Deepening EMDR treatment effects across the trauma spectrum: Integrating EMDR and ego state work

The concepts, interventions, and techniques presented in this workshop are culled from theory and techniques of working with the range of the dissociative disorders). They have proved to be an effective addition to the preparation stage of the EMDR protocol. In other words, they can be used with clients who dissociate under certain conditions but do not have a dissociative disorder Most of the traumatized clients seen for EMDR treatment have a range of dissociative symptoms as well as symptoms of PTSD. This combination of PTSD and a dissociative disorder is often labeled DDNOS. However, people with a more complex variety of PTSD usually have experienced very early and enduring severe physical or sexual abuse (generally perpetrated by a family member), atrocities, war, or severe environmental disruption such as earthquakes. They are more accurately diagnosed with disorders of extreme stress (DESNOS). For these clients, the dissociated neural networks, or dissociative fragmentation, cause serious problems in adult life. The adaptive information processing system is on hold for these dissociated fragments or parts. They are easily triggered by internal or external cues to which they can have extreme reactions, (flashbacks, amnesia, losing time and place, and so forth.) Our goal as therapists is to use EMDR to help clients (and their internal dissociated neural networks or parts) find stability and resources to function adaptively in their present life, and then desensitize and reprocess the dissociated trauma memories and the PTSD symptoms. We aim to help our clients manage their symptoms. It is not our goal to eliminate dissociation, which has been a major survival strategy, but to help the client utilize it with conscious control. It is important to note that attachment issues are an aspect of development that are especially impacted by trauma. The attachment styles of the family pre trauma may have already affected the client in negative ways, impacting the client's resources and responses to trauma. One way to look at this set of problems is to utilize two approaches in the preparation phase of EMDR. These approaches combine the treatment of dissociative symptoms with ego state work and are an essential aspect of treating these clients with EMDR. This work may extend the preparation phase considerably, but will add safety and structure to the trauma processing experiences for these clients.

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Forgash, C. A. (2005, June). Deepening EMDR treatment effects across the trauma spectrum: Integrating EMDR and ego state work. Freningen EMDR Sverige, EMDR Tidningen, 7(2), 6-14