The use of imaginal and cognitive interweaves with sexual abuse survivors

This hour and a half presentation addresses the use of cognitive and imaginal interweaves in the treatment of adult survivors of sexual abuse. The overall course of treatment with EMDR is briefly outlined including a variety of interweave interventions for use in the beginning, middle and end of EMDR sessions. In working with sexual abuse survivors with EMDR it is important to understand the issues commonly encountered in their treatment. These include issues of safety, trust, responsibility, choice/control, interpersonal relationships, body awareness and image, sexuality and self esteem. A sexual abuse assessment can be taken which includes information on the perpetrator(s), severity and frequency of abuse, type of abuse, age of onset of abuse, duration of abuse, disclosure and family response. Sexual abuse survivors present themselves in treatment in different ways. Some clients come to treatment remembering abuse and want to clear it with EMDR. Other clients come to treatment with no clear memories of incidents but have a "feeling" something happened to them and have symptoms of abuse. There are clients who have no clear memories but something has triggered flashbacks and nightmares of sexual abuse. Finally, there are clients who have no memory of abuse and come to therapy for another reason but uncover what they believe to be sexual abuse memories with EMDR. There are three phases of treatment in sexual abuse cases. In the beginning phase, a history is taken and there is the establishment of a trusting relationship. The client is prepared for EMDR. In the middle phase, there is the reprocessing and working through of traumatic memories and transference work. In the end phase of treatment there is integration of the information which has been uncovered and preparation for life outside of therapy. Interweaves can be utilized in the beginning, middle and end of EMDR sessions. In the beginning of individual EMDR sessions there is a check-in with clients to see how they have been doing during the week. What has come up for them in their dreams or daily life since the last session? Next there is the selection and development of targets for EMDR (body sensation, memory, flashback, symptom, dream, feeling, vague sense, negative cognition or drawing). A safe place is then established where the client can go at the beginning, middle or end of the session as needed. Along with the safe place an inner advisor or other inner resources can be contacted and developed for use in sessions. A connection with the client's inner child is important which can be done through the use of guided imagery, photographs and/or artwork. Instructions on how EMDR will be used are given with attention paid to issues of safety and control (they are in control, they can stop at any time, they can return to the safe place, they know the signal for stop). Negative and positive cognitions are established along with the EMDR protocol. In the middle of individual EMDR sessions there are commonly problems with looping or being "stuck." This seems to occur frequently with sexual abuse survivors because of the intensity of the trauma and because the child self is often frozen in time lacking access to the adult self's information. Ways to work with this include looking for the blocking beliefs (i.e., The perpetrator can hurt me), look for blocking images, and talking to the child part (what does he/she need?). Imaginal and cognitive interweaves can be used in a variety of different ways in the middle of EMDR sessions. Some of these include: imagining the adult self helping the child self in the traumatic scene, bringing in inner and outer resources for help (i.e., a powdl imaginary being, a strong loving fiend, the therapist, etc.), and reality check interweave where is the perpetrator now?, can helshe hurt you now?) It is also important to educate the child part that his or her feelings are normal, sexual feelings are normal etc. It can be helpful to ask the adult self to talk to the child self explaining things to the child. Another useful interweave is to have the adult self hold the perpetrator and allow the child to beat him or her up or have the adult self beat up the perpetrator allowing anger to be expressed safely. Asking clients if they would like to return to the safe place for a break can also be helpful if they are feeling too overwhelmed. There are a number of ways to end or close incomplete EMDR sessions. Often it will not be possible to completely clear a traumatic memory in a session or the memory worked on is completed but connected to a whole network of other traumatic events. For these cases there are a number of interweaves that can be used. Clients can be requested to have the adult self comfort the child self in the . safe place. The client can imagine putting the scary unfinished disturbance that has been uncovered in a file folder, box, safe, leave it in the therapist's office, etc. The client can return to the safe place where the child and adult selves can play together. The adult can comfort the child or do whatever is needed to create safety and containment. Clients can imagine their child self being held by protector figures repeating cognitions related to safety, responsibility and choice. They can also be asked what they learned from the session, installing their response with eye movements. It is helpful to give homework to clients such as journaling, artwork, walks in nature, meditation, stress reduction, group work, exercise, nutritious diet, and restriction of drugs and alcohol. Loving Kindness or Metta Meditation is another very helpful tool for teaching self soothihg to adult survivors of sexual abuse.

Conference

English

Laurel Parnell

Parnell, L. (1995, June). The use of imaginal and cognitive interweaves with sexual abuse survivors. Presentation at the EMDR Network Conference, Santa Monica, CA