carry it off to be purified, but as she watched, the oil began to recede to the bottom and be replaced on top by a clear fluid resembling water. The children reached into the water and picked up a small piece of coal with a very large diamond on it. Then they gave the brilliant diamond with its black mounting to Linda, and told her to use it to stimulate her empathy and understanding of others, especially those who come to her for healing. This was a very vivid image and one that clearly pleased Linda. The interweave with the closing saccades focused on safety and the right occupation. Linda is safe now. Her father is old and sick and can no longer hurt her. Because all of her child parts feel safe enough to bless her healing work (as symbolized by their special gift), and they are willing to help stimulate her understanding and empathy for her clients, it is only right for her to appreciate how worthwhile her work is, and how worthwhile she is. While the path of service may be the highest spiritual path there is, it is sometimes a very expensive one. As Linda continues to seek further training in this field, she will need to be able to pay for that training. Just as she expects to pay for services rendered to her, her clients expect to pay for services she renders to them. Afair exchange will help ensure that her healing work will not only continue, but progress and imprwe. After installing a sense of safety and self-efficacy, Linda said that she had always been t e d i e d of tapping into her anger for fear that it would overwhelm her. She was very relieved and pleased by the way she had processed it. She felt empoweredclearer, more energized, happier, and more in control of her emotions after the session. She was even able to imagine feeling comfortable while receiving payment for her services in the future. (To be continued.) in your body then, but it is now." She agreed, and we did another set of eye movements. At the end of that setshe exclaimed, "I can feel myself in my body for the first time! I never knew I wasn't in my body before." She kept saying how strange it felt to be in her body. She was so surprised! It was like she had been living hovering outside of her body since she was a child without being aware of it, and suddenly had popped back into it. The next week she came in and reported that she felt physically very different. She realized how cut off from her body she had been all of her life to the extent that she typically went all day without going to the bathroom or eating. She reported feeling more solid, centered, and present with anew assertiveness. T i hs feeling of being in her body stayed with her over several months continuing until she left treatment. You or your clients may be coping with Attention Deficit Disorder (ADD, termed Attention Deficit Hyperactivity Disorder in the DSM IV). For reasons I will explain below, it is more likely if you use EMDR that you will encounter this condition. I was working with a woman who had been repeatedly molested by her teenage brother when she was very young. As we reached the end of the session, she was aware that as a child, she left her body so he could not hurt her. Although she believed that it was not safe to be in her body, she did feel safe and secure outside of her body looking down on things. I suggestedto her that, "It wasn't safe tobe The symptoms we usually associate with ADD are hyperactivity and defiant or destructive acting out, especially in young boys and a few girls. For many years, such children were prescribed Ritalin, a stimulant that helped them function and focus. It was believed that ADD goes away with adolescence. Now we know that ADD never goes away; it only becomes less problematic in certain situations and more �EMDR Network Newsletter 1 9 9 5 Issue 1 Emotional labilitv. with a low taler- risk-taking, boundaryprotection,conflict, gncefor~rocessin~ne~ativeemotion~. relationships, parenting, and Irritability, boredom, impatience and performance are all common in adults confusion, depression and anxiety, with ADD. Family histories often exhaustion and self-doubt are typical; include other family members who with frequent shifts in affect and con- have ADD as it is inhetited. There are tent. During EMDR, the client may also reports of allergies, depression, begin with vivid content and intense addiction, and learning disabilities. Chronic anxiety. This can rise to emotions, but there is tangential or Iquickness, empathy, panic or feeling overwhelmed. &trackdprocessing, and less complevisualization, intuitive thinking, and tion. problems persist even when high IQ also characterize these very Im~atience. person has trouble EMDR goes well. The interesting people. They are drawn to completing informational reading, finemotional intensity and expression. ishes sentences for other people, be~ d d i ~ tm i~ is typical and i s~ . are writers Or artists comes angry a t waiting, etc. He or she ers drugs and alcohol as well as food, feelthatsomethingis~reventingthem often leaves relationships or jobs or work, sex,or destructive relationships. changes plans. ~h~ ,.bent is impulsive, even with from living up to their potential. high motivation and insight, and reAs you can see, these symptoms can Piles of unfinished ~roiects, mail, sistant to treatment. appear with many other conditions, paDers. Keeping track of detail may including fear of success, depression, elicit anxiety andlor frequent errors. Hmerfocug' With the right stirnu PTSD, anxiety disorders, personality There may be anger a t demands for lus, often emotional or visual intendisorders, and dissociation. When the more organization. sity, it is possible to become so focused therapist checks the history, there that distractions disappear. This is so usually are a number of traumas and Low self-esteem.. No matter how soothing to the person that such acmuch the person has realistically ac- tivities are compelling. For example, family dysfunctions to explain them; complished, there is a haunting fear even though reading for information however, these symptoms return or that, due to some error or neglected is difficult, reading fiction can become do not clear when EMDR is done. detail, everything could come crash- a compulsive activity, especially be~ ~ l land R~~~~ inl the 1994 ~ ~ ~ l ing down. O r t h e r e may be fore sleep. For some, there is a con- book, D~~~~ to ~ ipoint out ~ overdependence on others to give posi- stant quest for and in- that this genetic disorder could not be tive feedback. The person may be tense action. Periods of transition or diagnosed with much assurance until highly self-critical and demonstrate unplanned leisure often lead to rest- a test was developed using an MRI to an inability to sort negative feedback. lessness, poor use of time1 even de- map the brain and demonstrate the He or she may experience the im- pression. difference between normal glucose poster syndrome. uptake (brain area activity) in the Or These frontal lobes and ADD-type uptake Body ~ a i n By age 30 to 50 years of individuals are typically disorganized patterns . far less activity in age, there are chronic aches from con- and anxious in groups, and shy when those regions. For those clients who stantly using fear as a stimulant for meeting new people. They are impul- need a definitive diagnosis, find and focus. Jaw grinding during sleep, sive or reactive and make unguarded refer to a specialized ADD ,,hic for musculoskeletal, digestive, and im- comments that get them in trouble in the test. mune system diseases such as chronic social situations. Often issues defatigue may be experienced. There is velop with authorities about followJust how common i ADD? Should s also often hypersensitivity to hot and ing procedures. There is discomfort youscreen everyone? Hallowell (1994) cold, noise, odors, messes, clothes or or insecurity when around organized proposes a possible reason why there other textures, as well as low pain or highly successful people. For this are so many more people with ADD in tolerance. reason andothers,including aneedto the United States. In Europe and feel understood, people often ~hoose elsewhere, of the people in a e v e n Disorganization and ~rocrastina- to marry someone with ADD--even area or ethnic or economic group who tion in handling time. work. DaDer, when neither partner is aware of the were experiencing negative con&For example, precence of ADD. (Raising ADD chil- tions, $hose with ADD were far more the client is usually late to sessions, dren is especially difficult for ADD likelv to emimate. In fact, it is poseven when seeming sincerely eager to parents.) sible that it is so common in Americans be there. There is difficulty with that it has affected the development making and following through with Accident wroneness, restless sleep, of our national character--creative, plans of all kinds. and problems with impulse control, now-oriented, fast-paced, problematic in others. ADD in adults, especially without hyperactivity, in women; and in conscientious, anxiety-driven people; looks very different, and mimics many other problems. Possible cues in the lives of people with ADD are: �EMDR Network Newsletter 1996 Issue 1 - - tient with tradition and long-term goals. Following this reasoning, consider these questions: 1. Of those in the United States, who is likely to move to California? The Bay Area? 2. Of those in the Bay Area, who is likely to choose therapy as a profession (emotional focus, little distraction, creative and empathic, autonomous)? Of those, who would be most likely to be attracted to EMDR? (It is quick, intuitive, visual, intense, new creative . . . ) 3. Of clients in therapy, who is likely to be attracted to doing EMDR? Who is likely to have PTSD, be suffering from phobias or anxiety, or not be improving in other therapy? Obviously, we are in a unique position as EMDR therapists. We are likely to be or know peers who have ADD; we are alsovery likely to attract clients with ADD. Once we understand if we have it, we are far more likely to be able to spot the symptoms and ask the questions needed. Given the impatient and self-critical nature of such clients, it isvital that we check for ADD early on in the treatment process to maximize our clients' chances of success. Knowing about it is extremely helpful, even if the client refuses medication. There are now support groups available that are more appropriate than most recovery groups for this population. Medication can be very effective; look for doctors willing to prescribe Ritalin, Cylert, a n d Dexadrine, as they are usually more effective than antidepressants for ADD. Biofeedback can be helpful for those seekingnon-chemicalintervention. For clinicians, understanding the special therapy needs created by ADD can improve both the relationship with REGIONAL NETWORK COORDINATORS USA .- National Coaxdinaton Norva Aecornem, MSW (408) 366-1414 Arizona Jonathan Brooks, Ph.D. Pat Penn, Ph.D. Arkansas Stephanie Zack, LCSW California (Northern) Norva Accornero, MSW (Southern) Curtis Rouanzoin, Ph.D. Ron Doctor, Ph.D. Laura Knutson, LPC Colorado Jana Marzano, MA Connecticut SteveLazrove,MD David Russell, Ph.D. DC Deany Laliotis, LPC Dan Merlis, LCSW-C Pat Hammett, Ph.D. Georgia Silke Vogelmann-Sine, Ph.D. Hawaii Dean Funabiki, Ph.D. Idaho Howard Lipke, Ph.D. Illinois Gene Schwartz, LCSW-C Maryland Mike Brenner, MD h r i e Bollinger, MA Massachusetts Marcia Whisman, LCSW Missouri New York William Zangwill, Ph.D. Gerald Puk, Ph.D. Peggy Moore, LSW New Mexico Kay Werk, LISW 0hio Ann Kafoury, LPC Oregon Georgia Sloane, MS Pennsylvania Carol York, MSW Texas Dan Sternberg, Ph.D. Utah Steve Riggins, MA Washington your client and the results of your efforts. Youcan help coach your client in planning and decision making, and provide education on the way ADD is interacting with other problems. You can also support your client in delegating difficult tasks. With a rethink of the messages from parents and others throughout life, many negative cognitions can now be reprocessed more completly. I t is also clearer why some, such as, "I can't count on myself, something's wrong with me" never did move. The identity needs to be "decominated to eliminate shame about the history of inadequate functioning. Problem solv- (602) 493-3 110 (602) 770-7407 (501) 442-9997 (408) 356- 1414 (714) 680-0663 (8 18) 885-2827 (303) 620-7198 (303) 220- 115 1 (203 787-0227 (203) 231-9191 (301) 982-9259 (301) 982-9259 (404) 633-4796 (808) 531-1232 (509) 334-0677 (708) 537-7243 (410) 889-8338 (410) 77 1-4438 (508) 456-8623 (3 14) 644- 1241 (212) 663-2989 (914) 635- 1300 (505) 255-8682 (614) 274-7000x349 (503) 291-9343 (2 15) 667-6490 (5 12) 343-9550 (801) 364-2779 (206) 328-5626 ing and effective tolerance skills can then be gradually increased as the motivation to avoid disappears. Once these clients are adequately diagnosed and treated, they become more reliable, more relaxed, andmuch more rewarding. References Hallowell, E. & Rate , J. (1994) Driven to hstraction. : Random House. d+ �EMDR Network N e w s l e t t e r 1996 Issue 1 Below is some correspondence between clinician Michael E. Holtby, LCSW, BCD, and Douglas E. Mould, Ph.D., who is with a managed care organization. Mr. Holtby thought this would be of interest to EMDR practitioners and I agree. Dr. Mould has clearly stated his company's policy regarding abreactive work and, although it may not represent theviews of other managed care organizations, I suspect any differences are probably minimal. September 5, 1995 Dear Dr. Allen-Byrd: I thought you and the Network membership would be interested in the response I am getting from managed health care groups to my use of EMDR. The enclosed letter from PMHM is in response to my description of a specialization with EMDW hypnosis, detailing my training and experience. I am also sending you the letter I am writing in reply. I am aware this specialization is proving a liability with not just PMHM, but other groups a s well, i.e., MCC. PMHM was just courteous enough to express their concerns, whereas with the others, I hear of things more indirectly. I would be interested in what others are doing about this. Sincerely, Michael E. Holtby, LCSW, BCD August 29, 1994 Dear Mr. Holtby: I am in receipt of your application tobe apreferredprovider with us. Let me be forthright in my concern. We have found that therapists who use abreaction as the cornerstone of their therapy with PTSD andlor dissocia- tive disorders have a high rate of undesirable results, often with multiple suicide attempts, hospitalizations, and false memories on the part of their clients. Thus, we will not knowingly provide coverage for such treatment, and neither do we include in our panel therapists who rely on abreaction for treatment of PTSD or dissociative disorders. Parenthetically, I believe we have seen only the tip of the iceberg vis-a-vis litigation and false memory syndrome. Thus, please clarify for us whether or not abreaction is your treatment of choice for such clients. Sincerely, Douglas E. Mould, Ph.D. Preferred Mental Health Management, Inc. to PTSD (i.e., Joseph Wolpe). If this does not assuage your concerns I would be happy to I1P-t use these methods with PMHM cases. I hope that you will, however, use me for my primary specialization areas of homosexual clients and HIVIAIDS concerns. These cases are much more typically unrelated to PTSD or dissociative disorders Again, thank you for your consideration. Sincerely, Michael E. Holtby, LCSW, BCD September 16, 1994 Dear Dr. Allen-Byrd: September 5, 1994 Dear Dr. Mould: I greatly appreciate your letter, as you could have easily rejected my application to be a part of your panel with no explanation. I appreciate the opportunity to respond, as I too am concerned with the adverse consequences of abreactive therapy. The last thing I want is a lawsuit, or a client's hospitalization or suicide p m ci~itatedby my own interventions. For this reason, I am extremely cautious with any use of EMDRor hypnosis. Yes, I do get abreactions with these modalities. However, it is not before a thorough assessment has been done, as well as some relationship established with the client. In the ten years I have been using these methods, there has not been a single instance of adverse reactions. My rate of inpatient hospitalization is about one every two years, and in the last two instances, it has been for drug and alcohol abuse. I do have clients sign an informed consent form for EMDR. Although EMDR can be abreactive, it has never in my experience led to problems. In fact, EMDR is gaining a reputation as faster and more effective than other approaches Just a follow-up on the letter I shared with you from the managed health care group, PMHM, that had reservations about using providers who do abreactive therapy. My letter in response to them (which I also sent to you) was sufficient to allay their reservations and I was admitted onto their panel. Sincerely, Michael E. Holtby, LCSW, BCD NOTE! LEVEL I SCHEDULE CHANGES At t h e r e q u e s t of p a s t particip a n t s t o h a v e m o r e practica time, t h e EMDR Level I traini n g h a s b e e n expanded t h r e e h o u r s t o include o n e evening session. Day 1: 6:30PM - 9:SOPM e v e n i n g session Day 2: 9:OOAM Day 3: - 6:30PM 9:OOA.M - 6:3OPM . �EMDR Network Newsletter 1995 Issue 1 ONE MORE SECOND Rebecca Goldman, 7th Grade Daughter of member Robert Goldman ~ vrything sopeaceficl; everything caCm e N o indication of fear, no one thing h i n g wrong. 54 NormaCse tting, a ncw7naCdh.y f i e n we a n got h n t o p r a y . An explbsion of sadness, innocence a d f r i g h t N o t a p r e t t y wmu not a p r e t t y sight. What a secmdctbes, no one un&rstood Not untiltodhy, no one ever would f i e burst, ttie 6 b o d ttie screaming, ttie cries N o w it's time, w e n e e d t o rise. Puning victims out, having not a clue N o t a memmy retraced not & w i n g what to rtb. Needing a hospitalas quick as they can One more secondcoulit6e the e n d Where's m y Cavedmes, where's m y f r i e d ? ACive m & a d anhearts 6 e n d Looking andsearching in every direction N o t leaving tilcwe findperfecttion On@ one question lies W f i y me? W f i y Okhhmna? Answer wm't youphase. Strangers stopping 6y, topuCCanother out f e w m a d fiwm,running aEa6out. W h e n antiopes are gone, w h e nfaith has steeredaway W e gather toge ther anddistinguish this to-. So m a n y &serve praise, so m a n y &serve more But the thanks they receive is much countedfm. W h a t we'dctb without them, how coulitwe survive? Hm we wouGfstruggCe, how w e woulitstrive., W e cannot say enacgfi, w e cannot say a n y less, Hopefirffy it works out to 6e the v e r y hest! W e give our hopes, to a n our hurt a n d c h a n g e d f i - i e d W e are here kt our hearts andsou& m e n d EMDR Helping Hands has been launched in Oklahoma City. The Hospice of Central Oklahoma and the FBI expressed interest in having EMDR and CISD (Critical Incident Stress Debriefing) trained and experienced therapists work with their staff who were first on the scene after the senseless bombing of the Oklahoma City FederalBuilding on April 19,1995.In faith that the funds would bo forthcoming to cwer expenses, Judy L. Albert, Clinical Coordinator, and Chair of the EMDR Association Disaster Response Committee, arrived in Oklahoma City on May 5th. Dr. Sandra Wilson, Research Coordinator, followed on May 9th to assess the feasability of a research study. After Judy conducted an assessment ofthe community need andpositive receptivitytoEMDR, Dr. Francine Shapiro and Robbie Dunton made a special written appeal to facilitators interested in donating their expertise, time, and financial support to help the victims of the bombing. They were requested to answer a detailed questionnaire used to aid in the selection of the most qualified and experienced volunteers. The response has been marvelous with thirty national trainers and facilitators offering to help in the healing effort. Tentatively we are planning to have a t least two EMDR therapists in Oklahoma City for the next 3 months or longer. We already have in place two office locations, in both north and south sec- tions of town. Many doors are opening as we network and educate commu- �EMDR Network Newsletter 1996 Issue 1 nity and mental health professionals about EMDR. The first six EMDR sessions have had excellent results with concluding comments such as, " 1 got me back." "These are tears of joy which I havenot felt in over 10 years." "I'm whole again." "This crap just drained out of me." THE CHALLENGE! EMDR Helping Hands challenges every EMDR trained clinidan to DONATE ONE SESSION FEE to aid in healing the friendly, open, and needy community of Oklahoma City. Please send immediately; tax-deductible donations to help defray the costs to: EMDR Network-OKC PO Box 51098 Pacific Grove, CA 93950 Obtain EMDR Oklahoma City Volunteers Questionnaire if you have Level 1 & 11 training and can donate a minimum of 1 week. Write: Judy L. Albert, MFCC 17610 Beach Blvd #38 Huntington Beach, CA 92647 The response of EMDR facilitators to the request for volunteers for the Oklahoman tragedy has been heartwarming. As of May 15th, we have approximately 30 volunteers. The intent is to remain in Oklahoma City until the end of August for a total of 15weeks, requiring 2 therapistsminimum per week (30) to provide an estimated 500 EMDR treatment sessions. At the request of Virginia Denman, LCSW, an Oklahoma EMDR therapist, Judy Albert was on the scene May 5th andbegan coordinatingagencies, providing treatment, and meeting with the local EMDR therapists. The local EMDR therapists have been incredible in their support of this effort; to date they have provided two free offices for our use, a free onebedroom apartment fortherapist housing, free transportation, and important community networking. They have also offered a southern hospitality that makes a stranger feel like family. I arrived May 9th, to continue the efforts and work that Judy Albert had begun. Karen Kleiner arrived May llth, and as of May 16th, 20 clients have received EMDR treatment. The need continues to grow daily as the community and clients become familiar with the positive treatment effects. Lee Becker and Bob Tinker spent two days here to help determine the most accurate way to assess treatment effectiveness. Steve Lazrove and Stephanie Zack will arrive the weekend of May 20th. Several other therapists have also been scheduled. If you have an interest in volunteering, please fax your information sheet to Judy Albert. This grassroots effort is EMDR at its finest. We are so grateful that we have a treatment to offer to a community in pain that makes ADIFFERENCE. Please donateone EMDRtreatment session for someonein Oklahoma City. If each EMDR therapist would send to the EMDR Network office the cost of one EMDR session of treatment &our cost) we could have enough funds within our own network to fund our own project instead of the continuous begging that has become necessary. Some cost has already been deferred with donatedofficespaceetc. PLEASE SUPPORT OUR EMDR RELIEF PROJECT. Although I have not lived there in twenty years, Oklahoma City is still my home. I grew up there, my family and my roots are there. I have been back several times a year while I have lived in California. On the day of the bombing, I felt like I had been kicked in the stomach. My home had been violated. Now I am here in Oklahoma City with the EMDR trauma team. I see the familiar faces with their usual friendliness and southern ease. Very near the surface, there is a sorrow so heavy that I feel it everywhere. No one has been left untouched. It is in the voices of my friends and on the faces of the people I have contacted. I hear their stories--so many funerals, so much pain, so many tears, so much anger and disbelief, so many distraught children, so much fear, and so many memorials-flowers, pictures, and ribbons to commemoratethe dead. From those I have treated with EMDR the horrors emerge. A baby dropped by a male nursemed Cross volunteer as he is running out of the building (when the first rescuers had to evacuate fearing another bomb) had been found. The baby, probably dead, covered with blood and slick, is impossible to hold with the nurse's thick, bloody gloves. He feels responsible for the baby's death. The baby haunts him. He sees the baby, feels the baby's cold hand, and sees the baby's blue shirt with the "OshKosh emblem every waking moment and in his nightmares. He has lost fdteen pounds, cannot be with people, cannot concentrate, and lost his job four daysago. Hisstory is but oneofmany, his pain andhorror unique tohim, but also felt to some degree by all. The work is hard and very rewarding. The people are warm and welcoming;naturally skeptical ofEMDR, but very receptive. I am grateful to be here. > �EMDR Network Newsletter 1995 Issue 1 EMDR ResearchJTraining Institute The EMDR Researchmaining Center at MRI is looking for individuals who want to take part in two research projects; (1) Victims of natural &asters and (2) Smoking cessation. Any therapists who have clients interested inparticipating, pleasecall Cliffkvin, Ph.D. (415) 326-6465. Babies Anyone using EMDR andlor other body-mind therapies with babies, please communicate with me. I am willing to facilitate a round robin exchange of letters from all w e r the world and I am also interested in an EMDR perinatology study group in the East Bay. Contact: Sheryll Thornson, 1641 Hopkin St., Berkeley, C 94707, (510) 525-8031. A Spiritual Insights If you have clients who have reported experiencing spiritual openings or insights during or after EMDR sessions and would like to share these vignettes, please write up these cases and send them to: Laurel Parnell, Ph.D. 22 Von Ct, Fairfajc, C 94930. A (415) 454-2084 Published? If you are an EMDR trained clinician and have had any books published, please contact the EMDR office at (408) 372-3900. Research Subjects Needed Research subjects needed for PTSD outcome study, using EMDR and another proven treatment for PTSD. Potential subjects must be Kaiser Permanente Health Plan members able to receive treatment in the South Fluent in a 2nd Language? Bay Area. They must meet DSM-IIIAny EMDR trained therapists fluent R criteriafor PTSD, be stableon mediin a second language, please contact cation, not suicidal, have no litigation the EMDR office at (408) 372-3900. pending, no drug or alcohol abuse or dependence, no Multiple Personality Disorder or Dissociative Disorder, no Success with Schizophrenics? psychosis, and must have had sympAnyone having success treating toms for greater than one month. schizophrenia using EMDR. Please Since this is a randomized study, subcontact; Carol A. Anderson, 4781 E. jectsmaynotbe assignedto the EMDR Gettysburg Rd., fiesno, C 93726, condition and therefore, it is imporA (209) 445 8522 tant that they are not referred with the intention of receiving EMDR. Benefits to participation are that the Addictions individuals will receive careful evaluI would like to hear from Level I1 ation, treatment implementation and trained clinicians that have experi- follow-up, and will add to our knowlence using the addiction protocol with edge of treatment for PTSD. Once clients. I am summarizing results for again, it is important to remember the 1995 EMDR Conferencethis June that we cannot accept subjects into 95 in SantaMonica,Calif. Please write, the study who expect EMDR because call, or fax: A. J. Popky, M.A., 17461 they may be randomized to an alterPleasant View Ave., Monte Sereno, native therapy. All patient referrals C 95030 408-395-8542, A must be willing to receive either treatOF fajc 408-395-0846 ment. For questions and referrals, please call Linda Kolstud at (408) 236-6 763. RETIEMDR Practitioners interested or experienced in RETIEMDR, please contact: Dennis Coates, 216 Avenue P South, Saskatoon,Saskakhewan S7M 2W2 (306) 665-2788or (306) 242-6847 1995 International EMDR Conference June 23-25,1995 Santa Monica, California �. . . . . :..:: . :,:,: ::y:: ,,:.: :::::>>:::,::::::.. .................................................................... . . . . . ......... . . . . . ......... . . . . . ......... . . . . . ......... . . . . . .......... . . . . .......... . . . . .......... . . . . ........... . . . . . .......... . .. . . . ......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ." . . . . . . . . . . . . . ../........... .......... ........ . ..:':. . ::,.:.:,:..,:,:, ...................... .............................. ......:.:.:.:.:'::.:.:.:. :,:,s::;:, . ..... ......... ::.:.;.;.:.:.:s:', : .:.*:.: ....... y:: . . . .. : ................................................................... ....,.:,:,:,:,. ........... :..,.......... :.:,............................. .............................. . . . . . . . . . . . . . . . . . . . . . . . ....::...... ..: ..............................l .. -; . : . : . ..... ...:...:.:.:.:.:.:. . ..:.,.>:.:.x:.:... .,:::..::::::::<:. .......:,';.:.:::.'..>:.:.:.:.:.:.,.:.>>:.:.:.:.:.:.:.:..<*?;::::::::>:: :: .. . . . . . . .. . . . . . . . . . . . . . . . ... . . . ... I . : .