https://d1y502jg6fpugt.cloudfront.net/13023/archive/files/210f393fc8347736efd802ce18db2783.pdf?Expires=1792022400&Signature=MZjLsJhbDK5FekaZ6%7ERNDGvNiNjqhnru4I9oaWFiGgBP6h696LYmHRxoIYvvaW7Cct3gs%7EOI8lbsyM8muKccd%7ECK9dfaXtXOBCUvz05VMpPHbdJpA-YjkK1xwKdBptBEgaMEJ7OKc1uzOdLk3fX%7EzDA8E1Ki%7E2vvZ%7E530V-zAUHp0zRW5lbigsEAHVxab8J7aY8rLL1cwfADQHPy5fAqIn5a455G1WIi7CNBbHdVL4U1aR9zQT23JLVCjNm-NrP6kWieFTh7mrffowWr8jgNOm-0xkbaaLvz4UZZAZ8mNKzX0iR%7En-NiDq9EQggufuDvWYL2XGrO78SQhF%7Eb2kHs6g__&Key-Pair-Id=K6UGZS9ZTDSZM f758c6dbab77101d931191a32fcbce9b PDF Text Text # May 1992 N e t w o r k Newsletter EYE MOVEMENT DESENSITIZATION AND REPROCESSING Copyright 0 1992 EMDR P.O. Box 51010, Pacific Grove, CA 93950-6010 (408) 372-3900 Palo Alto, CA Questions have arisen about the use of EMDR in the courts and the comparison to hypnosis. So far EMDR is not well enough known to have been tested in court; it is simply described under the rubric of cognitive-behavioral techniques (as it is for insurance purposes). However, I want to make sure everyone realizes that just because a scene emerges during an EMDR session, does not mean that it is "true" in a literal sense. Things can be "truly experienced without having actually happened. I remember an experience when I was around eight years old. I was convinced I had brought home acrafts project to show my grandmother. I was so convinced that I started arguing with her later in the day, when she assured me she had not seen it. Finally, distraught, I raced back to thecamphouse, only tofmd the project still on the floor where I had left it. If I had not gone back to check, EMDR would undoubtedly have revealed the memory in its original, disturbing, 'true and invalid form. Please make sure if incest, abuse, or other disturbing memories arise, that you use full clinical judgment and cross- checks to determine actual validity. Present thought on cult abuse reports, for instance, is that in many instances adults use trickery to make the children thinkcultsorlarge groups are involved. By the same token, individual perpetrators couldconceivably fool children into believing that their parents were actually present and approved an abuse. A strong enough suggestion could implant that image in the child, which is subsequently repressed. While EMDR may release the repressed "memory," we do not know if it would necessarily reveal the trickery in every instance. All clinical cautions must be in place. I thought it might be useful to include the Protocol for Cancer Patients. This, of course, is not a substitute for appropriate medical care. However, it was successful with one cancer patient I tried it with and was taken up with excellent results by a therapist for self-use after a cancer operation. Having reported on it at the Somatic Disorders section of the EMDR Conference, I am also looking forward to feedback from the field. I do not mean to limit the application to only cancer patients, and expect it will be successful with a variety of somatic complaints. Please let us know your results. With cancer, as with most presenting pathologies, the EMDR model re. quires a search for the touchstone memories, present factors, and fears V O ~ . Issue 1 2 of the future that may be involved. EMDR must be used on all revealed problem areas. A good history may reveal patterns of self-sacrifice and difficulty in dealing with anger. Present factors may include a "nowin" situation that is generating the feelings of helplessness and hopelessness. The future must be dealt with in terms of questions regarding "Who am I without the cancer" and "What do I have to change or confront." If they apply, the memories that laid the groundwork for feelings of low selfesteem and powerlessness must be metabolized. Issues withparents, family, significant others, career, identity crises, and prese~itupsets must be addressed. The question, "Do I want to live," must be explored, along with any negative emotions that arise. An excellent resource for cancer patients is a book called Getting Well Again by Carl a n d Stephanie Simonton. As psychoIogist and radiologist, they received referrals of primarily the terminally ill. They were intrigued by the question of differential survival rates and their analysis revealed that these were often correlated with the attitude of patients and mentalimagery they were using. They suggest