Self-soothing and the multiple trauma survivor

Remember the joke about the doctor who says, "The operation was a success, but the patient died"? That's how some clients feel about EMDR. They succeed in accessing deep and important material, but find themselves extremely depressed and/or anxious in the days afterward. For these clients, who are often survivors of multiple trauma such as long-tenn child abuse or incest, the ability to self-soothe (both during and after an EMDR session) makes the difference between whether they regard EMDR as a useful tool or a necessary evil. To find out what self-control techniques work best for such clients, I interviewed EMDR clients (all women) who had experienced long-term sexual abuse in childhood. The first thing I learned was that for survivors of multiple trauma, the ability to feel safe starts long before EMDR is ever used. Many women cited their relationship with their therapist as the foundation of their feeling safe with EMDR: "I trust my therapist absolutely." One client's therapist told her he had used EMDR himself: "That made a huge difference to me," she said. Other advance work included planning and taking preventative measures. Planning means picking the right time (and pace) for doing EMDR: being sure the therapist and/or other support people will be available in the days after the session; not driving or going back to work afterward (if possible); being able to have plenty of alone time; and going slowly, doing EMDR in small increments. "I didn't expect myself to go out in the world and be social afterward. I was pretty raw for a few days, sometimes for a whole week," B. told me. Planning also means taking preventive measures, such as teaching the client how to find "a safe place." Most clinicians know the importance of this, but one of the women I interviewed was emphatic that creating a safe place was very different from being able to go to it when she was in a session and reliving the experience of being a three-year-old overwhelmed by extreme grief or terror. She said she needed a lot of practice accessing her safe place and some special interventions (see below) to get through the intense times. Being able to self-soothe between sets of eye movements was very difficult for most clients. "I cry all the time we do it," S. told me. "I have to sit near the door and not have my therapist sit too close," said M. Another woman said, "We do the eye movements for a few seconds and we talk in between."One successful intervention, especially for clients overwhelmed by the intensity of their feelings, involved the therapist asking his client to listen to the sound of his breathing and to breathe along with him. Another clinician has his client when she gets extremely upset ask her "inner guide or "higher power" whether it's "okay to continue;" a third asks, "Is there more underneath or is it time to wind down?" Letting the client control the pace and progress of his/her own processing can be an important way to teach self-trust -- especially to people for whom loss of power was endemic to their abuse. Some clients are able to repeat special phrases or afirmations over and over between sets to calm themselves. L., a ritual abuse survivor, said she grounds herself by silently reciting a mindfulness verse from Zen master Thich Naht Hanh in time with her inbreath and out-breath: "In, out. Deep, slow, Calm, ease. Smile, release. In, out. Deep, slow ...... Different kinds of self-soothing techniques work best after the eye-movement sets are completed. Immediately afterwards, while still in session, one client said she falls asleep for a few minutes -- she finds this a big help in countering the dissociated state in which she typically concludes an EMDR session. Another said she and her therapist share a cup of tea and talk over what happened as a way to "come down" and normalize the experience. Some clinicians close a session by doing eye movements to reinforce the client's safe place. One woman said her therapist has her "cement the present in place" by doing eye movements on either a present-day image, an image of her inner child in the safe place, or a positive statement. Francine Shapiro has often said that what happens after the EMDR session can be as important as what happens during it. The women I interviewed felt exactly the same way. They had learned the necessity of talung exquisitely good care of themselves in the hours and days that follow. "I take time-and time out," declared B., who often has a delayed fear reaction following EMDR. Most clients said they go home and either curl up in bed or in a favorite rocking chair with their stuffed animals. They cry, sleep, write in their journals, draw pictures, listen to music, look at favorite photographs, and/or call a support person. M. uses self-talk to ease her feelings: "I say to myself, 'You know that knot of fear. I know it's only fear. I know that nothing is going to hurt me right now'." For others, going home immediately is not the best option: D. takes a walk along the shores of Long Island Sound; C., the mother of three young children, finds solace in a favorite bookstore. Sometimes all the planning in the world doesn't help: the abreaction seems to launch the client back to the age she was when she was abused - and she simply can't remember how to calm herself. To counter this, several clients said they carry a list of things they can do to quiet themselves. S. finds reading mystery stories comforting("At the end you always find out what really happened."), but has to keep two of them on her bedside table at all times: "If they're not in full view, I forget about using them." One interesting example of "assigned" self-soothing was given by a ritual abuse survivor who was new to EMDR. After a session when a lot of memories came up about how her sexuality was used and degraded during the abuse, her therapist gave her very specific instructions on how to care for herself, including buying a romantic nightgown and soaking in bath salts for 45 minutes; listening to romantic music; and not touching or kissing her partner for 48 hours. "It worked out great!" she told me happily. "I felt SO pretty and so safe." The conclusion I reached about how multiple-trauma survivors learn to self-soothe in the face of the intense feelings EMDR can trigger is not revolutionary. The recipe is: Step 1. Plan for the worst. Step 2. Let the client select the self-soothing techniques that specifically fit for her or him. Step 3. Make sure s/he is able to use these techniques no matter how intense his/her emotions are. Sometimes this will call for the therapist to take an active role by either leading the client in specific calming techniques or by assigning very clear-cut homework. If the recipe calls for planning and practicing, then the pot in which the ingredients are cooked is labeled "TRUST"-trust before initiating EMDR, trust during the eye movements, and trust after the sets are completed. Unless the client deeply trusts the clinician, the method itself, and his or her own capacity to go into the feelings and me out safely, the recipe for success with EMDR can turn into a recipe for disaster.

Conference

English

Margot Silk Forrest

Forrest, M. S. (1995, June). Self-soothing and the multiple trauma survivor. Presentation at the EMDR Network Conference, Santa Monica, CA