>,.,: ...... . . . . ..............'. . . ' ................................. . . . . . .................................................................... ...:.... : .................................. .'.......:; ;::........................... .. .................................. :............. :: .......... .:.:.:.:.: ..... .:........................... ............................... . . . . . ..,<, . . . . ..:.:.:.:.:.:.:.:.: ............... :..;.;.:...:.:.:.;.:.;... ....................... ::' ....................... .. ..................... ............................................. ......................................... . . . . . .. , . . . . . .......... . :. . . . . . . .;.:.:.:.:.:.:.:. .: .::: .,.:.::.:..:..:.:,:,:.:,:,:.:.::.::..:..:; :.............:... ................................................ ... .. : : >:.:.: ......................................................... . :: . . . . . . . . . . . . . . .:..............:2 ........................................................................................................ ::.::.:.,.:.:.:.,..:.:..:.>:.:.:,:,:.:.:.,.::,: :,::::.:.>:.:.:,.......... .......................... .....::.......... . .: . . . . . . . . ...................................................................................... . ............................................ N&*&;A r . , : : : imD:R$SUbY'~RQupgg$&,;@$~gj;j@j$;*~;;~&i;:;;jj ~ ~ i j ~ ~ w ; i ~ ~ t t f f ~ $ k I ~ C ji;jk:; o ~ ~ $:jj o CENTURY CITY/SANTA MONICA REDDING Robert Goldblatt (213)917-2277 Coordinating a new group 90067, 90401 zip area for West L.A. DaveWdson (9 16) 223-2777 Meets monthly a t the Frisbee Mansion on East Street. Discussions, case presentations, videos, role playing, troubleshooting. CERRITOSICENTRAL CITIES Pauline Hume Pat Sonnenburg Coordinating a new group. Open (213) 869-0066 (310) 924-7307 CUPERTINO EXST RAY Edith Ankersmit (610) 626-6297 Meets 3rd Fri. 7:30pm. Case discussion only. Group is closed to new members, willing to coordinate a new E. Bay group. EAST RAY/AL&wY Sandra Dibble-Hope (6 10) 843-1396 x48 Meets let Mon. 8 - 9:30pm, 1036 San Pablo Ave., Ste. 8. EAST BAYIOAKLAND Hank Ormond (610) 832-2626 Meets one Friday a month. Call for time 8 day. Open FRESNO Darrell Dunkel (209) 436-7849 Meets let Fri. at Frewo VAMC. Primary cam discussions. Nancy Stark, MFCC (209) 292-1700 James Shepard, MFCC Meets every other Friday. Call for information. . - SACRAMENTO G r y Bauer er (408) 973- 1001 Meets 2nd Wed. 2:00 3:00 pm. Case condtation. Open - RIVERSIDEISAN BERNARDINO Byron Perkins (909) 737-2142 Meets 3rd Friday of every month, 9:30am 11:00am. FULLERTON Curtis Rouanzoin Jocelyne Shiromoto Meets 2nd Tuesday from 9:30 - 11:30 AM. (714) 680-0663 (714) 966-1650 Jocelyne Shiromoto Open. Call for time. (714) 966-1660 HUNTINGTON BEACH Bea Favre, Pq.D. (9 16) 972-9408 Connie Seam (9 16) 483-6069 Meets third Friday of every month 1:00 3:00pm. At 2740 Fulton Ave., Sacramento, CA 96821 - SAN DIEQO Jim Fox, MFCC (619) 260-0414 Meets second Friday of Each Month, 9:30am 11:OOam. - Arthur T. Horvath, Ph.D. Call about meeting times and places. (6 19) 466-0042 (6 19) 434-4422 Mary Anderson Meets 2nd Friday of every month from 9:00 - 10:30am. Primarily case discussion. Call regarding availability. Elizabeth Snyker (6 19) 942-6347 Meets 3rd Wednesday of every month, 9:OOam 10:30am. 191 Calle Magdelena St., Ste. 230, Ehcenitas, 92024. - SAN FRANCISCO Sylvia Mills (416) 221-3030 Meete Friday, call for next date. Potluck dinner and cam discua- sion. New members welcome. Stan Yantis (416) 241-6601 Meets 1st Wed. 8 10pm., 180 Beaumont St. Please call to confirm. Caw discussion and group process. Open. - IRVINE SAN LUIS OBISPO Charles Willrereon Meets ad hoc a t Pacific Graduate School of Psychology in Palo Coordinating a new group. Contact Florence. SANTA CRUZ AREA Meete the 3rd T h u s . 12:OO-1:30pm a t Mission Oaks Hospital, Dwight Goodwin Meets alternate Fridays, 9:30am 1l:30am. - SOLANO1 NAPA COUNTY Micah Altman Willing to coordinate new group. Call if interested. Coordinating a new group. MARIN COUNTY SONOMA COUNTY MONTEREY Robbie Dunton (408) 372-3900 James Pratty Coordinating a new group. Open Marguerite McCorkle WEST LOS ANGELES (707) 226-6066 NEVADA CITY/QRASS VALLEY (916) 477-2867 Geoffry White David Ready Call for time. Open PALMDALEXANCASTER Elizabeth White Coordinating a new group. Open PAL0 ALTO Ginger Gileon Seeking new members. Contact Ginger. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter Newsletter Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter, 5(1), 1-16 https://d1y502jg6fpugt.cloudfront.net/13023/archive/files/aad07be90ee0cd2a32fa5f207b9fb007.pdf?Expires=1790208000&Signature=HKEdADb5MP-oc1sYPPWT8P3wngs-Kxhzt2Y0gzC1pqXczLWdsPbJrAVBmCHap4MFogPH2wilfj6p%7E%7Ezz1qBgsNIgWRfiCLMUCP0K8J0wM9%7EvuqX9DKvmVfeMd%7EY4t0wnpGXIlHzZGLnNq3w4CFJ2W2Gs-SpBQHQjbitokIRnvulbu9n6RoqwRGzryoF6BWt-BI53VX%7EdihWFY8xlF5CspjZHgZXHkpVipwBXlTGBlytklKy1oEmBBbt4MJpRuMylnp%7E9OQBeye%7EOOxePOkn5jEUOcrVmhwzdpT8njUqsEgG73saoGU7QS%7ExTLybfiBKYnNY%7EpDH%7EQOOtAfglDKue7A__&Key-Pair-Id=K6UGZS9ZTDSZM 808bdc9fc658731a8c5018e3d01e90bc PDF Text Text <@> WLIWOIILMC. EMDR Network N e w s l e t t e r 1 9 9 5 Issue 2 1995 Issue 2 Network Newsletter EYE MOVEMENT DESENSITIZATION AND REPROCESSING Copyright O 1995 EMDR NETWORK, INC. P.O. Box 51010,Pacific Grove, CA 93950-6010 (408) 372-3900 FAX (408) 647-9881 Table of Contents STRAY THOUGHTS Francine Shapiro, PkD. Senior Research Fellow Mental Research Institute Palo Alto, CA PROCEDURAL ELEMENTS Over the years I have been asked a number of times why the EMDR pro- cedural steps are done in the present order. I would like to give a brief summary to clear up any confusion, The client is asked to start with an image because that allows an initial access to the stored information. The image also is assumed to have within it a Of the cues. The cognitions are then elicited in order to handle the more "intellec- tual" ormeta-perceptualaspects while the client is relatively disengaged fromthematerial. Oncetheclienthas a high level of distress, it is often much more M i c u l t to elicit the Posi- . tive assessments. ~h~ negativecognition is di. rectly after the image in order to gain access to- and heighten- the strata of dysfunctional information t h a t would be relevant to self-assessment. Identifying the negative cognition a t this juncture allows the client to change h i s h e r frame of reference to a point necessary to evaluate it. By this befPs that it is to see and undeserved. The positive cognition is then elicited because it can more easily be identified before Stray Thoughts .......................................... Francine Shapiro, Ph.D. ............... 1 A Case of Past Life Interweave. ........... Stephan Bodian, M.A. ................... 3 Newsletter Submission Information. ..................... ............................... 3 . . Eye Movement: A Method of Axis Rotation ...................... . . . ......................... Marcia C. Cotton, Ph.D. ................ 4 . Finding the "PATH"in Pathology: An Approach to Cognitive Interweave. .... Chad Glang, Ph.D. ......................... 5 Targeting Defensive Avoidance and Dissociated Numbing ........................ . . . ...................... Knipe, Ph.D.. ................... . Jim . 6 A Modification of the EMDR Trauma Treatment Protocol .................... . . .......................... Steve Lazrove, M.D. ..................... 7 On Circumcision, Other Childhood Medical Procedures, and EMDR ........................................................ Sheryll Thomson, MFCC ............... 8 Tidbits ..................................................... ~ o h M arquis, Ph.D. ..................... 8 n .......................................................... Chad Glang, Ph.D. .............. :........ 9 International Update. .............................. Francine Shapiro, Ph.D. ............... 10 . ................................. 10 . . Regional Network Coordinators .......................... EMDR in Belgrade Former-Yugoslavia. ........................... . ....................... 13 . Help wanted ....................................................................................................... 14 EMDRIA, EMDR International Association ................... . . ..................................Ronald Doctor, Ph.D. ..................... 14 The Poetry of Loftus and Calof............. William Zangwill, Ph.D. ............... 16 A Response to Dr. Zangwill. ...................David Calof ................................... 17 Vision Therapy. .......................................... Gilman, O.D., D.O.S............ 21 Greg Letter to Dr. Shapiro. ............................. Jim Kohl .......................................... 23 California Study Groups. ................... . . ...................................................... 24 1995 Conference Audiotape order form. ............................... . ................. 25 . . the dysfunctional material is fully accessed and because its direct placement after the negative cognition allows the client to more easily choose a polar opposite. A U N concept is, of ~ ~ course, associated with a "Yes" concept. It an important change of reference. Even though the Positive cognition may not be highly probable during the Present state of mind, it also offers apotential light a t the end of the tunnel. Eliciting the information also begins to activate those neuro networks that contain the positive information, thereby theoretically making them more accessible for assimilation into the target network, Asking the client to then pair the image and t h e negative cognition the to be stimulated to a greater degree: So the c h i c i a n would need to have done all the preparation work before hand. The client is then asked to identify the emotion because while it is useful to have a label for c h i c a l purposes, it also detnands more of an evaluative/ cognitive assessment This is followedby the identification ofthe SUD l e v e l a l s o for evaluative purposesand then the location of the body sensation. It is preferable to ask for the SUD first, because those clients who have a difficult time locating sensation can be helped along by asking: "You said you felt a 7 SUD. �EMDR N e t w o r k N e w s l e t t e r 1 9 9 5 Issue 2 Where do you feel the 7?" This final step joins the client's awareness of image, negative cognition, and body sensation so that reprocessing can immediately begin. r therapy in our profession, based on clinically unproven conjectures and theories, that has caused harm to clients. While some clinicians report that they prefer doing the steps in a different order, I suggest evaluating the reasons for the present order that I have described and then rethink the variations. If you still believe another way would be better, by all means write to me with your reasons and results. Since EMDR is now in the hands of approximately 14,000 clinicians, it is being used within the context of many different models, by therapists who were schooled with many different presuppositions. I have heard a numberofclinicians makestatements like: "You have to get worse before you get better; You have to get to the really horrible memory that underlies all of it; You have to reexperience and abreact all the trauma; You have to be in therapy for years to get well and stay well." The different therapists that make some or all of these claims even come from a variety of clinical backgrounds and models of therapy. However, I have not found those presuppositions to be true in my eight years of EMDR practice. Nor have these presuppositions been validated by the work of other EMDR clinicians. If these concepts were true, then by now we would have had reports ofclients who were seen in 1987199 1 regressing and becoming highly symptomatic again; yet, the reports I have received show them holding steady. EMDR has to continue to change and grow for it to remain vital and vibrant. CLINICAL EVALUATION AND RESEARCH I want to reemphasize that gross deviations from the procedural steps might best be inaugurated only after sufficient clinical evaluation and research has been done. There are a sufficient number of single-case and case series designs to make an initial investigation feasible. For instance, I have heard clinicians say that they do not use the negative or positive cognition, etc. Please make sure you are making your choices for valid reasons, not simply because it is easier. Most of the steps have multiple reasons for being there. The concise procedural elements not only access material for processing, but serve to .aid in clinical containment. The client will generally be less disturbed during and after processing if all the steps and procedural elements are maintained (even if in a M e r e n t sequence). The eight phases of treatment are also delineated for that purpose. At the annual EMDR conference we had a "Town Meeting" and panel discussion of "What Can We Learn from the Falsemelayed Memory Controversy." Ichairedthepanel with Walter Young, MD, Wendy Maltz, LCSW, and David Calof. What we need to keep in mind, I believe, is that regardless of what side of the controversy you feel most in tune with, there is hardly any disagreement that there is I think we have to be very wary of molding our EMDR clinical practices to previous models because EMDR with its rapid treatment effects, encourages a paradlgm shift. If any clinician believes that a different paradigm is more appropriate, I would only ask that a thorough examination be done by researching the observable treatment effects derived from both models. Controlledresearch on EMDR has shown that robust effects are maintained after 1 to 3 sessions of treatment (Renfrey & Spates, 1994; Shapiro, 1989; Vaughan, et al., 1994; Wilson, Covi, Foster, & Silver, 1995; Wilson, Becker, & Tinker, in press). Clients are able to leave therapy symptom-free in weeks, or months, of therapy instead of years. Careful c h i c a l evaluation has indicated that even those clients with diagnoses such as dissociative disorders and borderLine personality disorder are showing great improvement or complete resolution within much shorter treatment time (e.g., two years) rather than decades of treatment. .If variations of model and procedure are not obtaining the same positive results- if the client is undergoing more suffering, more severe abreactions, more decompensation prior to improvementI would ask the c h i c i a n to reexamine his or her premises. I would ask the clinician also to abstain from calling what he or she is doing EMDR--or at least offer clients sufficient opportunity for informed consent by letting them know that the procedure is not being applied as it is taught. As the originator of EMDR, the textbook I wrote (for now) offers the mentalhealth profession standards of practice in EMDR. It is based on eight years ofpersonal experience developing and refining the method, plus a compilation of cases and reports from trainedclinicians and researchers over the past six years. I want to stay open to change and am very wary of any practice that smacks of stultifying orthodoxy. That involves an adherence to "set in stone" EMDRpatterns of practice as well. I believe that we are going to have to be very careful in the coming years to avoid adhering to beliefsout ofmere tradition, but rather focus on concepts of client safety and enhancement. It is vital that EMDR evolve to another plateau, with input from all of you, so that it is a t least as different in 2007 as it is now from 1987. However, let us make sure the changes are beneficial for clients and offer equivalent or better treatment results. COURAGE, INNOCENCE, AND HOPE Virginia Denman is the EMDR clini- cian who opened her Oklahoma City home to the EMDR relief effort. At the EMDR annual conference, she brought a poster that had been made by her state government to recognize the openhearted response of the na- tion as a whole. The poster was per- �EMDR N e t w o r k N e w s l e t t e r 1995 Issue 2 sonally signed by the Governor of Oklahoma and the Mayor of Oklahoma City to give special thanks for the work of the EMDR clinicians. I t has a picture of the ribbon worn to remember the bombing: purple for courage, white for innocence, andyellow for hope. The poster says: For compassion on a national scaleA vast shining outpouring, u n precedented in its depth, and scope, and need. For countless, tireless h o u r s For words and tears and prayers received from states united b~griefjandabeliefmgoodness. And for recognizingthe strength Oklahomans hold-seeing the courage and caring that lives here, that lives on. Ribbons were sold a t the conference I saw to supportthe relief them on practically everyone's lapel. It is a privilege be a part of this expanhg of open-hearted " nicians. Thank you for making it possible. References Renfrey, G & Spates, C.R. (1994). Eye movement desensitization and reprocessing: A partial dsmantling procedure. Journal of Behavior T h e r a ~ v E x ~ e r i m e n t aPsvchiaand l 25, 231-239. Shapiro7 F. (1989) Efficacy of the eye movement desensitization procedure in t h e t r e a t ment of traumatic memories. Journal of Traumatic Stress, 2, 19-223. Vaughan, K., Armstrong, M.F., Gold, R., O'Connor, N., Jenneke, W., & Tarrier, N. (1995). A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in posttraumatic stress disorder. Journal of Behavior Theraov and Exoerimental Psvchiatrv, 25, 283-291. Wilson, D., Covi, W., Foster, S., & Silver, S.M. (1995, Vay) Eye movement desensitization and reprocessing and ANS correlates in the treatment of PTSD. Paper presented a t the American Psychiatric Association annual convention, Miami, FL. EMDR Network Newsletter Submission Information EMDR has generated a tremendous amount of enthusiasm amongpractitioners and all of us are anxious to read about the latest developments in, and/or experiences with, this exciting method. Because of this enthusiasm and desire to acquire more knowledge, I believe that it is important to produce apublication thatprovides a forum for articles that are more formal (e.g., research, protocols, etc.), as well as for those that are less formal (e.g., case studies, innovative ideas, etc.). TO this end, the following represent the guidelines for submissions to the Newsletter: Send articles to Lois Allen-Byrd, Ph.D., Editor, EMDR Newsletter, 555 Middlefield Road, Palo Alto, CA, 94301. Please include home and business telephone numbers. professional degree, location of practice (city and state only), professional affiliation(if applicable-university, if a lecturer or teacher, and/or institute, if a n associate). Example: John Smith, Ph.D., John Doe University, Johnson, WA. If possible, please submit articles on a diskette, IBM format. ARTICLES SHOULD BE DOUBLE SPACED WITH WIDE MARGINS. APA STANDARD AND STYLE-BOTH TEXT AND REFERENCES MUST BE IN ACCORDANCE WITH APA STANDARDS. ALL SUBMISSIONS ARE SUB- JECT TO EDITORIAL REVISIONS. Proofreading of material is required before submission Authors submitting a manuscript do so with the understanding that, if it is selected for publication, copyright of the article is assigned to the Newsletter. Because the Newsletter depends on you, the members of the network, I welcome any suggestions or comments that you may have. I f there are any questions regarding the above, I can be reached at (415) 326-6465. Wilson, S . A , Becker, L.A.,&Tinker, R.H. (in press). Eye movement desensitization and reprocessing (EMDR) treatment for psychologically traumatized inhviduals. Journal of Consulting. and C h i c a l psvcholoPv, perience into the reprocessing of a childhood memory. Stephan Bodian, M.A. An Italian-American in his early 40s, Peterpresented with the problem that h e had become deadened to his own emotions because he believed that other people h d not welcome his intensity. This deadness hadprevented him from becoming deeply involved with a woman; instead, he had a series of superficial affairs that left him feellng unfulfilled and his needs unmet. Although I spent 10 Years as a Buddhist monk and mehtation teacher before a I have always considered myself an agnostic on the issue of reincarnation. So it was much to my surprise, and without any prompting on my Part, that one of my clients recently had a past-Me experience d u r W an EMDR session and then s ~ o n t a n e o u swove the exl~ In his family of origin, there had always been quite a bit of chaotic, openly expressed emotion which to Peter seemed to be hurtful and out of control. Based on his childhood experiences, he believed that, "If 1 let myself feel, I'll go out of control." When we targeted this belief, the memory that, emerged was ofhis family, he among them, arguing and yell,g a t the home of his grandmother. A CASE OF PAST-LIFE INTERWEAVE �EMDR Network N e w s l e t t e r . 9 9 5 Issue 2 The feeling was one of deep sadness. The positive cognition was: "It's O.K. to feel. I won't go out of control." This session was the key piece in a series of sessions on the issue of be~omingmoreomfortablewith his own c emotions. Peter now reports that he fmds it much easier to experience and share his feelings, including his angry and aggressive feelings, and as a result, he can be more open and intimate with women than he had been able to in the past. As we began processing, Peter first had a.memory of having his feelings squelchedas an infant, then amemory of his umbilical cord being cut. Next he was back in the womb, with a peaceful, loving feeling in his heart. During the next series of eye movements, he had a brief glimpse of a past Me in China, then a clear image of himself as an Indian warrior. The. warrior, who was preparing for battle, felt angry andpowerful, but alsopeaceful and self-contained. "Anger and peace can go hand in hand," Peter reported realizing. During the next series, he felt a wave of terror as the battle approached, but the terror quickly turned to a deep feeling of peace.' In the next series, Peter was back a t his grandmother's house, feeling uneasy that the situation would get out of control. Then his Indian warrior alter-ego appeared in his grandmother's living room, and he realized, "I can be here and love my family, but not get caught up in their drama." The uneasiness changed to peace. In the next series, Peter imagined himself sitting with a woman, feeling quite comfortable with himself, as he realized, "I can be myselfwith her and that's O.K." Then he spontaneously shifted to an image of himselfwith his little daughter on his knee (in reality he has no children). "I have the capacity to be a family man," he reported; as his heart filled with love. "It's O.K. to be a man and have masculine feelings," he said. "It's O.K. to feel. I won't go out of control." As he felt how true that statement was for him now, he superimposed it w e r the original memory as he followed lay fingers. By this time, the memory had lost all of its charge. "I have a soul," Peter concluded, with a big smile on his face. I received Level I EMDR Training in November 1993 in Austin and Level II in July 1994 in Denver. The bulk of my clients are adult survivors o f childhood trauma with PTSD, DD, orBPD diagnoses. In using EMDR with these clients, I noticed that they would sometimes get stuck (i.e., not continue to resolution/SUDs=O) after several sets of lateral, side-to-side eye movements. I sensed that they somehow needed to "access more areas of their b r a i n and so began to experiment with the pattern shown in Figure 1. Figure 1. Methodof axis rotation for eye movements sets. I have been using this pattern, or some variation of it, for some time now. With new clients, I usually begin with the conventional horizontal, side-to-side eye movements for i ' respond in this lateral mode. With these new clients, I will then gradually move to doing some portion of the circle, usually beginning the set with about 12 lateral repetitions and then moving off the horizontal plane only a few degrees of angle for each succeeding repetition, arriving usually to about 45 degrees in 24 to 27 repetitions before taking a break from that set (see Figure 2). Figure 2, Rotation of EM axis to 45 degrees. With each succeeding set, I will again begin at "1" and move further and further through the circle, usually achieving the completion of the circle over a course of about three or four sets. I then repeat the complete circle (using from 24 to 48 to sometimes 60+ repetitions per set) for as many sets as needed to move the SUDS to zero. Having worked with this method of axis rotation for some time, I have noticed quite frequently that many clients willvisibly begin to relax (i.e., shoulders sink, face relaxes, client takes a deep breath, client yawns) when the revolving axis approaches or reaches the vertical, up-and-down motion. o n e client who has had years of experience with many alternative "mind-body" therapies, actually commented that it was at that vertical location that she began to feel the traumaltension release in her body. She stated that her criteria for treatment effectiveness was experiencing the release in her body, and that when she tracked vertically and then felt her body begin to release, "that was how I knew it was working." With some clients, I have felt pulledto leave my hand a t one angular location the first few sets. This provides a (which I wl call a "criticaldegree")or il baseline, allowing me to see how they another for a greater portion of the �EMDR Network Newsletter 1995 Issue 2 set. Usually this has occurred at the 30- to 40-degree or 140- to 150-degree angles (see Figure 3). My sense is that they may be accessing something a t this angle and need longer to process here. This is entirely speculative (intuitive) and NOT empirically validated, of course. am very careful not to move too far from the horizontal axis too rapidly or too early in treatment. This caveat is equally applicable to clients who acknowledge abuse, but whohave dissociated much of the traumatic affect in order to remain functional. Ellen is a 34-year-oldhomemaker and mother of two young children. She was feeling deep guilt over an abortion she had a t age 20. We targeted the abortion scene and Ellen's SUDs went quickly from 10 to 4. Her cognitions, however, were stuck along the h e s of "What does the baby think of me? It hurt and suffered, so I deserve to also." I do, however, use the full 360-degree rotation of the axis when doing installations. This includes work done prior to targeting trauma in order to establish inner resources and build "self capacity" (e.g., safety, self-soothing, and relaxation skllls). It also includes using the 360-degree rotation in Phase Five of EMDR Treatment (Shapiro, 1994). I had her close her eyes,hold a plllow, and talk to "her baby" (her term). During a strong abreaction, she said things m e , "I'm so sorry 1 h d that to you. You'd be swimming, ridmg your blke, having fun now. I ruined it. I References hope someday I can hold you in Briere, J. (1995, February). Treat- heaven." I t seemed clear that Ellen felt a deep need to 9 maintain contact .v Featured speaker a t the Disso- with this child, and probably had for ciative Disorders Study Group of all these years. The only ways she Houston Annual Symposium, Hous- had found to maintain were through guilt, or anticipating reunification ton, TX. after her own death. Fine, C. (1994, March). EMDR and structuredtheraDv Paper Seeing how tenderly she was holding presented at the Annual EMDR Con- her "baby" in the moment, and how much love flowed from her as she ference, Sunnyvale, CA. spoke, I suggested that she try this Shapiro, F. (1994). The eight phases statement: "I can feel my connection of EMDR treatment. EMDRNetwork to this baby in a loving way; I don't need to do it through pain." Visibly Newsletter, 2, 1-4. relieved, Ellen responded, "I Like this better!" We were then able to complete t h e session satisfactorily. Figure 3. The EM axis is rotated to a "critical degree" and repetitions are done at that angle before completing the full circle of rotation. With clients who are more experienced in EMDR (i.e., have been doing EMDR comfortably and effectively [SUDs to 01for a number of sessions), 1may begin the session with the circle pattern (or some portion thereof, if their energy dictates) immediately. This is especially true if we are doing ongoing work on some aspect of their trauma. If the client is working a t a more cognitive level (e.g., examining a dysfunctional belief), I often stay with lateral, horizontal movements for the full set. If, on the other hand, they are working through residual affect, the full circle has proved time and time again to be especially effective in its thoroughness andcompleteness of bringing reliefllowering SUDs to zero. RED FLAG. Because rotation of the axis serves to get clients "unstuck," it may also facilitate their accessing traumatic material sooner than they are ready to handle it. As John Brier'e (1995) has pointed out, it is absolutely essential to maintain the balance of what he calls "selfcapacitf and