Treating a highly defended client: Reworking traditional approaches

Several key points emerge for consideration when treating the highly defended client with EMDR, in particular clients whose primary defenses are distancing ones. The first is to carefully gauge the client's level of functioning, the depth of therapeutic alliance, and the client's perceived sense of safety. These factors determine the appropriateness of EMDR, and presuming that, the style and directiveness of the clinician.Secondly, the use of EMDR with highly defended clients may require a directiveness that exceeds the basic protocol designed by Shapiro. Once the therapeutic alliance has been established, the clinician must balance, while being sensitive to, the client's need for control over the therapeutic process, hopefully avoiding unproductive periods of defensive distancing. This balance and sensitivity, inherent in all effective treatments and psychotherapies, is particularly important when the modality is as potent and emotionally evocative as EMDR can be. The case of William illustrates the risks in a directive approach, such as initiating EMDR too early, promoting a withdrawing or angry transference, or choosing the wrong cognitions. Knowing your client well and securing an effective working alliance is crucial to success.

Book Section

English

David C. Manfield

Manfield, D. C. (1998). Treating a highly defended client: Reworking traditional approaches. In P. Manfield (Ed.), Extending EMDR: A casebook of innovative applications (1st ed.) (pp. 217-231). New York, NY: W. W. Norton & Co