Assessing for EMDR readiness, intervening with deficit areas inhibiting readiness and determining EMDR targets

This workshop will discuss (1) assessing for the appropriateness of and client readiness for EMDR, (2) determining specific areas of non-readiness for EMDR, (3) intervening with deficit areas inhibiting readiness for EMDR when appropriate, and (4) assessing negative self perceptions and associated present and past experiences for EMDR intervention. The format will be didactic and experiential. The workshop will start with a generic intake interview which, for the EMDR therapist, serves to (1) collect comprehensive intake information, including a psychosocial history and mental status, in order to begin identifying dysfunctional behaviors which are driven by unresolved traumatic experiences; (2) begin the assessment of the individual's readiness for EMDR treatment; (3) provide initial education regarding connections between current difficulties and earlier traumatic experiences; and (4) increase the individual's readiness for EMDR treatment by identifying themes of negative beliefs and associated experiences, feelings, and sensations. A case example will be provided as to how information is collected and how this information relates to dysfunctional behaviors, EMDR readiness, and education. Clients are also encouraged to read the Impact of the Wounded Child article by John Bradshaw which serves to reinforce links between the present and the past, as well as stimulate the client to make further connections between the present and the past. With the client's increased awareness of how the present links to past experience, the workshop will next focus on the content of the session which introduces EMDR. There is a need to tailor the presentation to each individual. Areas covered will include: we all carry the past with us as the interwoven fabric of self perceptions through charged experiences; personal difficulties as skill vs. motivational/emotional deficits; the initial EMDR study; the effects of the past generally being more subtle for those without PTSD, that is, without the "benefit" of the visual flashbacks of traumatic scenes; EMDR growth; EMDR components-eye movement, desensitization, and reprocessing; experiences between sessions; and EMDR as a process of peeling away layers of an onion. Although providing valuable information, the initial structured interview generally falls short of providing an adequate assessment of dissociation, EMDR appropriateness and readiness, and potential EMDR targets. Consequently, several questionnaires discussed below have been developed and will be presented. These questionnaires along with the Dissociative Experiences Scale by Carlson' and Putnam are generally given as homework to the client. The CSDDQ (Clinical Signs for Dissociative Disorders Questionnaire) developed by Vogelmann-Sine, Sine, Wade, and Wade is a 19 item Yes-No questionnaire adapted from Puk's clinical signs for dissociative disorders. The ERQ (EMDR Readiness Questionnaire) developed by Sine, Vogelmann-Sine, Wade, and Wade is a 12 dimension multi-item questionnaire. The first nine dimensions cover Basic Needs (BN), Social Support (SS), Feelings (F), Emotional Liability (EL), Rigidity (R), Ego Strength (ES), Openness (O), Dissociation (D), and Alcohol/Drugs (A/D) with responses to individual items being on a 5 point scale--Not at All, Rarely, Sometimes, Often, and Always. The last three dimensions include Serious Mental Illness (SMI), Medical (M), and Legal (L) with responses to individual items being Yes or No. The client's response pattern to the above, in combination with the clinical interview information, assist in determining EMDR appropriateness, and if appropriate, possible deficit areas inhibiting readiness. Time will be spent discussing possible interventions to address deficit areas inhibiting readiness. Such interventions include the ability to tolerate overwhelming affect, manage trauma-related symptoms, self-soothing, education, various types of skills training, and structuring the person's life situation. The NCQ (Negative Cognition Questionnaire) developed by Sine and Vogelmann-Sine is based on the premise that negative self perceptions are charged by underlying historical negative experiences. Consequently, possible EMDR targets can be identified by having the individual first rate on a 7 point scale how true each of 38 negative "I" statements feels at a gut level. For the 6 cognitions with the highest ratings, the individual identifies a recent incident and an earlier incident which capture feeling that way. Then for each incident, the individual further identifies the associated emotions/feelings, intensity of disturbance, and location of body sensation. This approach of mapping the strongest negative beliefs operating in an individual's life and using these self statements to derive negative experiences has been found to facilitate identification of underlying material. The list of negative cognitions and adapted procedure for evaluating incidents comes from Shapiro's Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures. Several examples of completed questionnaires will be presented. Cautions and limitations of the questionnaires will be discussed. These questionnaires facilitate the successful implementation of EMDR but do not replace, however, standard clinical assessment.

Conference

English

Larry F. Sine
Silke Vogelmann-Sine

Sine, L. F., & Vogelmann-Sine, S. (1997, July). Assessing for EMDR readiness, intervening with deficit areas inhibiting readiness and determining EMDR targets. Presentation at the 2nd EMDR International Association Conference, San Francisco, CA