exposure to traumatic affect so as not to exceed what he calls the "therapeutic window" (Briere, 1995;cf. Fine, 1994). Therefore, with clients who have not reported early trauma, but whose symptoms inhcate this possibility, I egy can guide the therapist's thinking in utilizing cognitive interweave. , FINDING THE "PATH" IN PATHOLOGY: AN ASFROACH TO COGNITM3 INTERWEAVE Chad Glavag, Ph.D, I One approach to using cognitive interweave is to view the client's symptom as an ineffective attempt to meet a healthy need. If we can correctly identify the underlying need, we can seek a more efficient route toward its f u l f i i e n t . I think of this as finding the " p a t h in pathology. The following twocasesillustrate how thisstrat- , Jack is a 37-year-old brick mason. From his early teens until age 32, he was a heavy drug abuser. His drug career was dangerous by virtue of the quantities and types of chemicals he used, and also because of underworld dealings involvingviolence and weapons. He had seriously injured others and had been suicidal on several occasions. In spite of all this, he had changedhis Life significantly and when he sought therapy, he hadbeen stable and supporting his wife and stepchildren for 5 years. Though he had stopped using heroin, hallucinogens, and cocaine, h e continued to smoke marijuana several times a week. He �. . EMDR Network N e w s l e t t e r 1995 Issue 2 willingly gave this up, however, at my suggestion. After several successful EMDR sessions dealing with childhood abuse, he was ready to work on his most frightening symptom: the nightmare he continued to have several times a week. Jack's dream took him back to a scene i which he had just purn chased a large quantity of cocaine. "I was in my room, shooting up lots of coke and smoking pot. Then I asked myself, 'How much can I do? I kept injecting until I passed out-twice. Then I shot once more, sure that this one would blow my heart. I passed out again and woke up the next day. I knew I'd nearly killed myself and flushed the rest of the coke down the toilet. It's that last hit that wakes me up screaming, now, drenched in sweat." Targeting the memory brought up issuesoffeelingrejected,empty, alone: "Where were my rescuers? When he seemed stuck in this material, I asked him to picture himself in bed, having just awakened from the nightmare. Jack: "I'm embarrassed for my wife to know my past still has a hold on me. I like my life now, but I'm afraid if I have onejoint, I'll want more. I could slip back, maybe not all the way. I know I'm stronger now, but I obsess anyway." Therapist: "Perhaps your excessive worry is the way you've found to stay safe." Jack: "When you say that, I feel instantly more relaxed." (EM) Jack: "Yes, more relaxed." Therapist: "I think your dream may serve as a warning to you. When you get a little scared,the alarm goes off to make sure you don't slip." Jack: "Yes!" I'herapist: "Maybe you could thank your nightmare for the goodjob it has lone keeping you safe, and let it know you can take over now." Jack: (laughing) "Yeah,thanks! I can take over that job now. I know I'm strong enough." Jack: "I don't need the nightmare anymore. I can do it!" TARGETING DEFENSIVE : AVOIDANCE AND DISSOCLATED NUMBING Jim Knipe, Ph.D. Colorado Springs, CO For some clients (perhaps 10-15%),I have found that the effectiveness of EMDR (Level I, Level I1 version) is blocked or hindered by defensive processes which may or may not be conscious or voluntary, and which function to protect the individual against unpleasant affect. In such instances, it has frequently been useful to use the 0-10 scale to measure aspects of experience other than unpleasant affect. This is similar to the Level of Urge (LOU) innovation designed by Popky (1994) and used as part of his protocolfor the treatment ofsubstance addictions. Since addictions can be thought of as substance-induced avoidance of feeling, I have tried adapting the LOU to avoidance itself. For example, a woman in her mid-30s, a survivor of childhood sexual abuse, had successfully used EMDR to resolve several troubling present-day situations, but felt extreme terror, which then went to numbness, whenever she contemplated using EMDR with memories of her sexual abuse. Week after week, she would be frustrated by her own quasi-voluntarypattern of avoidance, being late for her session, and then in the session, talking about "easier" problems, and even jokingly expressing a desire to run out of the room. When she tried to force herself to think of the abusive memories she would experience a numbing feeling. At the end of each session, she would express enormous frustration with herselffor not "workingon the abuse," ~ n l y repeat the pattern the followto ing week. Thus, after several weeks, at the beginning of a session I asked her, "When you think about thepossibility of using our time today to work on your memories of abuse,how much do you want to talk about something else, 0-10?'She stated that it was a " 10'' and was able to locate this " 10" in her body sensations. We then began the eye movements, and traumatic information began to come up and was metabolized, but in a way that appeared more comfortable andsomehow "softened," with the client feeling much more in control. Whenever I went back to target, I would phrase my question in the following way: "When you think of continuing today to work on the issue of your abuse, how much do you want to talk about something else, right now, 0-lo?" What this approach seems to do is allow clients to keep their defense of avoidance as they do the work. What occurs as the levelof urge to avoid the trauma drops to 0 is that realitybased and health-inducing information regarding the trauma spontaneously emerges, as is typical in the standard EMDR. The method can be varied according to the particular needs of the client. For example, another client might be asked, "When you picture yourself at age 12 standing there at the door, just after your stepfather told you to come into his bedroom, and you have that vague sense of terror,how much 0-10,doyou not want to know what happens next?" The question should be asked in such a way that the client reports his or her feeling-based to get away from the affect, not his or her more cognitive "wish" or "desire." Sometimes this requires a bit of discussion sothat theclient willunderstandexactlywhat �EMDR N e t w o r k N e w s l e t t e r 1 9 9 5 Issue 2 information is being requested. formulating negative andpositive cognitions. This article points out a heretofore unrecognized obstacle to cognitive restructuring and describes a simple modification of the EMDR trauma protocol that can be quite helpful for restarting stalled processing. Many clients will attempt to force themselves to bring up traumatic images. but then wdl involuntarily "get away" from the traumatic feelings by numbing. Often, this numbness wdl hft away with eye movements if it is targeted like any other body sensation. Sometimes, though, this is ineffective. In such instances, the client is usually able to sense the presence of the traumatic anxiety or helplessness "under" the numbing, or "covered by" the numbing; thus, the client can be asked, "0-10,how much do you want to get away from the anxiety by feeling numb?" Strong dissociative barriers (e.g., numbness without anv conscious anxiety or the amnesiac barriers between alters in DID) probably are strong for a good reason within the ecology of the personality system, and for those clients, this method would, in most cases, be unwise. For others, though, targeting avoidance defenses may make the benefits of EMDR more accessible. Method During EMDR, the patient is told to bring up his or her trauma, and as the memory begins to change, is told (connotatively), "Let it go, it's just old stuff." Fine. It & old stuff. Yet to the extent that the person sees the trauma as redefining his or her self, or as necessary to derive new meaning to existence, being told, "Let it go," can be hstracting or even harmful. This conflict impedes cognitive processing and can disrupt the progress of the EMDR session. References Popky, A. J. (1994, March). Smokintr ~rotocol.Annual EMDR Confer- ence, Sunnyvale, CA. A MODIFICATION OF THE EMDR TRAUMA PROTOCOL Steve Lazruve, M.D, New Hauen, CT Trauma produces a change in our sense of self, our sense of the worlds meaning, of its safety, of its rationality. For better or worse, the victim of trauma is no longer the same as he or she was prior to the trauma. One of the greatest strengths of EMDR is that it specifically acknowledges the need for cognitive re~t~ructuring, as well as serves as a means to that end. 1 I A number of techniques have been devised to help restart processing (changing the direction or speed of the movements, asking what is keeping the SUDSfrom going lower or the VoC from becoming higher, using the cognitive interweave, etc.), usually with good results. However, when a patient is having difficulty letting go of some aspect to a trauma, it may be because it has personal meaning. In this situation, the patient is asked the following specific question, "What about what happened do you to holdon to, and what do you -to let go of?" It is essential that the initial clause use "need and the second clause "want." Discussion Asking, "What about what happened do you need to hold on to, and what do you want to let go of?" accomplishes four goals: 1. It acknowledges that there may be aspects of the trauma that, although painful, carry essential meaning and must be retained. 2. It suggests that not all painful aspects to the trauma are essential and that change is possible. 3. I t places control over the decision completely with the patient. 4. The question is self-reflective: to answer it, the patient must go back into the experience, which restarts the processing. Once an answer is offered, the therapist responds with, "Go with that," and continues with the standard protocol. This intervention may be repeated as necessary. The following is a representative example of the use of this intervention in one type of trauma. Parents dealing with the death of a child often have trouble letting go of painful images. This is not because they are attached tosuffering; rather, they are frightenedof what will happen if they let go of the memories. For example, they may fear that letting go of the pain will mean that all memories of their child wdl disappear and that in essence, the child will no longer exist, will cease to have existed, wdl never have existed. Addtionally, by remembering the original pain, their child is kept alive magically because the parent feels the same pain, merged with disbelief, as he or she did the moment he or she learned that the child died. In exchange for the suffering, the parent does not fully have to accept that the child is gone. Asking, "What do you need to hold on to, and what do you want to let go of?" acknowledges that the parent is doing 1 the best that he or she can, and offers avehicle for synthesis of meaning a t a higher level. As with all therapy, but especially with EMDR, the therapist wdl hear a spectrum of unique personal responses. One mother said, "I want to remember him the way he was, not as I saw him in the hospital." This response signified that the core memory of the child was intact and that the memories of the suffering were not essential. Another parent explained, "I need to find a place for him in my �EMDR Network Newsletter 1995 Issue 2 before leaving the state for a new job. I chose this moment "out of the clear blue sky.") He said, "Well, it's funny you ask this because for the last ten minutes I have been feeling a sharp pain all around. . . there" (the head of his penis). As he moved his eyes, focusing on the sharp pain, it got increasingly dull until it went away. (Incidentally, processing this pain may have elicited, or made him feel safe enough to realize, another related fact-his attitude toward his body.) heart. That place wdl always hurt, but I think that is the way it is supposed to be. I'll put my memories of him there. I don't think it would be right if it didn't hurt." It is common for religious or spiritually oriented parents to speakoffinallyunderstanding what their child's existence meant, often that they had personally received some gift of insight from the child while alive or after death. "What do you need to hold on to, and what do you want to let go of?" is a very general question and is useful in conhtions other than trauma for restarting stalled processing. It also may assist in obtaining closure when the patient is having trouble generating a positive cognition. I I ,I ON CIRCUMCISION, OTHER CHILDHOOD MEDICAL PROCEDURES, ] and EMDR 1 Sheryll Stuart Thornson,MFCC I I was using eye movements with a 47year-old client, J a y (pseudonym), focusing on an unnecessary tonsillectomy when he was about 9 years old. These operations were done on both his older brother and himself-just because this was what was done in those days. He described seeing his brother being wheeled, semi-conscious, out of the operating room with blood coming out of his mouth. He thought to himself, "Well, he's not dead . . . (is he?)." He was then dragged kicking and screaming to the operating room. His parents did not visit him for the 3 days he was in the hospital. He got no ice cream, though he had been promised some. As we were finishing the EMDR processing of this set of incidents, I asked him if h I he had been circumcised. ( ad been meaning to ask about this since he was intensively processing a list of traumas in a short period of time I parents of circumcised boys who read this without, hopefully, spendingalot of time on regrets about the past), I suggest that circumcision may be at least something to keep in the backs of our minds when working with any man or boy, if not a target to focus on specifically using EMDR. You can imagine as well as I the implications for a baby of having part of his most tender anatomy cut off-usually while he is wide awake. Men who can remember this procedure say it is extremely painful. Is this the genesis After moving to his new job, Jay of "castration anxiety?" If so, it would reported, during an EMDR session by be understandable. How much of the phone that his penis felt "unclean" (he parental bonding does this destroy? may not have been able to report this What does the baby feel about his in person). (Knowing his history, I body, his wholeness? What does he believe this may be unrelated to cir- feel toward doctors or rabbis? How cumcision.) This was processed (us- does this affect his temperament, his ing my tapping on my telephone re- capacity for close relationships with ceiver and his moving his eyes on his other human beings? It is possible we own). and weeks later h e r e ~ o r t e d have no idea what circumcision does ,. that he was now able to let any corpo- to boys and men because so many rate politics roll over him. Before he have had this procedure that it would moved to his new job, he had been be hard to compare. extremely anxious about being hurt by corporate politics, and just before I know this is a controversial issue this session, he had been feeling un- and would welcome your thoughts comfortable about his place there. about it, especially about using EMDR Now, two months later, he is seen as with it. Write: 1641 Hopkins St., a kind of guru in this multi-million- Berkeley, CA 94707; (510) 525-8081: dollar business; he feels comfortable (510) 527-3081 (home). and unconflicted about his role and sounds more confident than I can remember hearing him. He has not reported yet on subsequent sexual relations with women. TIDBITS I later heard on the radio a report (the source of which I have not been able to locate) of a study which suggested that boys who have been circumcised have a harder time with subsequent medical procedures of any kind-including a worse reaction to anesthesia and a slower healing-than boys who have not. (Please let me know if you know where I can find this study.) I t has only been in the last 20 years or so that we have begun looking a t babies as sensate, aware beings, capable of learning and of feeling acute pain, even in the womb. Starting from today (for circumcised men or Joha Mmquis, Ph.D. It has been a part of Level I training for several years to teach a signal for clients to use if they want the therapist to stop the eye movements. I have EMDR Network Newsletter Staff Editor: Lois Men-Byrd, Ph.D. Publisher: Arnold J.Popky, M.A. Data Entry: Sharon Lucas �EMDR Network N e w s l e t t e r 1995 Issue 2 found it useful to teach a signal to continue the eye movements a t the same time. This is a usual "come on" charade signal--palm up with fingers moving toward the client. It gives clients an even greater sense of control, and proves useful when they have not finished a scene they are picturing, or if they feel the need of continuing to process an abreaction. I have found it useful to use my left (non-dominant) hand to produce the eye movements. This allows me to write simultaneously with my right hand so that I do not have to interrupt the continuity of movements in order to make a note. It is particularly valuable during prolonged abreactions. TIDBITS Chad Glang, Ph.D. 1. The negative cognition-generating question! "What does that say about you? can be used at any point in the process, when the movement turns in a positive duectiOn. For example, a male client was workmg On the beatings he received hisolderbrother~who hadbeen beaten by their father. "My brother passed on the abuse, but I didn't turn and find another victim." "And what does that say about you?" "I guess I'm a caring person." EM. 2. This is an example of how new positive cognitions (PCs) can emerge. Rather than understanding this as the PCs changing, and i n s t i ~ i h just g one new PC, I have found it helpful to elicit and install all appropriate PCs at the close of a session. I t is as if the client has gotten to a new place, and it can be viewed through many lenses. Some examples: * Amolest survivor, whosepresenting problem had been angry with- drawal from husband and children, had as her closing PCs: "When I face the truth, I feel good about myself." "I'm not responsible." "Mom neglected me." "I'm a good person." "I'm a good mom." "I know I can become more relaxed and loving." * An incest survivor, who had tortured cats with her perpetrator brother, stated her PCs as: "I'm a loving, compassionate person." "I can trust myselfwith animals." "Ican feel at peace when I need to; it's a breath away." * A woman, afterprocessingascene of domestic violence, listed her PCs as: "I am really strong." "I'm getting more aware of what's healthy." "I deserve better than I've given myself.' "I am committed to learning to assert myself." "I am ready for a healthy relationship." After installing a collection hke these PCs, the picture I have is of the client leaving the office with a bouquet of PCs. 3. Anotherway t o e x ~ l o ~ ~ t h possibilities is t~ watch for expressions of delight, and do a set or two. A caretaking female client had followed an EMDR session by setting Limits with her irresponsible daughter. She had a longthat she had overdue confrontation with her husband regarding his driving under the influence, Responding to her beam. mg express;on, I had her do a set, targeting the latter conversation. Her exuberance intensified, a n d she giggled, "I can fly!" It was useful to then look a t some other issues from this point of view. 4. One of the ways I think of EMDR is as a highly efficient means to ask the question, "What is true for you about this?" Wisdom often seems to tumble forth. Though it can be cumbersome, I take nearly verbatim notes. The rhythm which seems least intrusive is to resume eye movements (EM) as soon as the client has spoken, then jot my notes after that set, during the moments the client is resting and gathering words. Sometimes the material seems too good to leave in my file. In these cases, during the followup session, I will review the highlights with the client while speaking into a recorder Almost always, the client has forgotten significant parts. The tape is then a permanent gift from the client to himherself. 5 . When the SUDS will not go below 3 or 4, how can one assess whether the client is stuck or done? Examples I have had: a man who slapped his infant, a parent who had lost a child, a woman grieving an abortion. A question I have found useful is: "If a close friend had told you this story, how disturbing would it be?" If the number is the same, the client has probably achieved an objective view of an intrinsically upsetting issue. If the number is lower, then, "What makes it more upsetting as your own experience?" may help us get moving again. 6. At the end of a client's first experience with EMDR, I like to ask, "What just happened? How would you dee scribe this process?" Some of my fa~ o s ~ ~ ~ ~ ~ vorite answers: "It's a short cut to the centerofyourself, and when youcome back, you know more than when you started... kea closet door that you open, and stuE piles out, You all cleared close the door until up some things, and away "It thhgs.. nus,new a nickname for EMDR "Stir and Cure." ., �EMDR N e t w o r k N e w s l e t t e r 1995 Issue 2 INTERNATIONAL UPDATE Francine Shapiro, Ph.D. Senior Research Fellow Mental Research Institute The annual EMDR Conference was a gratifying success with approximately 550 people attending. Over 60 cliniclans and researchers gave excellent presentations on innovations, advanced clinical applications. and the latest study fmdings. The overall assessment of participants came out at 4.6 on a 5 point scale. The plan is to move the conference to either the mid-westor eastcoast in Juneof 1996. The opening ceremony of the conference included apresentation of awards to the organizers of the humanitarian relief effort in Oklahoma City after the bombing. Sandra Wilson, Ph.D., has been the central figure of the effort. She flew in after Judy Albert's (MFCC) initial groundbreaking actions (described in the last Newsletter)and hasstayed in Oklahoma City since then organizing the community interface, clinical work, and training efforts. To-date, approximately 200 children, rescue workers, victims, colleagues, and mental health providers have been treated by EMDR c h i cians who have been flying in at their own expense toprwidea week's worth ofclinical treatment. They have been hosted by local Oklahoma EMDR clinicians Virginia Denman, Joel Westerheide, and Norma Leslie who have used all their community connections to take care of the support services. It has been a magnificent relief effort. Steve Lazrove, M.D.,has also flown in for two shifts to help in the clinical and organizational work. Support EMDRIA REGIONAL NETWORK COORDINATORS - USA National Coordinator: Norva Accornero, MSW (408) 366-1414 Arizona Arkansas California (Northern) (Southern) colorado Connecticut DC Georgia Hawaii ldaho Illinois Maryland Massachusetts Missouri New York N,, ~~~i~~ Ohio Oregon Pennsylvania Texas Utah Washington Jonathan Brooks, Ph.D. Pat Penn, Ph.D. Stephanie Zack, LCSW Norva Accornero, MSW Curtis Rouanzoin, Ph.D. Ron Doctor, Ph.D. Laura Knutson, LPC Jana Marzano, MA SteveLazrove,MD David Russell, Ph.D. Deany Laliotis, LPC Dan Merlis, LCSW-C Pat Hammett, Ph.D. Silke Vogelmann-Sine, Ph.D. Dean Funabiki, Ph.D. Howard Lipke, Ph.D. Gene Schwartz, LCSW-C Mike Brenner, MD h r i e Bollinger, MA Marcia Whisman, LCSW William Zangwill, Ph.D. Gerald Puk, Ph.D. Peggy Moore, LSW Kay Werk, LISW Ann Kafoury, LPC Georgia Sloane, MS Carol York, MSW Dan Sternberg, Ph.D. Steve Riggins, MA Karin Kleiner's prompt response and immediate recognition of the need for EMDR treatment for OKC residents was a primary impetus to the coordinated effort and made it all possible. The response to acall for assistance to the EMDR facilitators and clinicians was a great success. They responded by flying in for a full week-which meant also sacrificingtheincome from their private practices for that time. Clinicians who have flown to Oklahoma in cohorts of 2-3 per week include: Judy Albert, Bob Tinker, Karen Kleiner, Stephanie Zack, Johnathen Speare, Ed Hallsten, Ken Vanderlip, Peggy Moore, John Marquis, Mary Moore-Farrell, Helen Hill, Steve Lazrove, Beverly Schoninger, Lillian (602) 493-3 110 (602) 770-7407 (50 1) 442-9997 (408) 356- 1414 (7 14) 680-0663 (818) 885-2827 (303) 620-7 198 (303) 220- 115 1 (203 787-0227 (203) 231-9191 (30 1) 982-9259 (30 1) 982-9259 (404) 633-4796 (808) 531- 1232 (509) 334-0677 (708) 537-7243 (410) 889-8338 (410) 77 1-4438 (508) 456-8623 (314) 644- 1241 (2 12) 663-2989 (914) 635- 1300 (505) 255-8682 (6 14) 274-7000x349 (503) 291-9343 (2 15) 667-6490 (5 12) 343-9550 (80 1) 364-2779 (206) 328-5626 Sideris, Bob O'Brien, Tanya Russell, Roger Quillen, Kathleen Scott, Laura Knutson, Jim Dayton, Linda NeiderPowel, Linda Grundy, Laurie Tetrault, Howard Lipke, and Kay Werk. Thesecliniciansdeserveallourthanks and respect for theiractions. They all seem to feel that the work was rewarding and f u l f i i g . It gave them a chance to be part of the healing and they are interested in responhng again when needed. We would Wre to have their efforts supplemented by additional EMDR Level I1 tramed clinicians. In addition,a free EMDR training for �EMDR N e t w o r k N e w s l e t t e r 1 9 9 5 Issue 2 interested Oklahoma City mental health professionals was given by EMDR Institute staff who contributed their time and paid their own way. The Red Cross picked up the expenses for housing and American &line offered reduced rate fares. The training was given by Stever Silver, Ph.D. Facilitators who donated their services were: Bob Tinker, John Hartung, Jim Knipe, John Marquis, Stephanie Zack, Laura Knutson, Beverly Schoninger, Lillian Sideris, Steve Lazrove, Kathleen Scott, Donna Bruzzese, and Laurie Tetrault. Once again, i t is gratifying to see the calibre of support offered by these wonderful people. The training was a great success and the Oklahomans who attended were extremely pleased with the training and very gracious and he,artfelt in their thanks. It is wonderful to think of EMDR being used by the clinicians in the trenches to serve the long-term needs of clients effected by the horrendous act of terrorism. One client said, "The good is overwhelming the evil that was done." What more could any of us want than to be a part of that. Another training isplannedfor August taught by Gerald Puk, Ph.D., and I will be conducting a Level I1 in September. Donations to help the support services in Oklahoma City are still being requested. They are tax deductible for you as a professional expense to support the work of your professional organization. Please make donations payable to: EMDR Network--OKC, P.O. Box 51038, Pacific Grove, CA 93950. Al l monies willbeused elrclusivelyfor the clinical relief and professional support work. results. After hearing thevet confirm them, he flew out at this own expense to be trained and after seeing the results in his own PTSD inpatient unit, he sent messages, and arranged conference calls to tell everyone he could within the VA system of the need to learn the method. The number of VA units who received training is due largely to his efforts, and the efforts of those whose interest was catalyzed by him. Although he became an EMDR training facihator, he refused to take any money for his work in order to be free from any charges of confhct of interest or financial gain. Howard also published one of the first articles on EMDR in & chothera~v, conducted a survey of the first 1200 clinicians trained in EMDR and presented the results at APA, has made numerous presentations at the annual conferences of the International Society for Traumatic Stress Studes (and others), and has been a consultant for at least four research projects on EMDR. Needless to say, if more people even approximated his contributions, EMDR wouldbe much further along. Howard received a standmg ovation at the presentation which he richly deserved. Excellence in Research awards were presented to Sandra Wilson, Ph.D., LeeBecker, Ph.D., and Robert Tinker, Ph.D., whose study of 80 trauma victims treatedwith EMDR was accepted for publication as a featured article in the cal Psvcholoep. The effects of the inpress article are already being felt in that an article on the Croatian training, slated for publication in the APA Monitor, was going to be cancelled because of the "controversy" around EMDR-until the editors were inThe closing awards ceremony at the formed of its imminent publication. conference honored Howard Lipke, The findings of the study were prePh.D., who received the Ron A. sented at the American Psychiatric Martinez, Ph.D., Memorial Awardfor .ksociation this summer and a t the outstanding contribution to EMDR. EMDR Conference. Tapes of the preHoward was the first VA clinician to sentations are available from the reuse EMDR. After reading my 1989 spective sponsoring organizations. articles, he called California and man- When the article is published, we will aged to find one of the combat veteran try to get permission to distribute it to subjects in order toverify the research all the Network members. Humanitarian service awards were also presented at the conference to Geoffrey White, Ph.D., Steven Silver, Ph.D., and Gerald Puk, Ph.D., for their efforts in Croatia. As a result of the training Geoffrey arranged, and the wonderful job done by Steve and Gerry, we have been asked to give an additional training in Sarajevo. All three are intendmg to return this Fall. Many people in the audence were brought to tears by a song Steve wrote about their experience in Zagreb. I believe that we all left the ceremony with an understandmg of how the universal experience of fear and loneliness can be transformed into a sense of service to help h e a h g occur worldwide. It not only can be transformed, but it must be transformed. I am sure many of you have noticed that many of the same names keep springing up. Please join them - the rewards are intangible, but inestimable. Another important event at the EMDR Conference was an almost unanimous vote to turn the EMDR Network into a service organization starting in January 1996. AU other functions of the Network will be turnedover to the EMDRInternational Association. One of the projects will be the Humanitarian Assistance Program which was officially codified and launched by those attending a special interest NOTE! ' LEVEL I SCHEDULE CHANGES The EMDR Level I training has been expanded to include 3 hours more practice time. The workshop schedule includes one evening session. - Day 1: 6:30PM 9:30PM evening session Day 2: 9O A : OM Day 3: - 5:30PM 9O A - 5:30PM : OM �EMDR Network Newsletter 9 9 5 Issue 2 group at the conference. Steven Silver, Ph.D., is serving as the acting chair of the project and sent me the proposal. The EMDR Humanitarian Assistance Program (EMDR-HAP), would have the responsibility of organizing and providing assistance on a nonow fee basis for humanitarian or emergency need. projects. Once again, the EMDR Network willcontinue to be an alumni organization of the EMDR Institute. However, as of January 1996, it will be devoted exclusively to humanitarian service. We will also be attempting to raise additional funds for the projects. If you have any ideas or contacts, please let us know. EMDR-HAP would provide support through voluntary efforts and contributions for the following types of circumstances: disasters, including both emergency relief an'd long-term assistance; training of indigenous mental health professionals in areas without resources to make use of usual EMDR training services; providing scholarships for training; and such other activities as would be considered humanitarian and be operated on a nonprofit basis. During the opening ceremony of the conference, Ronald Doctor, Ph.D., announced the inauguration of the EMDR International Association (ENDRIA). In earlier Newsletters I wrote about the need to have a separate professional association in place in order to set standards for the clinical practice and training of EMDR. Now that the book is published, and everyone has been releasedfrom their training agreements, there are bound to be a number of excellent- and, unfortunately, some incompetenttrainings done worldwide. The purpose of EMDRIA will be to try to guide both clients and clinicians in the search for well-qualified therapists and trainings. Full membership in EMDRIA will be limited to those clinicians and researchers who have meet appropriate standards of licensure and training. As a professional organization, EMDRIA will also support a number of outreach committees to educate other professionals, insurance and managed care companies, and laypeople about EMDR. In order to maintain the integrity of EMDR practice, a professional organization of this kind is vital. EMDR-HAP would perform the additional services: *Develop and maintain a database of EMDR clinicians available for humanitarian efforts. *Provide coordination of requests for assistance. *Provide eduation services a s needed for EMDR clinicians who are HAP members (e.g., critical incident training). *Perform outreach education to . other professional groups in the field of humanitarian services. *Encourage the conducting of research and study in the area of EMDR applications to humanitarian situations. *Serve as a conduit for financial assistance for these activities; ccordinate or assit in fund raising The goals will be to have in place available personnel and resources in advance, as far as possible, of identified needs. Once again, please let us know if you can be of any assistance regarding donation of time, effort, or financial support. In addition, HAP will also provide research grants for worthy Some of these activities were previously done by the Network. However, the Network was running at a deficit since it started in our attempt to provide on-going education and support for the trained EMDR clinicians. The Institute has administrated the Network andprovidedservices to underwrite the Network to provide the needed benefits to the members. At this point, there are regionalmeetings, studygroupmeetings, and consultation services worldwide, and the Network Newsletter \ has blossomedunder the editorship of Lois Allen-Byrd, Ph.D. After this year, the resources of the Institute will be directed to helping to support the humanitarian efforts worldwide. The EMDR clinicians who truly care about EMDR's reception in the world and its use with clients throughout our profession, will be asked to support EMDRIA as a professional organization that will take over all the previous services of the Network (including the annual conference), in addition to setting standards, and offering educational outreach. When I realized that the publication of the book was going to necessitate a separate organization independent of the Institute and Network-I asked a number of people to organize a Task Force to develop bylaws andestablish a viable organization. I asked people who had the least ego, largest heart, previous experience with organizing similar projects or with ethics boards, those in a close enough proximity to meet continually, and with the willingness to make the commitment to get the job done. The initialmembers of the task force were: Ron Doctor, Marguerite McCorkle, Rodney Nurse, Curt Rouanzoin, and Jocelyne Shiromoto. They were all California based in order to make sure they could consistently attend meetings. Shortly after, David Wilson was invited as a Task Force member. Peggy Thompson organized a meeting in Phoenix with attendance from clinicians throughout the United States. Committee reports were given on outreach and educationalproposals. Committee members gave each other and the task force input and reactions to the work already done and a tentative committee structure was established for the new association. Amember of that group, Carol York, was asked to actively become involved as tempory membership chairofEMDRIA Other committees were put on holduntil the association became active. 111order to get input from the EMDR clinicians trainedoutside theunitedstates, and to make sure that it was truly an international organization, the task �EMDR N e t w o r k Vewsletter 1995 Issue 2 force voted to bring on board Marilyn Luber who is the EMDR Institute's coordmator of international trainings. She provided them regular input from the c h i c i a n s in Europe, Australia, and South -4merica. The result has been a truly international endeavor. Consequently, we now have a n organizational structure t h a t people of good faith believe strongly will serve EMDR c h i c i a n s and clients worldwide. While the benefits of EMDRIA will not be fully realized until 1996, when it takes over all Network functions and begins educational outreach, the task force, now the founding board members, ispresently asking for members and charter members to provide funds now to the Association to cover the startup costs. The costs of an independent, international, functional, professional, outreach organization far outweigh the costs of the Network-therefore, the dues will be higher. However, they are directly in h e with the costs of other professional organizations and with the true costs of the Network. It will give you even more benefits than the Network. Addtionally, if you use EMDR extensively in your private practice, it may offer you more benefits than other more generic professional organizations. Clinicians wdl have the benefit of EMDRIA referrals and validation via the membership b e c t o r y andcontinued access to innovative new protocols. Researchers will have a vehicle in which to publish and a professional conference for presentation of papers. If you join EMDRIA before December 3 1, 1995, you can choose to become aWChartei' Member with some added benefits to full membership. In addition, as a Charter Member, you wlll have a lifelong designation as one of the founding members of the organization. You can also join as a Full Member, Associate Member, Affiliate Member, or Student Member. AL1 members who joinnow wdlhave membership through December 3 1, 1996. Network benefits will continue until December 31, 1995 and then will terminate unless you join EMDRIA as a way to continue these services, including the Newsletter, and information resources. Please allow the momentum to continue worldwide by supporting the unified effort. What we can accomplish as a single individual can be multiplied a thousandfold if we work together. arrange for an EMDR training for professionals working with war trauma cases a t the Institute's Stress C h i c and other clinics in the area, patterned after the very successful training arranged by Geoff White of Los Angeles and presented in Zagreb. Croatia, by Steve Silver and Gerald Puk. Barbara welcomes communication with anyone interested in treatment of war trauma/refugees. (Box 7755, Berkeley, CA 94707; phone and fax: (510) 843-0360) EMDR IN BELGRADE, FORMER-YUGOSLAVLA During February 1995, Barbara Zelwer presented short trainings in Belgrade for mental health professionals and laypersons who work with refugees and people suffering warrelated trauma. There are about 800,000 refugees in the Serbian part of former-Yugoslavia. They include Croats a n d Muslims, a s well a s Yugoslavs of Serbian extraction who have fled Bosnian and Croatian territories. The ethnic diversity of the refugees is echoed in the diversity of people who work with them. Somehow, for many ordinary people, the ethnic M e r e n c e s do not matter. This i s only one s m a l l piece of t h e psychosocial and political puzzle the region represents. Barbara found that many people do not support their government's stance on the war in Bosnia, but feel (and are) helpless to force changes in policy. Mental health workers feel overwhelmed andburned out by the increased amount of emotionaldisturbance broughton not only by b e c t experiences of war, but by Living a t its edge. Barbara's discussion of the value she has found in EMDR in treating survivors of war and torture in a Central American population in East Oakland generated considerable enthusiasm. She was invited to make a longer presentation a t the Friday Morning Seminar for some 60 psychologists andpsychiatrists who work a t the Belgrade Institute for Mental Health. She is currently trying to To register for Charles Figley's traumatic stress list on the internet send an email to: Listserv@netcom.comin the body of the message type subscribe traumatic-stress andyour name. �1 EMDR Network Newsletter 1 9 9 6 Issue 2 ! EMDR HELP WANTED - Welp Wankd" is designed to assist you in a variety of ways. If you w e looking for a msition, have positions available, have a n interest in research collabordwn, want information of specific populc&ms or problems, etc., submit them b the Newsletter and include your name, address, telephone, and fm numbers. EPE MOVEMENT I I Research Subjects Needed Research subjects needed for PTSD outcome study, using EMDR and another proven treatment for PTSD. Potential subjects must be Kaiser Permanente Health Plan members able to receive treatment in the South Bay Area. They must meet DSM-111Rcrlteria for PTSD, be stable onmedication, not suicidal, have no litigation pendmg, no drug or alcohol abuse or dependence, no Multiple Personality Disorder or Dissociative Disorder, no psychosis, and must have had symptoms for greater than one month. Since this is a randomized study, subjectsmaynotbe assignedto the EMDR c o d t i o n and therefore, it is important that they are not referred with the intention of receiving EMDR. Benefits to participation are that the individuals wlll receive careful evaluation, treatment implementation and follow-up, and will add to our knowledge of treatment for PTSD. Once again, it is important to remember that we cannot accept subjects into the study who expect EMDR because they may be randomized to an alternative therapy. All patient referrals must be willing to receive either treatment. For questions and referrals, please call Linda Kolstad at (408) 236-6 763. EMDR ResearchlTraining Institute The EMDR Researchflraining Center at MRI is looking for individuals who want to take part in research projects on victims of natural disasters. Please call Cliff Levin, Ph.D. (415) 326-6465. . Wanted EMDR clinicians in the EAST BAY who are willing to donate time a c h i cal study ofthe efficacyof using EMDR to treat PTSD. Therapists wouldtreat a minimum of 2 clients for 8 sessions each. Please call: Barbara Colton (510) 869-5118 Published? If you are an EMDR trained clinician and have had any books published, please contact the EMDR office a t (408) 372-3900. Spiritual Insights If you have clients who have reported experiencing spiritual openings or insights during or after EMDR sessions and would like to share these vignettes, please write up these cases andsend themto: Laurel Pantel, Ph.D. 22 Von Ct, Fairfaw, CA 94930. (415) 454-2084 RETIEMDR Practitioners interested or experienced in RETEMDR, please contact: Dennis Coates, 21 6 Avenue P South, Saskatoon,Saskatchewan S7M 2W2 (306) 665-2788 or (306) 242-6847 Managed Care In speaking to managed care organizations, hospitals, and reluctant-tobelieve colleagues, it would be helpful to be able to offer names of recognized institutions which endorse the use of EMDR. I would like to compile lists of treatment facilities, large employers, and insurance companieslmanaged care organizations that do support its use. These lists could be distributed via network mailings. Please send contributions (including a name1 phoneladdress for verification) to: Chad Clang, Ph.D., 1027 N. Weber, Colorado Springs, CO 80903. Babies Anyone using EMDR andlor other body-mind therapies with babies, please communicate with me. I am willing to facilitate a round robin exchange of letters from all over the world and I am also interested in an EMDR perinatology study group in t h e East Bay. Contact: Sheryll Thomson, 1641 Hopkin St., Berkeley, CA 94707, (51 0) 525-8081. DESENSITIZATION AND REPROCESSING INTERNATIONAL ASSOCIATION (EMDRIA) Dear EMDR Practitioner, The Buddhists' say that life is always changing and fluctuating and that meaningful survival depends on our ability to see these changes, give up the old, and transform it into something new that is responsive to our greater understanding. Likewise, the practice, of and training in, EMDR is going through a radlcal change in terms of training and organization and this change wlll affect each of us over the coming years. I am asking for your understandmg, considerable patience, and support in this process and in our efforts to anticipate and plan for these changes. Specifically, training in EMDR is now moving out to individuals and institutions that have little, or perhaps no, connection with Francine Shapiro, Ph.D., the EMDRInstitute, or what we have come to know as our EMDR community. Many pressures are forcing this change, but certainly Dr. Shapiro's book has been a major impetus in broadening training sources for EMDR Therapy. Book or no book, however, there is stdl growing pressure from people not &&ated with the EMDR Institute to provide training, supervision, research and other EMDR related activities. The only way to insure that these activities are going to be of high quality and effectively represent EMDR procedures and applications, is to develop training and application standards. It is essential that these standards come from outside the Shapiro Institute, since the Institute could be seen as having a competitive interest and therefore, any standards it promoted would not be acceptable in the therapeutic and �EMDR N e t w o r k N e w s l e t t e r 1995 I s s u e 2 academic communities. All this is to say that we need to develop an independent association that can house practitioners and researchers from many M e r e n t EMDR trainingbackgrounds, and yet have high standards for its members. We have now developed such an association and we are asking you to join it and to help us preserve and further the EMDR Therapy that we practice. The new association is called the EMDR International Association (EMDRIA). Bylaws for EMDRIA have been developed and we are in the process of incorporating as a nonprofit organization. A few committees have been activated in order to dwect initial business that is needed to get a new organization off the ground and to provide services to its members. EMDRIA is international in that it will serve the world-wide EMDR community and hopefully serve as a central organization for maintaining high quality standards, as well as helping each of uscontinue to improve our skills in EMLIR Therapy applications. EMDRIA has a foundmg Board of Directors (see below) that has met with Dr. Shapiro to discuss the roles ofthe ShapiroInstitute andEMDRIA in the future. Dr. Shapiro has agreed to r e h q u i s h most of the activities associated with thenon-profit EMDR Network (a subsidiary of the Shapiro Institute thatcurrentlyprovidessupport services to clinicians) to EMDRIA on January 1, 1996. At that time, EMDRIA will take over the Newsletter, regional support, and interest group activities, and the conferences. In addition, EMDRIAplans to publish a directory of its membership, sponsor a professional applications journal, serve as a resource to promote EMDR in appropriate professionalorganizations, become accntral organization for the promotion and dissemination of information on EMDR world-wide, and, of course, publish standards of training for EMDR Therapy and ethical standards for its application. The new Bylaws create an association that is membership-centered and able to accept a broad range of &scip h e s and levels of training. This structure is in place, but in order to breath life into the structure, we need your support and participation. The first way in which you can support the EMDRIA is to become a member. At this time, we are offering Charter Membership to those who enrollby December 3 1,1995. To qualify for Charter Membership, you must be have completed Level I1 training, be licensed and/or have academic/researchpositions and published research on EMDR in refereed journal. Charter Members are Full Members who, for a slightly extra fee in the beginning, receive this special designation and honor. In addition, future benefits will be available such as, but not limited to, discounts and a Founding Member Certificate. You may also enroll now as a Full (non-Charter), Associate, Affiliate, or Student Member. The Full and Charter Members will have full voting privileges. Other members can still enjoy services of the association, but wlll not have voting rights. The second way in which you can support the EMDRIA is to become active in its life. Many people are needed to keep the EMDRIAvibrant and hardy. In the past, Dr. Shapiro and The Institute have been fully responsible for the Me of the EMDR community. That has changed and we are now all responsible, including Dr. Shapiro, for its survival. Application forms for membership are included in this o r by call- ing the EMDRIA office (602) 9125300. Please join with me, other Board of Directors of theEMDR International Association, the Committee Chairs, and members in supporting this association both financially and with - I your energies. The integrity and evolution ofEMDRTherapy now depends on us! Sincerely, Ronald M. Doctor, Ph.D. Chair, Board of Directors of EMDRIA (818) 347-0191 and, Board of Directors: Marilyn Luber, Ph.D., (21 5) 545-8296 Marguerite McCorkle, Ph.D., (70 7) 25 7-8842 Rodney Nurse, Ph. D., (510) 254-3606 Curtis C. Rouanzoin, Ph.D., (714)680-0663 Jocelyne R. Shiromoto, M.S.W., (71 4) 764-3419 David Wilson, Ph.D., (91 6) 223-2777 Membership Committee Chair: Darlene Wade, M.S. W., (808) 521-EMDR Publication Committee Co-Chairs: David Baldwin, Ph.D., (503) 686-2598 Steve Lazrove, M.D., (203) 787-0227 Nomination Committee Chair: Jennifer Lend1 Ph.D., (408) 244- 7 9 4 27 ~ Ethics Committee Chair: Michael D. Calvin, Ph.D., (719) 634-4444 Conference Committee Chair: Carol York M.S. W., (512) 46 7-1 3 76 Professional Standards Co-Chairs: Curt Rouanzoin, Ph.D., (714) 680-0663 Rodney Nurse, Ph.D., (510) 254-3606 �EMDR Network Newsletter 1995 Issue 2 I THE POETRY O F LOFTUS AND CALOF William Zangwill, Ph.D. Recently we received network materials containing tapes by Loftus (1994) and Calof (1994) continuing the debate on the False Memory Issue. If you have not listened to them yet, do, for they each have a form of poetry within. Good poetry does two things well. I t helps us reconstructour experiences and see things in new and M e r e n t ways. It also stirs our emotions. Ldce poets and poetry, Loftus sees memory as influencing the world and being influenced by it. In this process, as in any process performed by fallible human beings, people will make a certain number ~f errors. We forget, we reinterpret (or misinterpret), and we reconstrue. Ldce goodpoetry, sometimes these reinterpretations, these reconstructions deepen our understandingandappreciation ofthe world around us. While poetry often allows us to see new relationships between the ordinary, it does not mean we see these relationships accurately-just Merently. It is this question of accuracy of memory that concerns Loftus. She claims that research has repeatedly shown that memory is fallible and malleable. Therefore, without corroborating evidence, we cannot accept every account of abuse by our clients as accurate. She did not say that abuse has not occurred. In fact, I clearly heard her say that there is much abuse and that people have benefited from good therapy Shapiro (1995) would appear to support this view when she said, ". . . all we and the client have are imaginal representations that correspond to affect, sensations, and beliefs. We cannot [emphasis mine] know if they are based on historical realities unless there is independent corroboration" (p. 3). The client's poetry may stir us, may reinterpret past events in meaningful ways; but often, we do not know ifit is accurateor not. Some will have trouble accepting this view, for it makes our Lives and the lives of our clients much harder. For what it means is that we shaU have to accept the fact that often times, despite our best efforts and the best efforts of our clients, we may not know whether or not particular instances of abuse occurred, or whether there was any physicalor sexual abuse at all. If we accept this view that we cannot be sure, we have to resign ourselves to ameasure of uncertainty and lack of knowing that can be terribly frustrating. How much more rekeshingandinvigoratingit is tomount the white horse of Truth and Knowing andcharge bravely into battle, the defender of the weak and helpless, the noble one. For most of my life, I have envied people who could do this. Who could look a t the world or a t a particular issue and see nothing but blacks andwhites. I envied those who were never weighed down by the grays, the need to see the other side. It must make the world a much simpler place. When we carry the flag of Truth and Sincerity and show that those who disagree with us are misinformed or evil, then we can invalidate, or a t least question, everything they say. Maybe that is why Calof responded to Loftus the way he did. He complained bitterly that the False Memory Syndrome Foundation (FMSF) folks, ". . . express outrageandcontempt fortheir opponents." Then he made over 30 different ad hominem attacks on Loftus in his approximatelyone-hourand-fifteen-minuteaddress. (His tape is fascinating, for it is one of the best examples of projection that I have ever heard.) It amazed me that a man who repeatedly tried to use guilt by association ("Loftus and her fellow lobbyists," "Loftus and other paid witnesses") and other innuendo (indirectly attempting to link her to a pedophile) could complain, his voice rising with indignation, that his gonents', ". . . tone has been ad hominem, anti-empirical, and emotional." While he claims his opponents are anti-empirical and faults t h e m for not doing research on traumatic memory, Calof neglected to cite his own empirical research. The fact is that there is a paucity of good research in this very difficult area. Yet he faults others, W e Loftus, who have done an enormous amount of research, because he feels they have not done enough research or the kind he would like. Mr. Calof, about this glass house you live in . . . Launching another attack on his adversaries, Calof stated that the "Explosion of poorly researched and sensationalistic media stories. . . coupled with the harsh, adversarial tone (of the False Memory Syndrome Foundation and) . . . of its advocates has kept us all so riveted to fast moving daily developments that we've scarcely been able to pause and reflect. . ." He feels that this has created a public crisis of confidence in therapists. Maybe, the FMSF is totally responsible for this. Maybe, but let us reread this last passage, and leave out the material in parentheses. Calof stated that the "Explosion of poorly researched and sensationalistic media stories . . . coupled with the harsh, adversarial tone . . . of its advocates has kept us all so riveted to fast moving daily developments that we've scarcely been able to pause and reflect . . ." He feels that this has created a public crisis of confidence in therapists. Is the FMS Foundation totally responsible for this atmosphere and for this public crisis ofconfidence in therapists? Not Roseanne with her 17,21, or whatever number of personalities? Not the mdhon and one dramatic reports of abuse in books, magazines, and on talk shows; not the s t a r t h g statistics on the supposed number of people who have been abused--statistics made on questionable assumptions using widely varying definitions of abuse? Not the therapists claiming that they can tell in one session �EMDR N e t w o r k N e w s l e t t e r 1 9 9 5 Issue 2 whether someone has been abused or not? A last accusation by Calof . . . In referring to Loftus and others, he accused them of setting up a straw man in the form of "Robust Repression" and refusing to deal with the real issue. Speaking of setting up straw men . . . Calof attempted to mock the False Memory group and their contention that therapists could implant false memories by the following example. "Ifaperson insists they were not abused and I insist they were, they are unlikely to believe me." The implication is that, therefore, when clients do report abuse, it is not because some therapist has dissuaded them from their strongly held beliefs or memories. He is probably right most of the time; but, once again, he missed the point. While a person "who insists they were not abused is more likely not to believe a therapist who tries to insist they were," what about the people who come into our offices every day who are confused? What about those who are not sure if they were abused or not? What If their memories are vague or nonexistent? How susceptible are these patients to suggestion? Though I clearly have more problems with Calof, Loftus' work certainly has flaws. Calof was right to point out that much of her laboratory work on memory has Limited external valihty when it comes to traumatic material. There is increasing evidence from the work of LeDoux (1989) and others that emotional experiences are processed differently in the brain than intellectual ones and therefore, may be remembered differently. Also, I . feel that she was guilty of a serious logical error when she cited the work of Poole and Lindsey (1995). Loftus reported that when she fwst began looking into this issue of false memory, she assumed that there might be a very low percentage of therapists doing this type of work and thus the damage they caused would be Limited. However, citing the Poole and Lindsey study, she expressed her concern at the results of the study suggesting as many as 25% of the people surveyed from the National Registry were doing this kind of work and that obviously the negative impact must be far greater than she realized. The error she made is that the question is not how many people might be doing various kinds of experiential work, but how many of them are doing it badly. These concerns about Loftus' work, notwithstanding, my emphasis in this critique has been on the manner in whichthedebatewasconducted. That is why I focused more on Calof s comments. The manner and style of his comments are where the poetry in his work resides. Unfortunately, the poetry is that of Yeats (1920) in The Second Cominz: ". . . for the best lack all conviction and the worst are full of passionate intensity." I do believe that it is not passionate intensity alone that will help our clients, but a passionate commitment to truth and mutual respect. If we cannot hscuss our differences with a tone of openness and mutual respect, we are unlikely tomake progress in helping our clients. If we cannot agree to hsagree civilly, if we are not strong enough to accept our limitations and the ambiguities of life, then this crisis of a lack of confidence in therapists that Calof spoke of will grow stronger-and we shall have earned that lack of confidence. References Calof, D. (1994). Res~onse the to f Talkgiven at the Seventh Annual Dual Disorder Conference, FACES, Bellevue, WA. LeDoux, J. (1989). Cognitive-emotional interactions in the brain. COpnition and Emotion, 3(4), 267-289. Loftus, E. (1994). The re~ressed memorv controversv. Talk given at the Seventh Annual Dual Disorder Conference, FACES, Bellevue, WA Poole, D., Lindsay, S. D., Memon, A., & Bull, R. (1995). Psychotherapy and the recovery of memories of childhood sexual abuse: U.S. and British practitioners'opinions, practices, and experiences. Journal of Consulting and Clinical Psvcholoev, 63(3), 426437. Shapiro, F. (1995). Affect, imagery and memory. EMDR Network Newsletter, 3, 1-3. Yeats, W. B. (1921). The second coming. In R. Ellman, & R. O'Clair (Eds.), Norton Anthology of Modern Poetrv (2nd ed., pp. 158). New York: Norton. A Response to Dr. Zangwill David L,Calof I fervently agree with Dr. Zangwlll's wise counsel that "we must accept our limitationsandtheambiguitiesofhfe." For the last two years, I have provided extensive training for trauma and abuse recovery therapists on the countertransference to client doubt, uncertainty, and ambiguity. I have emphasized several key principles in these presentations: 1. ~ h e r a ~ i smust honestly acts cept and express that they can neither bear witness to a client's disputed or uncertain memories, nor prove them wrong without independent corroboration. 2. Client doubt and uncertainty relative to recovered memories have a valuable underlying function, whether the memories are true, partially true, or false. The therapist must value and reflect back the client's doubt and uncertainty. �EMDR N e t w o r k N e w s l e t t e r 1995 Issue 2 3. Therapists must provide a container in which clientscan examine all sides of their conflicts over memories of abuse. Therapists must never take advocate (sic) for one side of the client's conflicts. 4. Therapists should work with clients to identify the underlying motivations, needs, and drives being expressed in the confusion over recovered memories. This is proper "grist for the mill." Therapists should focus on the dynamics surrounding the surfacing and subsequent confusion over memories of abuse more than on the content of memories themselves. This moves the therapy from a forensic quest for veridical truth to a discussion of issues that are more its proper domain: containment, cognitive distortion, secondary gain, and so on. 5. Therapists should confront attempts by clients to export the locus of authority regarding their memories or to place the therapist in the role of arbiter of clients' perception. 6. Therapists should confront client's illogical beliefs and improbable recollections as possible distortions of fact. 7. If the disputed memories are to move from the psychotherapeutic to the forensic domain, therapists should encourage clients to seekcorroboration. As a specialist in the dissociative disorders, I am very familiar with the human capacity to create self-hypnotic "reality" and to distort memory. I have written about my own false memory of childhood (Calof, 1994). In fact, I was an early voice in this polemic about the potential r'or distortion of memory (see, for example, Calof, 1993). Regrettably, Dr. Zangwill's review places me in two improbable positions: 1) disbelieving that clients are suggestible andvulnerable to the therapist's influence and 2) believing that the media and the False Memory Syndrome Foundation, Inc. are "totally" responsible for creating the present public crisis of confidence in psychotherapy. Both mischaracterize my beliefs. In numerous speeches and seminars (including one at the recent EMDR annual meeting), I cited the many of the field's contributions to the public erosion of confidence, for which the profession must bear total responsibility: 1.Therapists have actedout their inability to contain clients' unmetabolized rage, grief, and desire for revenge and retaliation by encouraging clients to export raw affects into their families or into the legal domain in the form of dl-advised confrontations or legal suits. 2. Therapists have adopted an in locoparentis attitude that shifted clients' locus of authority or responsibility to the therapist. 3. Therapists have engaged in premature uncovering and making "memory work," as opposed to personality integration and functionality, the goaloftherapy. 4. Therapists have demonized client families through projective identification, splitting, and political correctness. 5. Unrecovered abuse survivor therapists have projected their own unresolved material onto their clients andinfluenced their clients tovicariously act out their material. Dr. Zangwill's review does refer to a central point of my talk-the distinction between repression andtraumatic dissociation. Unfortunately, the review does not discuss this important issue, which occupied more than a third of my talk, so let me reiterate this crucial point. FMSF Scientific Advisory Boardmembers (including Loftus, Ofshe, McHugh, and others), in their frequent roles as hired expert witnesses against psychotherapy clients and therapists, tend to root their theoretical objections against traumatic amnesia not in the literature of dissociation, but in Freudian repression. In circumventing the literature on h s sociation, they go so far as to invent de nouo concepts such as "total" or "robust repression" and "recovered memory therapy." They then attribute these invented concepts to their ideological opponents and proceed to refute them. In railing against these strawmen, they demonstrate little awareness of the rich body of c h i c a l and experimental evidence on traumatic dissociation, dissociative disorders, and psychogenic amnesia that guides their ideological opponents' practice. This confusion of tongues has unnecessarily muddied both professional and public discussions. Let me summarize the critical distinction between repression and traumatic dissociation. Early in his career, Sigmund Freud recognized dissociation as a fundamental clinical mechanism in his hysterical patients who reported childhood sexual abuse. He noted, "the splitting of consciousness ......exists rudimentarily in everyhysteria," and considered "the tendency to this dissociation. [to be] the chief phenomena of this neurosis" (1936, p.8). By 1897,however, Freud fundamentally stopped believing his patients reports of childhood sexual trauma. Thus he abandoned the traumatic dissociation framework and subsumed the dissociative phenomena under his new concept of repression: the central psychoanalytic tenet that people tend to inhibit (and consequently tend not to remember) unacceptable wishes, impulses, affects, and especially unacceptable sexual impulses. We mistake oursehres when we call the dissociation of a traumatic experience "repression." We must learn to distinguish between not remember- �EMDR N e t w o r k N e w s l e t t e r 1995 Issue 2 ing (simple forgetting), burying intact memories (repression),andnever consciously knowing the whole of a memory (traumatic dissociation). FMSF ScientificAdvisory Boardmembers, such as Loftus, simply ignore the well recognized and documented phenomena of bssociation, which we often see in trauma survivors. These phenomena can not be explained by "repression" alone: bust repression: Q. What is your understanding of the Werence between dissociation andrepressedmemories or repression? "...lf we take the c h i c a l reports A. I don't know the psychotherapy distinction or whether there's even any agreement about what that is. Q. In your opinion, would the difference be important in a re- search setting? -Trance/autohypnosis -Personality-splitting/compartmentalization -Automatic behaviors/automatisms -Derealization and depersonalization -Amnesia [total, selective, or partial] -Fugue states -Somnambulism -Regression -Time distortion -Dissociative identity disorder -Analgesia/anesthesia -Sensory delusion/hallucination. Traumatic amnesia and dissociative phenomena long have been recognized as common sequelae to traumatic stressors including disasters, violent crime, assault and sexualassault, torturelmind control, concentration camps, cults, child abuse, vehicular and industrial accidents, life threatening events, multiple traumatic events, combat and war. Psychogenic amnesia has been included in the American Psychiatric Association's compendium of mental b o r d e r s since it was first published in 1952 @SMI). Despite a rich literature (going back to Charcot's earliest observation in 1872 that his hysterical patient's stream of consciousness often broke into diverse components), Loftus and her fellow FMSF Scientific-.ldvisory Board members insist that trauma clinicians have invented a de novo theory: "robust repression." Dr. Loftus is forthcoming regarding her lack of knowledge in this area, as in this segment from a recent deposition from a case in which she argues as a paid expert witness against ro- Having studied the extensive c h i c a l Literature on amnesia, Hull gave credence to the wealth of clinical reports demonstrating hypnotic recall of lost and traumatic memories: A. I'm interested in the accu- racy of memory or the malleabil- ity in memory. So, it might be important to somebody else (Loftus, 1993, p. 30-31). Dr. Loftus ironically overlooks the classic work in dissociation by the founder of her own field of cognitive psychology, the eminent psychologist Clark Hull. In 1933, Hull concluded the first extensive systematic experimental investigation of dissociation. This historic, decade-long study yielded thirty two published scientific papers and a book. Summarizing his results, Hull concluded that ample evidence existed to support the conceptofdissociativestatesofconsciousness. Hull found that great variations could exist in the range of "functional independence" between dissociative states-ranging from "completely amnestic and severed, to highly associated and interfering." Hull summarized the clinical evidence for complex, dissociative amnesia: 1 I "Many cases of amnesia have been studied and reported in voluminous detail. ... Extensive amnesias are very apt to be associated with shocks of some kind.. .the shock may be an emotional disturbance or even a moral conflict....cases not infrequently appear in which the pdtient can recall nothing of what took place during aperiodof severalmonths or even years" (p. 106). at face value, there is a great mass of evidence not only to the effect that the hypnotic trance is able to facditate recall of memories which have been inhibited by trauma of various kinds, but also that it greatly facditates the recall of ordmary memories of early childhood (p. 125-126). Though he gave them much credence, Hull, like Loftus, was an experimentalpsychologist anddidnot accept the c h i c a l reports at face value. Even though he understood that c h i c a l investigators usually obtained corroboration for the refreshed memories they reported, Hull recognized the scientific =culty of determining the genuineness of the memories reported in the extensive clinical literature. After posing the di£€iculties with the clinical data, Hull turned to the results of laboratory experiments observing, "Luckily it is not necessary to depend entirely upon such uncertain [clinical] data" (p. 111). Hull cited a variety of experimental evidence he believed "strongly substantiated his position and reinforced the c h i c a l findings. "There is some striking experimental evidencewhich ...tendsstronglytoconfirm the clinical observations that hypnosis fachtates the recall of childhood and...other remote memories" (p. 127). Regrettably, Loftus' latest book The Myth of Repression is not subtitled The Reality of Dissociation. While forcefully avoiding the substance of my arguments (". ..my emphasis in this critique has beenon the manner in which the debate was conducted"), Zangwill's review claims I made "over 30 M e r e n t dhominem attacks" against Dr. Loftus. It is far �EMDR N e t w o r k N e w s l e t t e r 1995 Issue 2 less meticulous, however, in listing them, naming only that I "repeatedly tried to use guilt by association" and "other innuendo (indirectly attempting to link b f t u s ] to a pedophile)." Regardless, these charges are serious and deserve a response. Regardmg the claim of guilt by association, the review pulls from context phrases such as "Loftus and her fellow lobbyists," and "Loftus and other paid witnesses." Nonetheless, I stand by each of these statements. In each case, the error of logic or unempirical claim I cited are legion among the FMSF advisory board members who function a s paid experts a n d who are associated with a national lobbying effort to coddy their dubious assertions into law. As for the charge that I attempted to h k Dr. Loftus to a pedophile, first let me hasten to say that I have no certainty that the man in question is indeed a pedophile. Having been privately accused by his adult daughter of incest, Chuck Noah, of Seattle, Washington, began a boisterous public effort to proclaim his innocence. I t is well known in the Northwest that in this process he joined forces with Loftus. Loftus met with Noah in 1992 and commented favorably on his case to a major Seattle newspaper. At the time, Noah was under a court order to stop harassing his daughter's former therapist and to seek counseling (an order he broke and was subsequently frned for and p u t on probation). Loftus told the newspaper that she found Noah "'extremely sincere' about his denial of abuse of his daughter" (Penhale, 1992, Bl). Commenting in this same story on the daughter's abreactions, and without benefit of any direct examination, Loftus declared, "There is absolutely no scientlfic evidence that these flashbacks correspond to some specific event" 031). ' Noah and his accusing daughter consider themselves to be recovering alcoholics. Perhaps because Loftus is not a trained c h i c i a n , she appar- ently failed to consider Noah's selfadmitted earlier heavy drinking as a factor in the accuracy of his memory or his denial. Even while the FMSF publicly acknowledges a high incidence of alcohol abuse among its members, FMSF scientific advisory board members such as Loftus have not spoken to the possibility that a t least some of the "falsely accused" are suffering from alcohol-induced memory defects. Long before the controversy over delayed memory, Loftus observed that alcohol can impair a person's memory without their knowledge: "It is not uncommon ...for people to say, 'I drink because it helps me to forget'...There seems to be very little doubt that regardless of whether a person is an alcoholic, a heavy drinker, or a moderate drinker, the ingestion of a few d r i n k s impairs memory processes.. .Although most drinkers are unaware t h a t their memory is impaired, laboratory tests demonstrate that alcohol significantly interferes with the efficiency of memory. ..events experienced under the influence of alcohol cannot be as well remembered as events experienced during the sober state" (1980, p. 8889). Loftus' incomplete and public psychological evaluation was a great boon to Noah's cause. Having thus touted Noah's position, Loftus then joined forces with him in secondary roles to organize the local "false memory syndrome'' group. Since then she has enjoyed a lucrative referral relationship with Noah and his fellow members. that therapists induce false memories solely for "profit motive," she does little to shed light on the complex transference and counter transferences that shape clients' memories and therapists' responses. With these kinds of ad hominem attacks more the rule than the exception among those associated with the "false memory" movement, there is little hope of elevating the debate. References Breuer, J., & Freud, S. (1936). Studies in hysteria (A.A Bnll, Trans.). New York: Coolidge Foundation. (Original work published 1895). Calof, D.L. (1994). False reality. Common Boundary, September-October, 1994. Calof, D. L. (1993). The truth about false memory, The Family Therapy Networker, SeptemberJOctober, 1993. Loftus, E. (1980). Memory. Reading, Massachusetts: Addison-Wesley. Loftus, E. (1993). Deposition upon oral examination of Elizabeth Loftus, Ph.D., Carol C. Smith vs. Richard Alton Smith, Case#67 52 64, Superior Court of the State of California in and for the Countyof Orange, January 18, 1993. Hull, C.L. (1933).Hypnosisandsuggestibility: Anexperimental Approach, New York: D. Appleton-Century Company. Penhale, E. (1992). Father torn by incest accusation. S e a t t l e Post Intelligencer, Fri, 12/11/92,p. B4, B 11. Zimbardo, P.G. & Ruch, F.L. (1975). Psychology and life. Glenview, 11: Scott Foresman & Co. Footnote While I did not attempt to "link [ Loftus] to a pedophile" a s D r . Zangwdl's review would have us believe, I still consider the association a n unsavory one. In the end, Dr. Zangwlll wisely counsels that we must "agree to dlsagree civilly." I agree, but when Dr. Loftus insists in the media time and a g a h 1 Readers should note that prior to her becoming a member of the False Memory Syndrome Foundation, Inc. Scientific Advisory Board, an organization that generally holds that people do not forget traumatic experiences, Dr. Loftus described the phenomenon of "motivated forgetting" (1980, p. 7 173). She wrote that "forces seem to �EMDR N e t w o r k N e w s l e t t e r 1995 Issue 2 operate to help people forget [traumatic experience], especially when such forgetting would make life more bearable" @. 82). To illustrate this concept, Loftus cited cases of airplane crash survivors who forgot both their crashes and subsequent rescues. She also dscusses a case study (from Zimbardo & Rush, 1975) of a college professor who lost her memory traumatically: "It seems that she had suffered an incredible series of traumatic events within the past year climaxing with the breakup of her marriage and the sudden death of her mother before her eyes. Amnesia put all that past u g h e s s , and more, out of awareness. In its place this motivated forgetting hadgiven her peace ofmind (1980,p. 73). Though the woman dissociated her identity and much of her memory, she held onto her professional knowledge (English literature) "so that she was able to teach again even before the rest of her memory returned" (p. 72). Over time, the patient pieced together the memories that had led to her massive traumatic amnesia. Identifying with the woman's plight, Loftus quotes from Christina Rosetti's Remember : "Better by far you should forget and smile than that you should remember and be sad." This sentiment is a far cry from the "false memory syndrome" hypothesis, which holds that people "forget" a happy childhood in order to "remember" terrifying "false" memories. VISION THERAPY Greg Gilman, O.D., D.O.S., Vision therapy is a series of clinical procedures that improves the quality of visual skills and vision perception. It has a long clinical history dating back tothe previous century. Itbegan in England and France and was originally named orthoptics. The name orthoptics comes from ORTHO meaning straight and OPTICS meaning eyes. Many of the original techniques were dehcated to treating those who had crossed or lazy eyes. In-the past 40 years, optometrists have further developed vision therapy procedures for treating vision related learning problems, particularly those visual problems that result in poor reading abihty. Behavioral optometrists use vision therapy to improve eye movements, eye coordination, focusing and vision perception. These are the sensory motor components of vision. Visual skdl deficits are almost always present in those who cannot read adequately. Frequently, the vision aspect is just part of the problem, but it is a crucial part. The three basic vision skdls necessary for reading are eye movements (tracking), eye teaming, and focusing. These skdls are independent of eyesight or 20120 acuity. Most poor readers have 20120 eyesight, but still lack thevisual skills necessary for reading. The term 201 20 does not mean perfect vision. It only means that a letter 5.5 mlllirneters high can be seen at 20feet. Visual acuity (20120) is a single, small aspect of the totality of vision. Although many poor readers can see 20120, they may s t d have a vision problem that causes them to lose their place while reading. Losing their place occurs because they have not developed an appropriate skill level of eye movements. As long as the eye movement ability is inadequate, they wdl not be able to keep their place while reading. Consequently, their reading abihty is below their intellectual potential. These eye movement skills can easily be improved with vision therapy. There are many techniques to improve eye movements. One of the most common techniques is using a 4inch rubber ball suspendedon astring from the ceiling at eye level. The ball has loo press-on letters on its surface. The patient is instructed to keep his or her or head still and track the ball, reading out loud as many letters as possible. The ball is moved in a lateral dmection to simulate reading. There are many modifications to this technique to train eye tracking ability. The other major visual skills of eye teaming and focusing can also be improved with vision therapy. Those who have problems with eye teaming and focusing will often have trouble with reading comprehension, visual comfort, blur, headaches, or generaUy decreased ability to read efficiently. I t is always surprising to find that a large percentage of the population, particularly professionals, donot feel that they read as well as they should. I t is often assumed if the intellect is adequate, then reading should be second nature. However, in addltion to intellect, reading involves the whole sensory motor visual system. This sensory motor system involves tracking, focusing, eye teaming, andvisual perception. Weakness or inadequate ability in any of these sensory motor skills may affect reading, sports, driving, movement, posture, and any activity that has vision as a component. When thevision skdls of tracking, eye teaming, and focusing are improved, perception skills often improve. Perception is understanding input; in this case, visual input, but there is a connection between all perceptual systems. Improving the speed and accuracy of taking in visual information can obviously help reading, but it may also help many other aspects of perception. Helping the indvidual improve his or her intellectual performance has additional benefits. Some of these enhanced abhties positively affect the ego and self esteem. This is evident in young children who have previously been having learning M i culties. Nothing is more exciting than f i n b g ' out that "you are not dumb, you were just not perceiving appropriately ." The same situation occurs in adults; we often see them express emotional reactions when they learn to process visual information more efficiently. For example, adults with poor eye teaming and subsequent limited or �EMDR N e t w o r k N e w s l e t t e r 1996 I s s u e 2 nonexistent depth perception have always seen the world flat. Therefore, spatial concepts are confusing to them. When they improve their eye teaming ability, the result is often greatly improved depth perception. With improved understanding of the spatial environment, the emotional changes that occur aresometimes overwhelming, especially when the adult sees depth for the first time. They talk incessantly about how three-dimensional the world now looks. Several patients have written books about these changes that have profoundly changed their lives. We have identified a visual syndrome called the Streff syndrome. In the past, we assumed this was strictly a sensory motor problem and we prescribed reading glasses and vision therapy with excellent results. We have attempted'to differentiate this syndrome from hysterical amblyopia, although we have always known there is a psychological component to the syndrome. I t typically occurs in children 6-l l years of age. These children have not had a previous history of vision problems. They are typically better than average students and the ratio of girls to boys is four to one. When they go into the syndrome, their distance vision becomes slightly blurred and their near vision becomes more blurred. They lose color distrimination ability and depth perception, and they are not able to focus accurately, particularly a t nearpoint (the reading distance). In addition to the decrease in focusing ability, they also lose the ability to track and eye team accurately. They also exhibit restricted peripheral vision, sometimes tunnel vision. They often become poor students during the time they have the syndrome. The syndrome occurs typically in the late fall and early spring. Part of the therapy for this problem is tracking exercises. For many of these patients, tracking is very difficult, even though they may previously have had good tracking skills. The reduction in peripheral vision may be part of the reason tracking is so d;fficult. With tracking exercises, we are working on expanding peripheral vision as much as we are directly improving tracking. In times of high stress, many individuals constrict their peripheralvision. This is accurately documented with thresholdvisual fields. The same peripheral vision constriction may be true for traumatic stress syndrome clients. I would strongly suspect that many traumatic stress syndrome clients have reduced peripheral vision. As far as I know, this has not yet been researched. Learning about EMDR makes me wonder what we have actually been treating with the Streff syndrome. We have known it was stress related, but we thought it was simply sensory motor stress. In the last several years, we have found children who have been sexually and physically abused and show the same clinical pattern of excessively reduced vision skills. Sometimes we have done vision therapy in conjunction with psychotherapy for these children. We always do tracking exercises for this problem. And during the tracking training, we are talking to the patient about his p hysiological feelings. When we get to the point that the child can feel his or her eyes track, team, and focus, we a r e usually done with therapy. My clinical judgment is that these children were probably helped sooner with the use of both therapies, but there is no research to document this. The sensory motor triad of eye movements, eye teaming, and focusing are easily measuredby behavioraloptometrists. We have literally hundreds of methods and instruments to measure these skills. We also know that they are directly related to perception. Sometimes vision therapy is done for the three basic skills only andperception improves. Other times vision therapy is done for the three basic skills and then perceptual training is done. Behavioral optometrists are convinced that these vision skills are necessary for normal physiologicaland psychological function. In the past 10years, we have begun to work with head trauma patients. There is a long history of many head trauma patients who have trouble with short-term memory and reading after head trauma. In the past, these problems were never directly addressed. We now know that many of them have convergence problems after trauma. They have lost the abihty to team t h e i r eyes together a t nearpoint; they can no longer converge their eyes for reading and nearpoint activities. Through previous records, we know that this was not the case before the accident. The good news is that these patients are now receiving vision therapy and regaining their short-term memory and reading ability. This result has come from the combined efforts of behavioral optometrists and occupational therapists. The referral relationship that has been developed has greatly helped many patients. Recently, apatient was referred to my office by a clinician for vision therapy. The patient had been diagnosed with traumatic stress syndrome. However, the c h i c i a n had trouble using EMDR because the patient had exceedingly poor eye movement ability. Her ability was so poor that she tended to move her head rather than her eyes. We know from research that children a s early a s 42,months of age have the ability to move their eyes separate from head movement (Gilman & Gottfried, 1983). This 44-year-old woman was not able to follow a moving object without moving her head and she exhibited several visual sklll deficits. I did conventional vision therapy for eight weekly visits and gave her home vision therapy exercises. We worked on eye movements, eye teaming, focusing, and spatial perception. A significant amount of therapy was dedicated to whole body movement in space. She had dS1culty moving and we usedprism techniques to help her. At the seventh visit, the patient told me about her traumatic stress situation. I listened �EMDR Network Newsletter 1995 Issue 2 and did not make any comments. I felt that her psychological stress situation would be treated by the referring psychologist. She finished the vision therapy with improved visual skdls and she could track sufficiently for EMDR., I noticed that a t the third visit she began smding and seemed more a t ease. Upon referral back to the psychologist, I was told that the patient no longer had the traumatic stress syndrome. The way we see has a lot to do with the way we think. We know that thinking and seeing are related. That is easy to say, but extremely M i c u l t to research (Gdman & Gottfried, 1985). Behavioral optometry has been criticized by medicine for 40 years because we did not have the research to prove what we were doing. However, a t this time there is not a school dlstrict or remedial teacher in the country that does not understand that tracking (eye movements) is necessary for reading. This is now common knowledge because we fought against the criticism and persisted in what we were doing; we knew that it helped our patients. We are now just beginning to have some of the neurological explanations of why vision therapy works. As c h i cians, we feel our first responsibility is to our patients and their problems. Eye movements were first accurately measured in the 1970s, although we have been doing eye movement training since the 1920s. I t would have been sad if we had waited for the research BEFORE we used the techniques. Vision therapy has been researched extensively and we know what it does. We are stdl trying to determine how it works. EMDR has a similar situation-i.e., the underlying neurological mechanisms are stdl not well understood. This would appear to open the possibhty of mutual benefit from research on the neurological mechanisms of ocular motilities and their correlates. I think there is sufficient common ground for future bridges between vision therapy and EMDR. I would be happy to answer any letters or faxes. Greg Gilman, O.D.,P.O. Box 3590, Quincy, CA 95971; phone (916) 283-2206; fax (916) 283-4976. To detail this support fully would take considerable time. I can, however, provide some basics. There is evidence of changes in gonadotropin releasing hormone (GnRH) pulsathty which occur during REM Optometric Extension Program Foun- sleep. Most notably, these changes dation, 1921E. CarnegieAvenue, Suite are associated with the onset of pu4L, Santa Ana, CA 92705;phone (714) berty-and with sexuality-as measured in humans by assay of luteiniz250-80 70;fax (714) 250-815 7. ing hormone &H). In various mental &esses, the changes are also apparCollege of O ~ t o m ~ t r i s t s in De- ent (e.g, anorexia nervosa, where LH Velo~menf, 2859 Chula Vista, CA Box is used as a index of recov91 910. Additional information may be requested from: cry). References G h a n , G. D., & Gottfried, A. M. (1983). Development of visual skdls in infants and youngchildren. American O~tometric Association Journal, 54(6), 541-543. Gilman, G. D., & Gottfried, A. M. (1985). Visual skdls and intellectual development: A relationship in young children. American O~tometric Association Journal, 56(7),550-554. To:Dr. Francine Shapiro Recent evidence also suggests that mammalian olfactory andvisual pathways are Linkedat the neuronal level. Moreover, humans have been shown to exhibit an LH response to visual stimuli-a neuroendocrine response that can be classically conditioned in other mammals. The conditioned response typically has been shown to occur with pairedolfactory stimuli. I have also read that, in many cases, post-traumatic stress can be triggered by olfactory stimuli; therein lies one link between your work and mine. It is also interesting tonote that many of the pharmacologic therapies used Partell Medical Center in the treatment of mental illnesses act on the EnRH neuronal system (e.g., dopamine, serotonin, opioids, etc. This letter was sent to me with a all act on GnRH secretion), andGnRH request for information,l a m forward- is unequivocally required for the reing it to network members for possible , lease of LH. brainstorming. Please contact the author directly, and write up any I propose that with REM sleep, we ideas. Jim Kohl, Partel Medical Cen- incorporate life's experiences that in ter, Ste. 300,2870s.Maryland Pkwy., many cases are associated with LH Los Vegas, NV 89109. release. That traumatic experience email: 76357.1414@compuserv.com may incorporate a strongly negative experience with LH secretion--one In a newspaper account of your link that could also be reissued from the between rapid eye movement therapy subconscious during REM sleep or andmentalillness, Inoted your specu- with induction of a similar physiologilative correlate with REM sleep. cal state by a particular trigger such as olfaction or eye movement-may I n my l i t e r a t u r e review of explain more of the '%big picture." psychoneuroendocrinologic studies Linking olfaction; genes; nerve cells; hormones; andbehavior, I have found support for your speculation. Jim Kohl �EMDR N e t w o r k N e w s l e t t e r 1995 I s s u e 2 CALIFORNIA EMDR STUDY GROUPS Norva Acmrnero California Network Coordinator (408) 864-4048 CENTURY CITYISANTA MONICA REDDING Robert Goldblatt (213) 917-2277 Coordinating a new group 90067,90401 zip area for West L.A. Dave Wilson (916) 223-2777 Meets monthly a t the Frisbee Mansion on East Street. Discussions, case presentations, videos, role playing. CERRITOSICENTRAL CITIES Pauline Hume Pat Sonnenburg Coordinating a new group Open (2 13) 869-0055 (310) 924-7307 CUPERTINO Gerry Bauer Meets 2nd Wed. 2:00 SACRAMENTO (408) 973-1001 Case consultation. Open - 3:00 pm RIVERSIDEISAN BERNARDINO Byron Perkins Meets 3rd Friday of every month, 9:30am EAST BAY Edith Ankersmit (510) 526-5297 Meets 3rd Fri. 7:30pm. Case discussion only. Group is closed to new members, willing to coordinata new E. Bay group. EAST BAYIALBANY Sandra Dibble-Hope (510)843-1396x48 Meets 1st Mon. 8 - 9.30pm, 1035 San Pablo Ave., Ste. 8. EAST BAYIOAKLAND Hank Ormond (510) 832-2525 Meets one Friday a month Call for time & day. Open FRESNO Darrell Dunkel (209) 435-7849 Meets 1st Fri. a t Fresno VAMC. Primarily case discussions. Nancy Stark, MFCC (209) 292-1700 Jams Sheppard, MFCC Meets every other Friday. Call for information. FULLERTON (909) 732-2142 - 11 OOam Bea Favre (916) 972-9408 Connie Sears (916) 483-6059 Meets third Friday of every month 1.00 - 3 OOpm At 2740 Fulton Ave., Sacramento, CA 95821 SAN DIEGO Jim Fox, MFCC (619) 260-04 14 Meets second Friday of Each Month, 9.30am - 1l:OOam. Arthur T. Horvath, Ph.D. Call about meeting times and places. (619) 445-0042 Mary Anderson (619) 434-4422 Meets 2nd Friday of every month from 9.00 - 10 30am Primarily case discussion. Call regarding availability. Elizabeth Snyker (619) 942-6347 Meets 3rd Wednesday of every month, 9:OOam - 10:30am. Ste. 230, Encenitas. 92024. 191 Calle Magdelena St., SAN FRANCISCO Curtis Rouanzoin Jocelyne Shiromoto Meets 2nd Tuesday from 9:30 - 11:30 AM. (714) 680-0663 Sylvia Mills (415) 221-3030 Meets Friday, call for next date. Potluck dinner and case discussion. New members welcome. Jocelyne Shiromoto (714) 965-1550 Stan Yantis (415) 241-5601 Meets 1st Wed. 8 - lOpm., 180 Beaumont St. Please call to confirm. Case discussion and group process. Open. HUNTINGTON BEACH IRVINE Charles Wilkerson (714) 543-825 1 Meets 2nd Thursday of month. Primarily case discussion. Open. Call for directions. LOS ALTOSIPALO ALTO John Marquis (4 15) 965-2422 Meets a d hoc a t Pacific Graduate bchool of Psychology in Palo Alto. Primarily case discussion. Open LOS GATOSISARATOGAICAMPBELL Jean Bitter-Moore (408) 354-4048 Meets the 3rd Thurs. 12:OO-1:30pm a t Mission Oaks Hospital, Conference Room 1, Los Gatos. Open MANHATTANIREDONDO BEACH Randall Jost Coordinating a new group. (213) 539-3682 SAN LUIS OBISPQ Marilyn Rice, Ph D. Pat Grabinsky (415) 692-4658 Florence Radin (4 15) 593-7 175 Coordinating a new group. Contact Florence SANTA CRUZ AREA Linda Neider, MA, ATR, MFCC (408) 475-2849 Meets monthly on a Fri. Call for time. Case discussion. SARATOGAIW. SAN JOSE Dwight Goodwin Meets alternate Fridays, 9:30am - ll:30am (408) 24 1-0198 SOLANOI NAPA COUNTY Micah Altman (707) 747-9178 Willing to coordinate new group. Call if interested. MARIN COUNTY - ll:30am. (415) 472-2765 SONOMA COUNTY (408) 372-3900 Kay Caldwell (707) 525-0911 Meets in Santa Rosa a t Kay's ofice the 4th Tues. 12:30 2:OOpm. Case discussion, videos and "troubleshooting." Open (707) 226-5056 Gilda Meyers 1 Friday per month. loam James Pratty Coordinating a new group. Open Call. MONTEREY Robbie Dunton Coordinating a new group. Open TORRANCE NAPA Marguerite McCorkle NEVADA CITYIGRASS VALLEY Judith Jones Call for time. Open (916) 477-2857 PALMDALEILANCASTER Elizabeth White Coordinating a new group. Open (805) 272-8880 PAL0 ALTO Ferol Larsen 1st Wed. loam (805) 438-3850 SAN MATEO/BURLINGAME/REDWOOD CITY MRI conference (415) 326-6896 room. Case discussion. (800) 767-7264 WEST LOS ANGELES Geoffry White (310) 202-7445 (3 10) 479-6368 David b a d y Coordinating a new group. Open WOODLAND HILLSfNORTHRIDGElWESTWOOD Ron Doctor (818) 342-6370 Ginger Gilson (8 18) 342-6370 Seeking new members. Contact Ginger. &4 I f you am iniemtsd in coordinating a n e u sfudy gmup hfourn g h , p l e a e a n o t i b the EMDR offks PO Box 61010, Praifio Grove, CA 93950-6010 (408) 873-8900 Far (408) 647-9881 at: �EMDR Network Newsletter 1995 Issue 2 AUDIO TAPE ORDER FORM ( ( ) = 1995 INTERNATIONAL EMDR CONFERENCE By Ilbail: Full Day Seaaiona coat $ 3 6 each; Half Day Sessions cost $ 18 each Single Tapes $9.00 FULL SET PRICE: $ 5 5 0 NOTE: These t a ~ e are available only to attendees of the 1995 EMDR Conference s and members of-ae 1996 EMDR Network! Please Circle - T a ~ Code # e N 329 N 330a (Full Day) EMDR 95 rev Opening & Closing Ceremonies FRANCINE SHAPIRO, PhD EMDR Applfcations to CrItical Incident Stress Management JEFFREY T. MITCHELL, PhD / ROGER SOLOMON, PhD N 33 1a (Full Day) Integrating Schema-Focused Therapy & Eh4DR JEFFREY YOUNG, PhD / WILLIAM ZANGHIU, PhD N 332a (Full Day) WALTER YOUNG, X D / ITsing EMDR in Dissociative Disorders G E R U D PUK, PhD / CURTIS ROUANZOIN, PhD N 333a (Full Day) Healing the Sexual Problems Caused by Sexual Abuse WENDY MALTZ, LCSW Integrative & Strategic Utilization of EMDR in DEBORAH KORN, PlyD Treating Survivors of Sexual Abuse Using Dream Work & EMDR with Survivors of Sexual Abuse RENA ZAHORSKY, LMPCC N 334a (Full Day) ROBERT TINKER, PhD Using EMDR to Treat Children Treating Severely Traumatized Children CAROL YORE, LMSW-ACP Assessments & Treatment Strategies PEGGY THOMPSON, PhD Using Eh4DR with Adolescents N 335a (Half Day) Interactive Guided Imagery & EMDR Synergy & Complementarity MARTIN ROSSMAN, MD / DAVID BRESSLER, PhD N 336a (Hall Day) The Use of EMDR in Medeal& Somatic Problems PHYLLXS H. KLAUS, W C C N 338a [Half Day Diverse Models of Understanding EMDR Generated Material ANDREW SWEET, PoyD N 339a (Half Day) Peak Performance in the Work Place SANDRA "SAMwFOSTER, PhD / JENNIFER LENDL, PhD N 340a (Half Day) RICKY GREENWALD, PlyD Children-Case Presentations Use of EMDR with Disruptive Behavior Disorders MICHAEL ABRUZZESE, PhD Treatment of Chlldrens' Fears with EMDR FRANCES "FRANKIE" BLAFF, PhD N 34 l a (Half Day) EMDR Case Formulation Symposium AM)REW LEEDS, PhD N 343a (Half Day) Symposium: Advanced ClMcal Applications of EMDR to Addictive Behaviors SILXE VOGELMANN-SINE PhD, ChPir A J. POPKY, MA, CO-ChPk / STEVE LAZROVE, MD / LARRY SINE,PhD / . JONATHAN SPEARE, PhD / DARLENE WADE, ACSW / TERRY WADE, PhD N 344a (Half Day] When Something Wrong with Me - EMDR & ADHD W R Y WILDWIND. LCSW DWIGHT WODWIN, PhD / Chafr N 34% (Half Day) Research Symposium N 346a (Half Day) Transpersonal Psychotherapy Panel: EMDR & Transpersonal Approaches to Psychotherapy SHEILA KRYSTAL. PhD / SHARON BERBOTRER, MFCC / IRV EATZ, PhD / SUZANNE PREGERSON, MFCC / SUZANNE SLYMAN, MFCC / JOAN WAGER, IXSW, BCD �EMDR N e t w o r k N e w s l e t t e r 1995 Issue 2 N 347a (Half Day) N 34% (Half Day) N 349 N 350a (Half Day] Narcissistic Disorders: Using EMDR with These Dlfncult Clients P W MANFIELD*PhD Beyond the Baslcs: Conceptual Issues h Advances in Using EMDR WILLIAM ZANGWIU, PhD Symposium & Town Meeting: What Can We Learn from the 'False Delayed Memory' Controversy ? DAVID C A t o F / WENDY w n , LCSW / FRANCINE SHAPIRO. P ~ / WALTER YOUNG. MD D Using EMDR in the Treatment of Sexual Problems BERNIE ZXLBERGELb. PhD N 35la (Half Day) N 352a (Half Day1 EMDR Application for Pain Management BRUCE N. EIMER. F+hD Applications of EMDR to Children: EMDR in the Treatment of NICK COCCO. M.Prych Darkness Phobia in Children EMDR with Children: Elwen Months to Eleven Years JOAN LOVETT. MD N 353a (Half Day) EMDR with Victims of Trauma: Protecting Your Client. Protecting Your Self AL COOPER. PhD N 354a (Half Day) PAT EMARI). LMFCC A Brief Look a t MRI Brief Therapy N 355a (Half Day) Researching EMDR The State of the Art So Far STEVE SILVER. PhD & GARY FULCHER. PhD N 356a (Half Day) University Training Course FRANCINE SIIAPIRO. PhD NOTE: Mail orders for thie session must be written on univerdty letterhead. N 357a (Half Day) EMDR and the Issues of Gay Clients DONALD WESTON. PhD N 358 EMDR Applications to Anxiety Disorders RON DOCTOR PhD N 359 EMDR Colorado Research Project: One Year Follow-up SANDRA WILSON. P h D / LEE BECKER. PhD / ROBERT TINXER. PhD N 360 Self-soothing & the Multiple Trauma Survivor MARGOT SILK FORREST N 361 Integrating EMDR in the Psychodynamic Treatment Process DAVID GRAND. RCSW. BCD N 362 N 363 EMDR in Croatia STEVE SILVER. PhD The Uses of Imaglnal& Cognitive Interweaves with LAUREL PARNEU. PhD Sexual Abuse Survivors () i (E) m Please mail order form & checka to: AUDIO PRODUCTIONS. INC. 8808 8. LAXE STEVENS W . EVERETT. W A 98208 U . S A 1-800-488-8468 [208) 338-8223 F X (206) 334-7866 A 2 2 # I NAME: or TAPES ($ 1.25/tape ( $ 1 5 max.1 maxed i WAI n SUBlWI'AL 1 (WA Remident.. add 7.8%tax) TOTAL =P: CC#: SIGNATURE: FOR OFFICE USE ONLY: PU PD INV 26 I SHIPPING ADDRESS: PHONE: [ =$ SHP Cod5207 =I =$ =$ 4 ( � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter Newsletter Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter, 5(2), 1-26 https://d1y502jg6fpugt.cloudfront.net/13023/archive/files/4e9eac82d02ec7f6ce5959fcae3b0cee.pdf?Expires=1790208000&Signature=mfG6pS8yyfeic%7EUPHfMXYR%7EfaWurpurmbQGKW79jyzjwDNztiUD1bMVWodj1Oz63qGQ1H8o3OTogbcYhZDKhmR7m6WQ-gOnf3yFDcJQN3gFR7iT5IrS7s0LS7V3OK1L2xA-ss3Q6tjFpu-x8voCWN3wudLDllTNSPa%7EM9irUhEzSr5o7jQJed6FSfdb1GEkUcrudagWTimKoMDtZ6WFfV%7EzaRZD3LkaK1mHBXvaw6K4z2Q8LqIODtU4PNzbVKFi3ZWFW2X6jC5uMZCd3HrOL4t5bzlkI1KwFZykdLJlqPZYqdNqDmieRAhGSUJD5TmCsnXHukzpftnuUhzvbOo7GFA__&Key-Pair-Id=K6UGZS9ZTDSZM e34f8e2586c2ed6c74108f339a2b09dc PDF Text Text EMDR Network Newsletter 1996 Issue 3 1995 Issue 3 I <G)~etwork NETWORK, PIC. I Newsletter EYE MOVEMENT DESENSITIZATION AND REPROCESSING 1 Copyright O 1995 EMDR NETWORK, INC. P.O. Box 51010, Pacific Grove, CA 93950-6010 (408) 372-3900 FAX (408) 647-9881 ................ One of the most upsetting professional experiences I have so far encountered occurred in November 1995. One of the participants at the Level I1 training in New York handed me a letter from a relative of hers. She had suggested that her sister get EMDR treatment and counseled her to call the EMDR Institute office for a referral. The following are excerpts from the letter: "For seventeen years I have not been able to have a good night's sleep and have been in varying stages of mood and depression. All these years I have been seeking professional help with no success. Six months ago I called Dr. Shapiro and she referred me to . I sought his Dr. in professional help for over ten hours. During this time he told me that my depression was at a very high level and that I have had more than twenty different traumas in my life." She had called the EMDR Institute office for a referral, and was given the names of three trained clinicians to call. As luck would have it, Dr.was the first one she spoke to. "We worked together on all my problems and he instructed me in the method of tapping under my eyes and MDR With Couples ................................. Arthur Anton, Ph.D. ...................... 5 Case Study ................................................ Jimmye D. Angell, Ph.D.. ............. 6 EMDR and Medical Conditions .......................................................... Graciela Rodriguez, M.D. ......................................................... Pablo Solvey, M.D. .........................................................Susana Tagliavini, Lic. Psic ......... 7 onal Update. .............................. Francine Shapiro, Ph.D. ............... ail List on the Internet ....................................................................... Network Coordinators ...................................................................... d Meniere's Disease. .............. Ann Martin,M.S. ............................ s Research ................................ Arnold J . Popky, M.A. ................... ted. ........................................................................................................... ......................... Editor-Lois Allen-Byrd, Ph.D ....... on top of my hands for which I have been doing with no luck. The first few weeks I felt a little better but then I went back to square one with having nightmares and being extremely depressed." Dr. treated her by standing at her side and having her do about ten eye movements. He then told her to tap under her eyes, and on assorted places on her body. He led her to believe that this was EMDR. "Dr. told me this technique of EMDR will work for some patients, the results will show after three sessions and if not it means that it is not possible to use on me." He had asked for $1000 in advance, and when her three sessions were up-told her EMDR couldn't work for her and there was nothing more he could do. But if she just continued the tapping (under her eyes and the side of her hands) she would be fine. "After a period of one month of not seeing him I was feeling very miserable and sad, I called him to get advice. He then told me the only thing he can suggest is for me to keep doing the tapping under my eyes and hands." To treat a client in this way is clearly reprehensible. What is also problematic is to call something EMDR, when it is not. EMDR should not bemisrepresented to clients. When EMDR is being substantially modifiedfrom the standards established in the trainings and research, clients should be told they are being offered an experimentalvariation that has no research validation. I t should also be made clear that the method is not being used according to suggested clinical practice-or that another method is being usedinstead. When I called this �EMDR Network N e w s l e t t e r 1996 Issue 3 client to investigate, she told me that she had become suicidal and the clinician told her just to continue tapping. She said that one of the things that caused her despair was the belief that EMDR hadn't helped her. She had trusted her sister-in-law and the clinician told her he was using i t - b u t it obviously didn't work for her! This experience has lead me to rethink our policy of referring clients to clinicians under the blanket assumption that they know what they are doing. Since the entire field of psychology seems moving to a competency based model, partially inspired by managed care panels, I believe we should do so as well. I have described a suggested framework for it in the International Update column of this Newsletter. The attention placedon EMDR by the media has caused a number of "eye movement techniques" to proliferate around the world. Misinformation is also causing a great deal of confusion in the field causing other approaches to be mistakenly equated with EMDR (see Steven Silver in this Newsletter). For purposes of clarity, it is important to reiterate that EMDR is not a simple anxiety-reducingtechnique. I t is a method that should be used by trained clinicians with prepared clients. According to clinicians that have been trained in different approaches, what appears to make EMDR different is the rapid accessing and processing of memory networks in a way that leads to not only a desensitization, but the emergence of insights, cognitive restructuring, and recognitions of patterns. The generalization of treatment effects and its consequent results with multiply traumatized clients is also being reported as unique. Since the EMDR model suggests a specific approach to pathology, it includes the installation of templates for appropriate future action. In order to implement EMDR most comprehensively for the clients overall improvement, it is suggested that all its strengths be utilized. * * * At the point the Wilson, Becker & Tinker study was accepted by the Journal of Consulting and Clinical Psychology, I calculated the number of subjects subjected to evaluation in other F'TSD studies. Here is the breakup of subjects studied in all the non-EMDR controlled studies combined. Desensitization - 40 - 46 Flooding Psychodynamic - 29 Hypnotherapy - 29 Cognitive -9 In contrast, the effect of EMDR has been evaluated on more than 400 subjects in controlled studies. I'd say one important goal for the field would be to increase the number of controlled clinical outcome studies of PTSD in general. It should be mentioned that an added advantage of the Wilson, Becker & Tinker study is that it included a mixed sample of subjects. Approximately half(47%) had a PTSD diagnosis, while the other half had some F'TSD criteria. That allowed a comparison of effects for a range of clients that is useful to the practicing clinician. In addition, the 37 subjects that did have a PTSD diagnosis, made it the second or third largest subject poolin all the extant, published PTSD studies. Hopefully, the scientific rigor used in its evaluation will become a hallmark for future studies. A very exciting study has been completed in Colorado Springs by M. Scheck, J. Scheffer and C. Gillete. The following is a paraphrase of the abstract: The subjects were high-risk females presenting in a community agency (e.g., prostitutes, pregnant teens, drug addicts, etc.). I t has been found that providing mental health services to this group is often hindered by their unstable lifestyles,however psychological dysfunction is a major issue. Sixty females, between 16 and 25 years old, approximately two-thirds who had PTSD, were randomly assigned to EMDR and an active reflective listening (ARL) control. Pre-post effect sizes for the EMDR group averaged 1.47 compared to the 0.64 effect size in the ARL group. Measures used included t h e - ~ e c k Depression scale, State Anxiety, Ten- nessee Self-Concept, Penn PTSD, and, IES. Since over 90% of the subjects reported childhood abuse, these statistically andclinically si&cantfmdings , after only two sessions, provide added incentive for trying to locate funding for pilot projects in the inner cities. Another study, by Puma Datta, Ph.D. also found clinically significant results in a study of adolescent males who were institutionalized for sexual offenses. The report indicated that three sessions of EMDR resulted in less disturbance, greater sense of cognitive control, and that after treatment, the subject felt greater empathy towards the victim. This is also very encouraging to the global vision that EMDR can be used to help stop the cycle of violence and abuse worldwide. Pilot projects that target inner city "prevention", and high-risk populations can be sponsored under the EMDR Humanitarian Assistance Programs (see International Update) if we can find funding. Anyone that knows any possible individual donors or corporate sponsors for any of the outreach programs, please let us know. * * * At the Evolution of Psychotherapy Conference this year I had the pleasureof meeting ArnoldLazarus, Ph.D. He has been one of the pioneers in the field promoting the concept of integration. I was most impressed with his BASIC I.D. model which is highly compatible with EMDR. I also thought very highly of his Multimodal Life History Inventory. I t would appear to be a tremendous boon to the practicingclinician. The complete inventory (by Arnold & Clifford Lazarus) may be obtainedhom Research Press, 2612 North Mattis Avenue, Champaign, IL 61821. �- EMDR Network N e w s l e t t e r 1996 Issue 3 EMDR Network Newsletter Submission Lnfoxmatian . TheNewsletter is now under "newmanagement." This means, among other things, that articles and disks will henceforth be submitted to: When I took the Level 1EMDR training, I was impressedby the fact that it dovetails very nicely with t h e multimodaloutlook and tends tocover the same essential modalities. In Las Vegas, while we were at the Evolution of Psychotherapy Conference, Dr. Francine Shapiro and I chatted about numerous ideas, including the way in which people familiar with EMDR could profit from employing multimodal assessment methods. Dr. Shapiro perused the Multimodal Life History Questionnaire (Lazarus & Lazarus, 1991),for instance, and felt that it could be a useful addendum in the hands of well-trained EMDR therapists and invited me to write this very brief outline of t h e multimodal therapy rationale. EMDRIA The Administrator 3900E. Camelback Rd, Suite 300 Phoenix, AZ 8501 8 has Remaining the same are the requirements for APA style and format, and that the editor cannot guarantee when, or if, an article will be published. Additionally, all articles are subject to editorial revisions. ~gical substrate, the multimodal orintation is most far-reaching. By asessing a client's BASIC I.D., one enleavors to "leave no stone unturned." 'he elements of a thorough assessnent involve the following range of luestions: 3: What is this individual doing that s getting in the way of his or her At base, we are biological organisms lappiness or personal fulfillment (self(neurophysiologicalhiochemicalenti- lefeatingactions, maladaptive behavties) who behave (act and react), emote ors)? What does the client need to (experienceaffectiveresponses),sense ncrease and decrease? What should (respond to tactile, olfactory, gustaielshe stop doing and start doing? tory, visual and auditory stimuli), imagine (conjure up sights, sounds k What emotions (affectivereactions) and other events in our mind's eye), are predominant? Are we dealing with think (entertain beliefs, opinions,val- anger, anxiety, depression, combinaues and attitudes), and interact with ;ions thereof, and to what extent (e.g., one another (enjoy, tolerate, or suffer rritation versus rage, sadness versus various interpersonal relationships). srofoundmelancholy)? What appears By referring to these seven discrete, to generate these negative affectsbut interaction dimensions or modali- :ertain cognitions, images, interperties as Behavior, Affect, Sensation, sonal conflicts? How does the person Imagery, Cognition, Interpersonal, respond (behave) when feeling a cerDrugs/Biologicals,the convenient ac- tain way? It is important to look for ronym BASIC I.D. emerges from the interactiveprocesses-what impact do first letter of each one. various behaviors have on the person's affect and vice versa? How does this Many psychotherapeutic approaches influenceeach of the other modalities? are trimodal, addressing affect,cognition and behavior-ABC. The S: Are there specific sensory commultimodal approach provides clini- plaints (e.g., tension, chronic pain, cians with a comprehensive template. tremors)? What feelings, thoughts By separating sensations from emo- and behaviors are connected to thesc tions, distinguishingbetween images negative sensations? What positivc and cognitions, emphasizing both sensations (e.g.,visual, auditory, tac, intra-individual and interpersonal be. tile, olfactory, and gustatory delights: haviors, and underscoring the bio. does the person report? This includer ;he individual as a sensualand sexual seing. When called for, the enhancement or cultivation of erotic pleasure is a viable therapeutic goal. I: What fantasies and images are predominant? What is the person's "self-image"? Are there specific success or failure images? Are there negative or intrusive images (e.g., flashbacks to unhappy or traumatic experiences)? And how are these images connected to ongoing cognitions, behaviors, affective reactions, etc.? C: Can we determine the individual's main attitudes, values, beliefs, and opinions? What are this person'spredominant shoulds,oughts, andmusts? Are there any definite dysfunctional beliefs or irrational ideas? Can we detect any untoward automatic thoughts that undermine his or her functioning? I: Interpersonally, who are the significant othersin this individual's life? What does he or she want, desire, expect, and receive from them, and what does he or she, in turn, give to and do for them? What relationships give him or her particular pleasures and pains? D: Is this person biologically healthy and health conscious? Does he or she have any medical complaints or concerns? What relevant details pertain to diet, weight, sleep, exercise, alcohol, and drug use? �EMDR Network Newsletter 1996 Issue 3 The foregoing are some of the main issues that multimodal clinicians traverse while assessing the client's BASIC I.D. A more comprehensive problem identification sequence is derived from asking most clients to complete the Multimodal Life History Inventory. This 15-page questionnaire facilitates treatment when conscientiously filled in by clients as a homework assignment, usually after the initial session. Seriously disturbed (ie., deluded, deeply depressed, highly aetated) clients will obviously not be expected to comply, but most psychiatric outpatients who are reasonably literate will find the exercise useful for speeding up routine history taking and readily provide the therapist with a BASIC I.D. analysis. I t should be understood that the multimodal approach is not one that insistson treating everyone across the entire BASIC I.D. Some problems respond better to focused interventions. However, when progress falters or when no treatment gains are evident, we recommend a BASIC I.D. assessment as a means of shedding light on otherwise concealed issues that may be amenable to change. If anyone is interested in obtaining much more detailed information on the subject, may I recommend my book The Practice o f Multirnodal Therapy (Lazarus, 1989)andtwochapters in edited books (Lazarus, 1992, 1995). References Lazarus, A. A. (1989). The practice of rnultimodal therapy. Baltimore: Johns Hopkins University Press. Lazarus, A A. (1992). Multimodal therapy: Technical eclecticism with minimalintegration. In J. C. Norcorss & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 231263). New York: Basic Books. Lazarus, A. A. (1995). Multimodal therapy, In R. J. Corsini & D. Wedding (Eds.), Current psychotherapies (5th ed., pp. 322-355). Itasca, IL: Peacock. Lazarus, A. A , & Lazarus, C. N. (1991). Multirnodal life history inventory. Champaign, IL: Research Press. her time, and was anxious about tell- "' ing her mother-in-law of her decision. ' Anotherwasa"walk-in" mental health counselor who happened to be visiting FSU, heard the presentation by Roger and myself, and volunteered for the study to work on some childhood memories. Yet another was a woman who was anxious about returning to the workforce after being unemployed for some time. Thus, this was NOT a study of treatment of PTSD. Unfortunately, many have characterized the study as being a comparison of PTSD treatments. As one of the two EMDR clinicians involved in the "Active Ingredient" project (Roger Solomon being the other), I have found myself receiving a number of questions about the other therapies investigated and how they might relate to EMDR. In the EMDR Level I trainings I have conducted, it has become clear that some clinicians have heard a variety of storiesof what took place a t Florida State University (under the direction of Charles Figley, Ph.D.), where the project was conducted, which has led to some unfortunate misunderstandings. Since the client groups for each treatment were not the same, it becomes extremely difEcult to compare results. For example, in the case of the person with the blood phobia noted above, a single session with one follow-up session for reevaluation was sufficient for complete resolution with EMDR. How do we compare that with the woman returning to the work force who got a job the day after treatment? Both were successful, but about all they had in common were the broad variables (of anxiety and sex of the subject. Indeed, I elected not to use EMDR First, I think it important to say that with the woman with the family busiEMDR and the other methods investi- ness a s it was not needed; she stated gated--ThoughtField Therapy 0, she knew what she had to do after Trauma Incident Resolution m R ) , simply getting a chance to t l about ak and NLP's Visual Kinesthetic Disso- it. Another subject, a woman who had ciation--all were selected on the basis been raped, asked for a female theraof reports from clinicians in the field; pist. I assisted her in being referred. none was intended to be the "gold After the study was completed, the standard by which the others were number ofsubjects seen were reported. evaluated. The attempt, as explained I was subsequently told that the to me repeatedly, was not toconduct a EMDR team was denigrated by some comparative "horse race," but rather for "selecting" our subjects as opposed to see what these four approaches tousing EMDR with everyone we were might have in common. assigned. I regarded my conduct as ethical and appropriate and, had I Subjects selected were not individu- known it wouldhave been usedtocast als having a diagnosis of PTSD; they EMDR in a negative light, I would were volunteers who had various lev- have done the same. els of anxiety. For example, one of my subjects was suffering from a severe We tried, as far as was possible, to blood phobia. Another was concerned follow the full EMDR protocol. The about terminating a family grocery intention, after all, was to identlfy an store which was taking up too much of ingredient common to all the proce- �EMDR Network N e w s l e t t e r 1995 Issue 3 dures, so clearly time was not meant to be a factor. For a couple of subjects this meant I spent a session ensuring there was adequate informedconsent, a sufficient client history was developed, and specifying thi target to be addressed. For others, after identifying and reprocessing the originalpresenting complaints, the client requested, or I suggested, targeting additional areas of disturbance. The use of the allocated three sessions was simply anopportunitytocwerasmuch clinical ground with EMDR as possible. Later, I was told that time spent in treatment was a variable being trackedandpresented. However, that was not told to either Roger or me before we began and as abwe, it would have made no difference. Thus, the study was not a comparative study of treatments for PTSD. The design would have had to have been radically different for such. AU that can be said is that all four treatments produced some positive outcomes with a wide variety of subjects. The results themselvescannotbecompared because clinical goals varied. For instance, although EMDR resulted in lower SUD ratings than the other therapies, we did not stop using EMDR when it achieved those results. What EMDR supplies is an acceleratedprocessing with a restructuring of a person's cognitive framework rather than just the desensitization which you might otherwise achieve with the other approaches. in an integrated approach, helps prepare the client for EMDR. Another aspect of integration, however, comes into play when the other treatment is viewed as another approach specifically for the kindofproblem for which EMDR is being considered, such as PTSD. There is now more controlled group research demonstrating the efficacy of EMDR than all other nonpharmaceutical treatments combined. It is very clear that EMDR is fast becoming regarded as the treatment of first choice. Thus, if there is a reason for not using EMDR, then I might use another treatment. In other words, there may be nothing to integrate if EMDR is effective. On the other hand, I use hypnosis, depending on the client, along with EMDR in the treatment of PTSD in a number of ways. Hypnosis and selfhypnosiscanbe effective stress reduction techniques to use during the dosure phase or between sessions. The ability of hypnosis to implant suggestions can often be useful in helping to develop ego strength. For clients with severe chronic pain, the anesthetic techniques of hypnosis might be usefulforpain control so they can participate in EMDR without distraction. The need for integration of methods is clear. Depending on the approach, it might be highly useful in terms of developing the therapeutic relationship, providing the client with tools useful for closure or between sessions, developing ego strength, or in dealing with secondary gain (and loss) issues. For example, I make use of a great deal of my early training in Rogerian Client Centered Therapy in developing therelationship, clanfjmg the target, and building self-esteem and ego strength. Does this accomplish thera- What were my own views of the other therapies investigated in the Active Ingredient project? I think the project wasimportantnotbecauseitsaidanything new about EMDR- the body of research on that is large and growing. Nor did it tell us much about how EMDR and the other treatments compared with each other - that will require adifferent protocol. Thevalue of the project is that it put several therapies out in view. Unlike EMDR, the other three therapies have virtually no research and the exposure they received in Florida will help to encourage that. As that is accomplished, we shall learn more about what works with our clients and, in the long run, that may well be the most important outcome ofthe Active peutic gains? Ofcourse it does. It also, Ingredient project. I t is generally held that EMDR is not to be used with couples, and I agree that it is not appropriate to do so when the primary items being dealt with are such *sues as power, intimacy, trust, communication, conflict, or control of impulses and emotions. However, I discovered recently that EMDRcanbe used successfully and effectively with couples in a t least one particular type of circumstance. The circumstance I have in mind is that in which a couple faces an external threat or severe loss that creates a crisis atmosphere to which each member of the couple is reachg withconsiderablemxietyand extreme distress. However, rather than allowing their relationship to degenerate into mutual blaming and fault-finding, the members of the couple maintain their bonding to each other, continue to support each other, and constitute a unified front in regard to the threat or loss. Recently I had occasion to treat two couples fitting the description given above. The first couple consisted of a health care provider--(not a mental health professional, I might add), who hadbeen accused (falsely, Ibelieve) by afemalepatientofhavingtouchedher improperly during an examination-and his wife, who assists him i his n ofice. The husband was stronglyproclaiming his innocence of the charge, and his wife was steadfastly supportinghis contention. ~ 0 t ofthemwere h angry a t the accuser and outraged at the accusations, but they were also experiencing acute and severe anxiety such that the husband was having chest pains and the wife was from an irritable bowel syndrome. Consequently, they both needed to be seen on an urgent basis. I found that their anxiety was being fueled by extremely negative thoughts--his having to do with damage to his reputa- tion, the loss of his practice, and of a �EMDR Network N e w s l e t t e x 1996 Issue 3 part-time teaching job, and hers with the loss of their financial base and of their home. While their anxiety-producing thoughts were not identical, they "hooked those of the other. I listed all of their thoughts and since they were sitting side-by-side on the couch in my office, instructed them both to follow my finger movements with their eyes after havingfirst read the first thought on the list (which happened to be the wife's) and elicited the SUDs level for each. After the SUDs level for both the husband and wife was reduced to zero, I followed the same procedure in regard to all of their other thoughts. After two sessions, both members of the couple reported that their anxiety levels had droppedconsiderably, that their physical symptoms had been substantially alleviated, and that they were both determined and optimistic in regard to the pending legal action against the husband. The second couple, also needing to be seen urgently, was reeling from the impact of a totally unexpected, particularly hideous, andnearly fatalsuicide attempt of a son. Their quest was for assistance in maintaining their unity and their ability to support each other in the face of this devastating family tragedy. They were both experiencing severe anxiety, shock, grief, and, in the case of the husband, some anger. As was the case with the first couple, their emotional reactions were being fueled by their own thoughts and while the husband's were not identical with the wife's, his were "hooking" hers, and vice versa. I used the same procedure as that which I described above in regard to the first couple, and after two sessions, they had both processed a great deal of the trauma, had achieved good emotional control, and were supporting each other very well. The foregoing demonstrates that it is possible to obtain good therapeutic results from treating both membersof a couple simultaneously. At the same time, I consider the circumstances in which this can be done to be circumscribed or limited, and would discour- age the use of the procedure described above in more typicalor usual cases of couples' counseling. The client is an intelligent, attractive, 46-year-old married woman with an abusive background (as well as multiple dysfunctions in her blendedfamily). Using EMDR, as well as other approaches, we have worked through many issues of co-dependency, anger, self-worth, boundaries, and assertiveness. Although she was feeling better, something was still amiss. We decided to do an EMDR session on the death of her 2-112-year-old son which occurred 21 years ago. On June 29. 1995 (which was the client's birthda;, as \;ell as her son's), we processed the middle-of-the-nightunexpecteddeath. She awakenedin 1974 terrified and knowing that something was wrong. She was frozen in our session,just as she was that night (eg., she was frozen in the doorway, her body cold andclammy,her upper chest heavy, sad, and feeling as ifavise was on her forehead). Her body became hot as she was able to move from the doorway and she told me, "I have been frozen in that doorway for 21 years, afraid to go forward or back, and now, I'm thawing:" We processed the rest of that night's events: telling her husband, not being allowed to feel anything because of taking valium, and being separated from her son's body. Cognitions changed from, "I'm helpless; I should have been there," to "I did the best I could with the lack of knowledge; it's okay for me to be spontaneous and emotionally close." The client felt her body temperature return to normal and she experienced relief from the tension of always ex. pecting the worst, day by day, in all aspects her life. She hadbeen of of everything, including attachment, for fear of loss. She felt good, even her eyebrows relaxed downward. ~ - - Her new calm has held now for 5 ' weeks, and pervasive systemic shifts in her life have been noticeable. She has no unrealistic fear, no w i l t regarding her son, no more of herself, has a slower pace, and has increased awareness ofher surroundings. "I was a t a fast pace to get through 'whatever,' before disaster more struck." She has been s~endine: time and money on herself. ~ G c her e changes, people around her also have changed. Her husband has become more responsive, helpful, and attentive; he haslistened to her a t last. For the first time, she feels like an adult; as if she h.as "grown into her skin." She is letting love in, connecting with friends, feeling no need to impress people, is more spontaneous, and her self-talk is more positive. Overwhelmed by these changes, she now wants to experience everything instead of avoiding life. She says her heart was encased in a locked metal box. Now, her oversized heart is softer and the box is gone. "I can cry now in the present moment, and I can empathize." No longer operating out of a need for approval, she now wants to give to others out of a sense of fullness. "I am a t peace, the fear is gone, and I stay calm in stressful situations. I feel 'cured,' 'healed,' 'light,' and no longer am I dreading the day when I get up in the morning." EMDR AND MEDICAL CONDITIONS Graciela Rodriguez, MD; Pablo Solvey, MD,. Raquel Soluey, MD; Susana Tagliavini, Lic. Psic. Argentine EMDX Foundation - We have successfully treated some clients with somatic complaints, and would like to share our experiences with you. The following very briefly �describe cases for which we used EMDR successfully. A 76-year-oldman, referred by an ear, nose, and throat specialist, had for 7 years been annoyed by a very troublesome tinnitus. He also had a concurrent insomnia, which was not caused by the tinnitus (when he slept he was not disturbed by it a t all). The symptoms had worsened when his wife asked for a divorce, some 2 years ago. The SUDs on the sensation was 8, the negative cognition was, "I can't stand it anymore," and the positive cognition was, "I can live with it," with a VoC of 2. We worked for three sessions, with the sensation as the target. The SUDs went to 2, and the VoC up to 7. He stated he continued having the tinnitus, but that it did not trouble him anymore. TI hear it, but I don't listen to it. It's there all right, in the background, but I kind of forget about it.") With a follow-up of 6 months, he is still fine, and his insomnia has diminished markedly. A 7-year-old girl had a severe allergy on her right hand: it was red and swollen, it was wet, it burned and hurt. We targeted those sensations, which had a SUDs of 10, and she remembered different scenes with her mother and her newborn sister. The negativecognition that then appeared was, "My mother doesn't need me anymore." After three sessions, the allergy gradually imprwed, untilitpractically disappeared. She is 90%better at a 6-month follow-up. An 11-year-old girl had a chronic allergy caused by low lgE, a low immunity disorder. Her whole body had itched andbledin places since she was 6. We worked for 12 sessions with hypnosis andEMDR, alternately, with no results. Her family insisted that she have only "positive thoughts," to which she paid lip service by repeating positive a£6rmations day andnight. It then occurred to us that she did not really believe them, so we targeted on the cognition, "I'll never get any better." After three sessions with this negative cognition, her allergy became 75% better. However, it was practically impossible for her to imagine herself totally free of the disease. We EMDR Network gewsletter 1995 Issue 3 had her symbolize her illness, her returned 8 months later, however, so being healthy, and different in-between states with different colored papers. These papers ranged in color from brown to yellow, and were in different sizes. While she watched the papers, from left to right and from brown to yellow, we did EMDR (actually finger snapping). We asked her what color best represented her allergy and what color represented herself free of the illness. (Both size and color represented the degree of illness.) We also included some brown papers in the middle of the yellow ones, toprepare her for relapses of the allergy, and she could accept them as temporary. During several sessions, she got stuck with one of the colored papers, saying she could not imagine getting any better than she currently was (that is, about 75% better). However, targeting on that little paper, she remembered some nightmares that made her very anxious, in which she saw herselfwith no skin and bleeding all over. She was actually afraid of losing all her skin, and that was by no means impossible. After we processed this, she was able to get past the little paper further on, to almost the limit of "health (the yellowest and smallest paper), and in a few days, her skin cleared another 15%. The treatment continues a t the present time, andsheis 90%imprwed. A 21-year-old medical student had fibrositis, a common disorder characterized by chronic fatigue, muscular aches, and non-restorative sleep. The disorder includes "trigger points" in different muscles, which ache, and sufferers may sleep for a normal period of time, but always awaken feeling tired, or non-restored. They actually have an increased amount of alpha frequency activity in their slowwave sleep EEG recordings-that is, an "alpha delta" type sleep patternand do not reach delta levels. Two sessions of EMDR allowed her to calm her muscle aches and achieve restorative sleep. As we could not find any negative cognitions, we simply targeted on the feelingof awakening tired. No memories appeared, just kinesthetic sensations. When the first session was over, she said, "I feel as if I had a brain massage." The disorder we had two EMDR sessions, and they were once again successful. This was 4 months ago and it is holding (we are keeping a close watch on her). A 50-year-old woman with Tourette Syndrome had a blinking tic and a coughing and hiccuping tic for years. Lately, thecoughing-hiccupingtic had worsened to the point that she swallowed lots of air, apparently causing her three neumothoraxes in the last 5 years. She also had a severe speech impairment because of her coughinghiccuping tic. We targeted on this tic, and she remembered three traumatic events with her sons. The tic got much better, but did not disappear, so we targeted on the negative cognition, "I have to tic this way and no other," and "This is the only tic that feels just right." The positive cognition with a VoC of 2 was, "I could tic some other way," andUOther tics--perhaps at the feet or toes-could feel just as right." We worked on it with EMDR for three sessions, and it went down toher toeswhich no one sees, of course. At a 7month follow-up, the tic is still a t her toes. In times of stress, she returns to the coughing-hiccuping tic, but only temporarily. The blinking has not changed. Three children, ages 8,9, and 14, with moderately severe ADHD, who were medicated with 10 mg of Imipramine, experienced improved grades and concentration. We then started working with EMDR. With an average of four sessions, the hyperactivity reduced some more, and attention increased-including grades a t school, which improved. We targeted the impulsive acting and its consequences, and the need to move targeting to future images ofbeing calm and quiet; the latter for which we used vertical saccades. We then included working on the cognitions that had developed over the years such as, "I'm lazy," "I'm no good," "It's my fault," etc. We soon suspendedmedication, and they maintained their progress. The treatment continues a t the present time, with no medication. A 46-year-old woman had asthma �L EMDR Network N e w s l e t t e r 1996 Issue 3 when she was 4years old which lasted for 2 years. She had asthma again a t 30, during a marriage crisis, and this time it lasted one year. She sought treatment because her asthma had returned about a month prior, again during a marriage crisis. We targeted on the memories of the asthma attacks (SUDs = lo), on the marriage crisis (SUDS = lo), and on her fear of divorce (SUDs = 10). The negative cognition on all scenes, including the childhood ones, was, "I'm no good," and the positive cognition was, "I'm lovable," and "I deserve to be listened to." The SUDS went down to 1, and the VoC up to 7. After four sessions, she stopped having asthma attacks, and at a follow-up of 8 months, she continues free of the disease, and goes about without the inhalator. A 52-year-old man with PTSD con- sulted us after the death of three very close friends, each ofwhom died in the space of 2 years of a lymphoma. He also complained of a chronic migraine, which he had been having for a t least 10 years and which struck twice a week, with a peculiar periodicity: it happened every S a t u r d a y a n d Wednesday. I t always started with a luminous aura and prodrome on his right eye, the pain lasting for about 24 hours, and usually no treatment was effective. As we could only work for two sessions, just before summer holidays, we targeted on the PTSD intrudmg scenes (the ones of the death of his friends, with a SUDSof 8))until the SUDS reduced to 0 When we . returned 2 months later and resumed our sessions, his migraines were 90% better. However, a very stressful incident happened in his family: his wlfe was diagnosed with advanced breast cancer. I t was then that the migraines returned, but a t a 50% level of intensity and frequency. We then targetedon the luminous aura andthe particular sensation on his right eye. The SUDs was 8, andnocognition was available. After two sessions, the luminous aura sensation had vanished and he could not bring it back. The SUDs went down to 1. When he returned the following week, the mi- I paine had. disappeared and.,to::this . -=like mad. (do not know who was late (3 months later), he is free of it. more scared of the two.) We had him ' move his eyes on and on, until the l'wo months ago, a 40-year-old man attack-which never got to a dangerlad developed a very severe symp- ous point-passed. Fortunately, he ;om: he had attacks of vocal chord did not need the shots. We then had :losure during which his glottis also two more sessions, targeting on the :lased, and he choked severely, with fear that his daughter could have a ~racticallyno air passage. He was relapse. This was three months ago. nospitalized several times, and an We keep in touch by telephone and he snesthesiologist had to use a tracheal is doing fine. He has had no more tube to allow him to breathe. He was attacks to the present time-and with warned that he could die of these at- no botulism toxin. tacks. The only solution they had to Jffer was shots of clostridium botulimum (botulism) toxin in his larynx and on his vocal chords to numb the :hords and the glottis, and diminish the nervous conductibility. This would work for about 7 or 8 months, and had to be repeated periodically. I t would also cause a severe impairment on his speech. He was referred for EMDR as holiday season and will enjoy a peacea last-chance treatment, even ifit was ful and prosperous new year. The a long shot, in the hope of avoiding the EMDR Network is taking off in a new clostridium botulinum toxin. direction and it is hoped that it will produce wonderful benefits for both The SUDSon the attacks was 10, and the organization and its members. we were pretty fearful of targeting on the symptom, since there was always I am writing this brief Editorial as a the danger of producing an attack. reminder about two issues that have Still, as there was no other way, we recently been brought to my attenprepared, just in case, some adrena- tion. The f i s t is regarding how cliniline and Decadron shots as a stand-by. cians describe their EMDR training. When we started with the eye move- I have become aware, while perusing ments, he said how happy he was that listings ofprofessionals (e.g., MFCCs, his little daughter had recovered from social workers, psychologists), that leukemia; she was considered cured. some people, including interns, are Two months ago-just prior to the identifying themselves as being certia t t a c k n h e h a d h i s h e d her last ses- fied in EMDR. sion ofchemotherapy and he was celebrating with his wife. He then remembered that he aid a last visit to the cancer specialist who said everything was okay, and told them to return next year for a routine check- up. The Thus, tolist yourself as such is untrue doctor was very optimistic, and so and misleading, particularly to othwere they. He then rememberedsome- ers who are not famihar with the thing he had forgotten: They had implications ofcertification vs. no cerseen in the waiting room another girl, tification. I am sure that these listwhom they knew also had leukemia ings indicate a misunderstanding by and was considered cured for some some EMDR clinicians. However, two years now. She was there with please remember that when you upher parents who were very distressed date existing listings or submit new because she had had a relapse. When information about your training, you he remembered this, he stated chok- do not state that you are certfied in ing, so we kept moving our fingers EMDR. �EMDR Network Newsletter 1995 Issue 3 Second, now that Dr. ShapiroJs.book is published, there may be professionals (as well as non-professionals) who read it, and then begin to use EMDR without receiving any formalized training. The ethics of the profession demand that we, as professionals,avail ourselves of as much training as we can in order to be deemed competent when using a particular method or technique. Therefore, to solely read a book when more comprehensive training is available does a disservice to our profession, our clients, and, in this case, EMDR. In essence, this Editorial is really a brief reminder that all of us must work to maintain the integrity of EMDR. We all are aware of the criticisms that EMDR and Dr. Shapiro have received and endured over the years, even to the present. When you consider the wonderful gift she has given to us and our clients, I think it is important for to do what we can to reduce the risk of engaging in behaviors, even if inadvertently, that may be questioned or considered unethical. International Update Francine s h a p i 6 , Ph.D Mental Research Institute Palo Alto, CA 1 conference for h i s - d o r t s to bring EMDR to the Balkans, "Allit takes for evil to exist is for good people to do nothing." Only through a united effort can good truly prevail. In that spirit, EMDR HAP is now seeking funds to finance trainingprograms that have been requested in Rwanda, Belgrade, Northern Ireland, Bucherest, Navajo Reservations, and Columbia. The request from Columbia has come from an organization called Forjar which treats abandoned children whohave been diagnosed with AIDS or cancer. We now have many requests, but littlefinancing. In order to aid in the humanitarian effort, I asked for avote a t the last conference, and received an overwhelming mandate to turn the EMDR Network into a service organization. Since the EMDRInternational Association (EMDRIA) will now take on all the professionalfunctions (Newsletter,directory, regionalmeetings, study groups, conferences) previously organized by the Network, we can turn our efforts in this new direction. In trying to conceptualize the relationships between these various organizations, as well as their separate functions, I came up with the following chart: m D R Institute trainings alumni support EMDR Network membership preferred providers I The EMDR Humanitarian Assistance Programs (EMDR HAP) successfully completed another training program in the Balkans. Drs. Steven Silver, GeraldPuk, Susan Rogers, andGeoffry White were flown over by Catholic Relief Services and gave two trainings in Sarajevo to mental health professionals, many of whom were them-selves traumatized by the war. The training team landed the day NATO troops arrived. During much of the training, there was sporadic gunfire in the background. Words cannot express our appreciation for their efforts. As stated by Geoffrey White when he accepted the EMDR Humanitarian Service award a t last yeais Obviously,before things are finalized, I would like your input on my ideas and any suggestions you might have about how to expedite the processmost judiciously. Here is my thinking so far: The EMDR Institute will continue offering trainings to mental health professionals. However, it will be only one of many sources, since the training restrictions were removed, and the training have been cancelled. However, in order to allow some hope of quality control in the mental health field, EMDRIA (as a separately incorporated professional entity) will serve as the professional support organization for clinicians trained by any that meets its requirements. Obviously, clinicians should have the opportunity to attend local trainings, but they should have some organization that can steer them to trainers that meet acceptable professional requirements. Clients should also have access to an organization that can refer to trained clinicians who have completed the appropriate courses, university sponsored, and otherwise. Membership in EMDRIA will be limited to clinicians meeting those standards. EMDRIA will provide professional support services including a newsletter (soon to become journal), general directory, regional meetings and study groups, conferences, and provide outreach to managed care companies, professional groups, and t h e public. EMDRIA is a fete accompli-independent of the Institute. The only connection between the two will be the co-sponsoring of the 1996 EMDR Conference in Denver. F u t u r e conferences will be handled completely by EMDRIA. Many of you have already joined, and elections will be held shortly. Their be sent this April. first -wil This is the last Newsletter of this kind that you will receive from the EMDR Network. The part that I am still conceptualizing, and would like your input on, is J2Mmuw! EMDRIA pro bono programs donations professional service training standards I the relationship of the EMDR Network and EMDR HAP. Since EMDR HAP is a non-profit, public benefit corporation, it is presently soliciting donations, through a fund-raiser, to fulfill the requests for services. For instance, the request to train clinicianstowork with children in Rwanda will take approximately $5,000 to fulfill. All services are being offered Pro bono. Trainers and facilitators are donating their efforts, but travel to Africa and housing alone cost $5,000. Likewise, in order to respond to a disaster, such as the effort to provide services to Oklahoma City, approximately $50,000 in travel, lodging, and professional support is required. Although the programs are obviously needed, and we have been profusely �I EMDR Network Newsletter 1996 Issue 3 thankedforprevious services, it turns out that corporate donors will generally not contribute unless there is a steady source of income. In other words, we must find a guaranteed financial support base. In order to do this, the mandate delivered at the conference to turn the EMDR Network into a service organization is perfect. The EMDR Network, which will be made up ofalumni of the EMDRInstitute, is a non-profit professional, membership, organization. All donations made to it by mental health professionals are taxdeductible. We will offer membership a t a sliding scale with dues that will allow the guaranteed financial base the corporate donors look for. The dues will go exclusively to finance HAP, and grants for specialized research projects (e.g., inner city prevention programs). A yearly Newsletter will - report to the membership on how the monies have been spent. In addition, because' of the problem I mentioned in the "Stray Thoughts" column, we will allow members of the Network to take a proficiency exam to established a preferred providers list. That way, those of us who truly care about providing humanitarian services worldwide, and support the concept of quality care, will have the opportunity tojoin forces. The EMDR Institute will then only refer clients who inquire about services to clinicians who are listed on the preferred providers list. The goal is for you to feel safe if you refer a family member or friend. The range of understanding and competency is so vast we need to start making descriminations. We have hundreds of requests for referrals every month, and it will become even more frequent when two books for lay people are published next year. For those who choose not to participate in a competency evaluation, EMDRIA will be providing referrals and a directory of its members who need only to have completed the required courses. I think participation in both organizations is vital, but choices are certainly available. However, EMDRIA will be the equivalent of an APA. It will continue to open up the doors for EMDR's expansion throughout the professional and lay community. It will make sure that standards are -recognized -worldwide so that EMDR is not lost amid the myriad of "eye movement therapies" that are proliferating. Therefore, I would expect anyone interestedin EMDRHAP to want to support EMDRIA's man- tations a t a number of major conferences in 1995, including a t the 1st ' Pan-PaciGc Brief Psychotherapy Conference, tbe American Academy of Psychotherapists, and the Anxiety Disorders Association of Americaconvention, the highlight came in December. As an invited speaker a t the Evolution of Psychotherapy Conference, EMDR was represented as a "state of the art" therapy. Six thousand people attended the conference and approximately two thousand of them attended my presentation on EMDR. The whole experience was gratlfylng to say the least. Facilitators are currently working on theexaminationforthepreferredproviders list. For those who do not pass, acourseis being designedout ofwhich, the clinician will have to test. We are committed to keeping the costs as low as possible. Facilitators will have to be paid for their time, meeting space, travel, etc. will have to be coveredbut the goal is to establish a resource base of which we can all be proud. It will exist not only to serve clients who IXquest aid, but to place clinicians O n the humanitarian assistance provider rolls for disaster response. In 1996, the following invitedpresentations are already scheduled: Jan. 12-15 New Traumatology Conference Clearwater Beach, FL Feb. 23-24 The Menninger Clinic Topeka, Kansas Feb 29- Mar 4 Trauma, Loss and Dissociation Washington, D.C. March 21-23 Family Therapy Networker Washington, D.C. March 25-28 American Society of Clinical H nosis Orlando. March 29-30 Active Ingredient Pro'ect FL A P 26-28 Societ for ~ tion of?'sycho%erapy Integration (submit- Many of you have heard me say repeatedly that I learned long ago that I could not please everyone. This structure is clearly not for those who ask only, "What's in it for me." I t is really for people who have the kind of awareness that 1have seen SO often in our trainings. People whose hearts are open. People who care about humanity. People who support 0thers and deserve to be supported. 8 ada ah as see. Years ago, I was told that the author Robert Heinlein lived nearby. Many of you may remember him for his novel, Stranger in a Stranee Land. I t was a book that inspired many of us in the 1960s. At any rate, the story goes that a young man came to see him saying, f'I want to thank you so much. What can I do to repay what you've done for me? What can I do to repay you for all you've given to me?" ~ ~ i n l looked at him gently and ~ i n said, " No, No. You're not getting it. You don't pay back. You pay forward." - Nov. 22 Dec. 11-15 That is what I would like the EMDR Network and EMDR HAP tobe about. Anyone that wants to play on that level is more than welcome. So, if any of YOU have other ideas or construetive comments about the plan, please do not be Write to me. We are in this together. * * * 'While I gave invited EMDR Presen- 9-13 I d,"!G..$?'cA American p s y c h o l ~ cal Association Toronto, Canada Mount Sinai Hospital Psychiatry Academic Day Toronto, Canada Ericksonian Brief Therapy Conference San Francisco, CA I think it is fair to say that judging from the wide range of invited keynotes, and the plenary sessions, EMDR has become generally accepted as an important advance in psychotherapy. N ~toconclude its acceptance in the ~ , field, it is only a matter of time until the already completedresearch makes its way into publication. The Ameri- can ~s~chological Association's Task force on the Evaluation and Dissemination ofEmpirica]ly Validated Meth- �EMDR N e t w o r k N e w s l e t t e r 1996 Issue 3 ods, has chosen not to include EMDR in this year's listing because the studies supporting it, that meet their other guidelines,have not yet been acce~ted For publication. TO-date,there &e a total of thirteen completed PTSD studies. One shows negative results, (Jensen, 1991). Two show mixed results (Boudewyns, 1990; Pitman, 1993). The others show positive results, with the most recent ones supporting that 84-90%of participants no longer meet PTSD criteria after only three sessions. No other controlled research shows equivalent results in so few sessions. No other method has this much controlled research supporting it. We have included a research overview of twelve of the PTSD studies with this Network packet. An additional two studies are: 1) a comparison of EMDR to standard Kaiser Care by Stephen Marcus and Priscilla Marquis for PTSD clients and 2) a study of women at risk (prostitutes, drug addicts, etc.) comparing EMDR and standardactive reflective listening by Maggie Scheck, Judith Schaeffer, Ph.D., and Craig Gillette, Ph.D. Both studies, along with an update on the Wilson, Becker, & Tinker data and the Carlson, Chemtob, et al. comparative research on combat veterans will be presented at the 1996 EMDR Conference. The Wilson, Becker, &Tinker study appeared as a special feature in the Journal of Consulting and Clinical Psvcholo~v December 1995. A in copy of the article is included in this packet. Ofcourse, this has not stopped the refrain I am sure all of you have heard, "it's too good to be true" and "there's no research." That is why it is vital for responsible clinicians to continue making presentations on EMDR at professional conferences. It is also necessary that more controlled research be done. Extraordinary claims, demand extraordinary proofs. Old paradigms die hard. One study that we are looking forward to is being conducted by Bessel van der Kolk, M.D., at Harvard comparing EMDR to prozac, using brain scans. The study should begin in February and continue to the end of the year. Steven Lazrove, M.D., at Yale is consulting on the project. Dr. Lazrove is also conducting his own - (408) 368-1414 National Caordimatar:Norva Aacaraexo, NSW JE1)AZ G C N L NIBWORK COORDINATORS USA - ARIZONA Jonathan Brooks, Ph.D. Pat P e w , Ph.D. (602) 493-3 110 (620) 326-2339 Norva Accornero, MSW (408) 356-1414 C r i Rouanzoin. Ph.D. uts Ron Doctor, Ph.D. Laura Knutson, LPC Jana Marzano, MA Steve Lazrove, MD David Russell, Ph.D. Deany Laliotis, LPC Dan Merlis, LCSW-C Carl Nickeson, Ph.D. Pat Hammett, Ph.D. Silke Vogelmann-Sine, Ph.D. Dean Funabiki, Ph.D. Howard Lipke. Ph.D. Lorie Bollinger, MA Mike Brewer. MD Eugene Schwartz, LCSW-C Don Beere, Ph.D. Harriett Mall, MA Marcia Whisrnan, LCSW Ardie Schoonover, LMHP Debra Wesslmann, MS, LPC William Zangwill, Ph.D. Gerald Puk,Ph.D. Peggy Moore, LSW Sheila S. Bender, Ph.D. Victoria Britt, LCSW Barbara Korzun, Psy.D. Kay Werk, LISW AM Kafoury, LPC Georgia Sloane, MS Michael West, Psy.D. Carol York, MSW Dan Sternberg, Ph.D. Marilyn Spiro, Ph.1). Steve Riggins. MA (7 14) 680-0663 (818) 885-2827 (303) 620-7198 (303) 220-1151 (203)787-0227 (203) 231-9191 (30 1) 982-9259 (301) 982-9259 (407) 898-8544 (404) 633-4796 (808) 531-1232 (509) 334-0677 (708) 537-7243 (508) 466-8623 (410) 771-4438 (410) 889-8338 (617) 774-6468 (810) 258-5720 (314) 644-1241 (402) 330-6060 (402) 330-6060 (2 12) 663-2989 (914) 635-1300 (505) 255-8682 (201) 994-7 179 (201) 746-5959 (609) 895-9784 (614) 274-7000x349 (503) 291-9343 (215) 667-6490 (615) 552-1075 (512) 343-9550 (801) 364-2779 (804) 282-6165 (206) 328-5626 CA LIFORNIA (Northern) CALIFORNIA (Southern) COLORADO CONECTICUT DISTRICT OF COLUMBIA FXORIDA GEORGIA HAWAII IDAHO ILLINOIS MASSACHUSFITES MARYLAND MICHIGAN MISSISSIPPI NEBRASKA NEW YORK NEWMWCO NEW JERSEY OHIO OREGON PENNSYLVANIA TENNESSEE TEXAS UTAH VIRGINIA WASHINGTON studies of EMDR compared to hypnosis for single trauma victims-many of whom are members of MADD. In consequence of his preliminary research with this group, MADD is supporting the dissemination and use of EMDR throughout its own network. It is quite wonderful to see the healing effects spreading so rapidly. nary conference designed for all those trained, working, studying, and involve with EMDR. There will be emphasis on enhancing skills and knowledge, as well as networking among clinical professionals and researchers. We are most proud to highhght the interest, the work, and continued effortsof EMDR professionalsinvolved in worldwidehumanitarian activities." The 1996 EMDR International Con- There will be presentations on using ference will be held June 28-30 in EMDR with family systems, compliDenver. The headliners are Bessel cated bereavement, various issues van der Kolk, M.D. , Catherine Fine, with children, somaticdisorders, anxiPh.D., Steven Gilligan, Ph.D., and ety, sports, etc. Each annualconferJefhey Mitchell,Ph.D. All are trained ence has increased in content, attenand using EMDR in their research or dance, and substance, with last year's clinical practice. In addition, I have participants giving it an overall ratbeen asked to give a keynote address. ing of over a 4.6 out of 5. We look According to the coordinator, Carol forward this year to an even greater, York. LMSW -it is "an interdisci~li- heart-warming. success. �EMDR Network Newsletter 1996 Issue 3 both sessions I suggested the client use an image that each ear was a speaker and she was a miniature person whocouldgo in and turn the knobs on the tuner down for volume on each ear. On March 6,1995,a female client, age 26, came in presenting extreme stress about performance anxiety in anticipation of her music h a l in voice. (She was a music major with a vocal emphasis at the state college where I am a counselor.) The client's complaint was that she could not hear many of the notes on the piano to sing due to the ringing and white noise in her ears. She began noticing hearing problems in high school when she was 15 years old, and was diagnosed with Meniere's disease (Stedman, 1990) in 1990 a t age 20 by her medical doctor. The client reported that her right ear was at 50.60% hearing capacity and her left ear a t 10%capacity. Her medical doctor had told her that her hearing would not improve beyond this 10%. Conclusion 4 Silke Voglemann-Sine, Ph.D., and Larry Sine, Ph.D., are developing a avoiding with Meniere's disease. Eat- After preparing the client and assess- creased and enhanced as well. ing the baseline information, we had References two sessions using Eye Movement Desensitization and Reprocessing (EMDR), targeting her hearing problem, Up to this time, she had been followingher dietfor Menierejs, avoiding salts, fats, caffeine, and some sugars. After the f i s t session with EMDR for her hearing problems, her Subjective Units of Disturbance (SUDS)Scale (Wolpe, 1991)numbers went from 8 to 516,and the Validity of Cognition (VoC) Scale (Shapiro, 1995)numbers from 1 to 516. The client took her performance h a l between the first and second counseling sessions. (In the second session, the client reported there was no ringing in her ears.) To her surprise all went well. She could hear the piano notes and her performance received an above average grade. We then focused on the white no*e in the left ear. She gave this a SUDSof 4 at heonset. When we&hed, the SUDS was 0, indicating that the white noise had been reduced significantly. In participating in the research project. ous independent efforts involved in this research task. �EMDR Network N e w s l e t t e r 1996 Issue 3 data entry, for your outstanding efforts in ensuring that the Newsletter was the best it could be. Without either one of these dedicated individuals, the sometimes painful struggle to get the Newsletter finished would have been unbearable. Thanks to both of you for your hard work and support. ... As most of you know by now, this is the last issue of the Newsletter as produced by the EMDR Network. I have had the pleasure of being the editor of the Newsletter for some time now, and have enjoyed the challenges that seem to have been inherent in the task. While it is wonderful to consider moving ahead to what hopefully will a stronger organization, it is important to take a moment and reflect on what has passed. We have watched the organization rapidly grow over the years, and have seen innwations in both the method and its a ~ ~ l i c a t i o n s since its inception. It has been a remarkable journey and one that has not yet reached its final destination. Many people have helped EMDR reach this point (with most of the effort and guidance being Dr. Shapiro's), and many of them have been mentionedin previous Newsletters. As with most organizations, there are those who do very important work--work without the glory, but work that helped hold things together-and I would like to take a moment to thank them and let them know I speak for all of us in expressing this gratitude. Announcing The ~ International EMDR Conference June 28/29/30, 1996 Denver, CO Beginning with the EMDR Network staff, thanks for your untiring efforts in getting the Newsletter out, organizing the material that would accompany it, andhandling questions, com- ments, and complaints--all while being responsible for your daily tasks- thanks Robbie, Stacy, Ravia, Anne, Lyn, Peggy, Karen, and Michael. To those of you who subscribed to the Newsletter andlor submitted articles, thank you for your continued interest in, and support of, EMDR. Last, but definitely not least -- tremendous gratitude to A. J. Popky, MA, publisher, and Sharon Lucas, The Westin Hotel Tabor Center Denver Sponsored by EMDRIA and the EMDR Institute, Inc. 1 Mark Your Calendar!! �I EMDR Network N e w s l e t t e r 1995 Issue 3 EMDR Researcmraining Institute The EMDR Researchfiaining Center a t MRI is looking for individuals who want to take part in research projects on victims of natural disasters. Please call Cliff Levin, Ph.D. (415) 326-6465. Going to be in Beijing? I recently met with a group of psychotherapists there who want very much to meet with exp'erienced Western therapists for the purpose of learning new approaches and discussion of cultural differences. These therapists meet monthly for mutual support and organizing creative projects, such as hot-linesfor single parents, HIV-counseling, etc. There is very little training for psychotherapy in China, and what there is seems dated. (The feeling they gave me when I twice met with them is reminiscent of the excitement and lust for learning inherent in the burgeoning field of psychotherapy in the 70s in the Bay Area.) Please contact me if you are planning a visit and can spare extra time and I will put you in touch with them. Also, books on psychotherapy and articles on family therapy are requested (in particular, "Copingwith Family Transitions and Research Methods Used"). Contact: Sheryll Thomson, MFCC, 1641Hopkins St., Berkeley, CA 94707; (510) 525-8081 (Office/Voice Mail). Fluent in a 2nd Language? Any EMDR trained therapists fluent in a second language, please contact the EMDR office a t (408) 372-3900. Spiritual Insights If you have clients who have reported experiencing spiritual openings or insights during or after EMDR sessions and would like to share these vignettes, please write up these cases andsend them to: Laurel Panel, Ph D. 22 Von Ct, F a i r f a , CA 94930. (415) 454-2084 Managed Care In speaking to managed care organizations, hospitals, and reluctant-tobelieve colleagues, it would be helpful to be able to offer names of recognized institutions which endorse the use of EMDR. I would like to compile lists of treatment facilities, large employers, and insurance companieslmanaged care organizations that do support its use. These lists could be distributed via network mailings. Please send contributions (including a name1 phoneladdress for verification) to: Chad Glang, Ph.D., 1027 N. Weber, Colorado Springs, CO 80903. Published? If you are an EMDR trained clinician and have had any books published, please contact the EMDR office a t (408) 372-3900. RETIEMDR Practitionersinterestedorexperienced in RETIEMDR, please contact: Dennis Coates, 216 Avenue P South, Saskatoon,Saskatchewan S7M 2W2 (306) 665-2788 or (306) 242-6847 Research Subjects Needed Research subjects needed for PTSD outcome study, using EMDR and another proven treatment for PTSD. Potential subjects must be Kaiser Permanente Health Plan members able to receive treatment i n t h Bay Area. They must meet DSM-IIIR criteria for PTSD, be stable on medication, not suicidal, have no litigation pending, no drug or alcohol abuse or dependence, no Multiple Personality Disorder or Dissociative Disorder, no psychosis, and must have had syrnptoms for greater than one month. Since this is a randomized study, subjects may not be assigned to the EMDR condition and therefore, it is important that they are not referred with the intention of receiving EMDR. Benefits to participation are that the individuals will receive careful evaluation, treatment implementation and follow-up, and will add to our knowledge of treatment for PTSD. Once again, it i s important to remember that we cannot accept subjects into the study who expect EMDR because they may be randomized to an alternative therapy. Al patient referrals l must be willing to receive either treatment. For questions and referrals, please call Linda Kolstad at (408) 236-6763. Babies I am still collecting stories and ideas about using EMDR with babies. Someone told me an interesting story about working with a traumatized 5-monthold which I will submit for the next Newsletter-along with others? Please callor write: Sheryll Thomson, MFCC, 1641 Hopkins St., Berkeley, CA 9470C (510) 525-8081 (Ofbe/ Voice Mail). �EMDR Network Newsletter 1996 Issue 3 CALIFORNIA EMDR STUDY GROUPS " Norva Accornero California Network Coordinator (408) 364-4048 CENTURY CITYISANTA MONICA Robert Goldblatt (310) 917-2277 Coordinating a new group 90067, 90401 zip area for West L.A. CERRITOSICENTRAL CITIES Pauline Hume Pat Sonnenbure Coordinating a n e w group. Open (213) 869-0055 (310) 924-7307 . , CUPERTINO Gerry Bauer (408) 973-1001 Meets 2nd Wed. 2:00 - 3:00 pm. Case consultation. Open EAST -- - BAY Edith Ankersmit (510) 526-5297 Meets 3rd Fri. 7:30pm. Case discussion only. Group i s closed to new members, willing to coordinate new E. Bay group. - - - EAST BAYIALBANY Sandra Dibble-Hope Meets 1st Mon. 8 - 9:3 (510)843- 1396x48 m 1035 San Pablo Ave., Ste. 8. $9.YIOAKLAND EAST PAL0 ALTO Ferol Larsen (415) 326-6896 1st Wed. lOam MRI conference room. Case discussion. REDDING 2 Dave Wilson (916 223-2777 Meets monthly a t the Frisbee Mansion on ast Street. Discussions, case presentations, videos, role laying. RIVERSIDEBAN BERNARD& Byron Perkins (909) 732-2142 Meets 3rd Friday of ever month, 9:30am 1 11100am. SACLAMENTO Bea Favre (916) 972-9408 Connie Sears (916) 483-6059 Meets third Friday of every month 1:00 - 3:00pm. At 2740 Fulton Ave.. Sacramento. CA 95821 ' SAN DIE& Arthur T. Howath, Ph.D. (619) 445-0042 Call about meeting times and places. - - --- Hank Ormond (510) 832-2525 -, Meets one Friday a month. Call for time & day. Open Mary Anderson (619) 434-4422 Meets 2nd Friday of every month fiom 9:00 - 10:30am. Primarily case discussion. Call regarding availability. Darrell Dunkel (209) 435-7849 Meets 1st Fri, a t Fresno VAMC. Primarily case discussions. Elizabeth Snyker (619) 942-6347 Meets 3rd Wednesday of every month, 9:OOam - 10:30am. 191 Calle Magdelena St., Ste. 230, Encenitas, 92024. Nancy Stark, MFCC (209) 292-1700 J a m s Sheppard, MFCC Meets every other Friday. Call for information. Sylvia Mills (415) 221-3030 Meets Frida call for next date. Potluck dinner and case discussion. Qew members welcome. Curtis Rouanzoin (7 14) 680-0663 . , Jocelyne Shiromoto Meets 2nd Tuesda fiom 9:30 - 11:30 AM. Stan Yantis (415) 241-5601 Meets 1st Wed. 8 - 10pm., 180 Beaumont St. Please call to codirm. Case discussion and grou rocess. Open. SAN LUIS Marilyn Rice, Ph.D. SAN MATEOIBURLINGAMEIREDI f o 5 ) 438-3850 OOD CITY Pat Grabinsky (415) 692-4658 Florence Radin (415) 593-7175 Coordinating a new group. Contact Florence. .- - - -- FRESNO FULLERTON H~NTINGTON BEACH Jocelyne Shiromoto I RVINE (7 14) 965-1550 Charles Wilkerson (714) 543-8251 Meets 2nd Thursday of month. Primarily case discussion. Open. Call for directions. LOS ALTOSlPALO ALTO John Marquis (415) 965-2422 Meets a d hoc a t P a d c Graduate School of Psychology in Palo Alto. Primarily case discussion. Open LOS GATOSISARATOGNCAMPBELL Jean Bitter-Moore (408) 354-4048 Meets the 3rd Thurs. 12:OO-1:30om a t Mission Oaks Hospital, Conference Room 1, Los ~ i t o s . P" 539-3682 (213) MANHATTAN/REDONDO EACH Randall Jost Coordinating a new EP ~ N COUNTY Gilda Mevers (415) 472-2765 ' 1 Friday per month. lOam - ll:30am. c&. MONTEREY SAN FRANCISCO OB&KO SANTA CRUZ AREA Linda Neider, MA, ATR, MFCC (408) 475-2849 Meets monthly on a Fri. Call for time. Case discussion. SARATOGAM. SAN JOSE Dwight Goodwin (408) 241-0198 Meets alternate Frida s 9:30am - ll:30am. s o d o i NAPA COUNTY Micah Altman (707) 747-9178 Willing to coordinate new oup. Call ifinterekted. SONO& COUNTY Kay Caldwell TO7) 525-091 Meets in Santa Rosa a t Kav's office the 4t Tues. 12:30 2:00pm. Case discussion, h d e o s and "&oubleshooting." Open TORRANCE Jean Paul Beaudoin, Ph.D. Evelyne Zulueta, MFCC Coordinating a new group. 0 en NA~A Marguerite McCorkle (408) 648-0845 (408) 373-1572 . . James Pratty Coordinating a new group. Open (800) 767-7264 . . (707) 226-5056 G e o e v White ~ a v i d ~ e a d ~ Coordinating a new group. Open (310) 202-7445 (3i0j 479-6368 Judith Jones Call for time. 0 en (916) 477-2857 . . Elizabeth White Coordinating a new group. Open . NEVADA CITYIGRASS VALLEY WEST LOS ANGELES WOODLAND HILLSINORTHRIDGEIWESTWOOD Ron Doctor 818) 342-6370 Ginger Gilson 818) 342-6370 Seeking new members. Contact Ginger. PLMDALEILANCASTER (805) 272-8880 , Zf you am lntenetcd in ooodinating a new study group inyour region, pleme notify the EhWR office PO Box 51010, Paclfia Grove,CA 93960-6010 (408) 379-a900 Fax (408) 647-9881 a: t � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter Newsletter Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter, 5(3), 1-15