helping the patient toformulate a mental image of the immune system as powerful and in some way defeating the weak cancer cells. A good cognitive groundwork is useful here. Assure the client that cancer ceUs are the weakest in the system. �That is why chemotherapy works; it kills off the cancer cells while the stronger, healthier ones survive. Often, a t this point, with EMDR you may have to work on some "nonuseful" statements made by medical personnel regarding t h e cancer's potency. It is unfortunate that there are still some physicians who a r e seemingly ignorant of t h e findings of psycho-neuroimmunology. My client had worked with Simonton and had developed a n image of electricity coming in through the top of his head a n d sparking through his entire body, killing all t h e cancer cells. However, when I first saw him, he reported that h e used the imagery only rarely, a n d the electricity often got " s t u c k in certain parts of his body a n d would not proceed the entire way through. Working with the EMDR, I had my client first formulate a positive cognition to go with the picture. He chose "My immune system heals me." I then had him hold the picture of the electricity together with the positive cognition a n d added in the eye movements until itstrengthened. I then had him close his eyes a n d imagine t h e electricity moving throughout his body. Any place it "stuck," we stopped a n d used the eye movement until it moved freely throughout his body. The objective is to allow a fluid image of the cancer cells being destroyed and leaving the system. We used the EMDR repeatedly in the office on the linked cognition a n d image until he could access both powerfully and easily. He then chose torehearse the imagery every time h e urinated, with the added thought that the cancer cells would be washed out of his system (i.e., "It will take away all the poison.") When possible, have the picture a n d cognition linked and use the eye movements. When that is not possible, for instance, if it is a moving picture a n d the client h a s diEiculty maintaining afocusedattention, then use the eye movements on the positive cognition a t the opening a n d close of the imagery. The client should log any doubts, resistance, pertinent memories, or current upsets. Fears should be addressed with the EMDR, along with all the traumatizing experiences of t h e cancer, including feelings of "body betrayal," real or perceived callousness or indifference of the medical profession, family, friends, a n d emotions related to hospital stays, medical tests, operations, etc. I want to emphasize that I consider most victims of severe illness to be suffering from post-traumatic stress disorder (PTSD). While we can see this clearly in the rape victim, or molest victim, let us not minimize the impact when the perceived perpetrator is the victim's own body or immune system. The sense of powerlessness and self-disgust can be paralyzing. We must be very careful to frame the work a s "self-healing" a n d help restore a sense ofpower and choice. Relaxation and pain control techniques, such a s those I taught in Level 11, can be very helpful to allow a sense of self- efficacy. Also helpful are alternative care approaches such a s massage, nutrition, etc., to help encourage a sense of "self- nurturing" a n d mobilization of resources. Self-careand logging doubts and fears is a n on-going process. Of course the EMDR treatment is never complete until the client is able to envision himiherself healthy a n d cancer-free and a body scan reveals no negative sensations. The image is of course strengthened a s much a s possible. My former client is now adding in the cognition, "I have control of myself-nothing will interfere with my feeling that I can get better," along with using the eye movements a t home. I become a resource if a reallife crisis emerges. He is the healer- doing his own h e a h g . FROM THE EDITOR h i d Fenstermaker, Ph.D. JRU University San Jose, CA It h a s been more than a year since Francine a n d I, while sipping Sake in a small J a p a n e s e restaurant, worked out the basic format for the EMDR Newsletter. I had no idea what it would really take to produce a Newsletter,which is probably the best way to undertake a project like this. There a r e two groups of contributors I want to thank. The first group is those to whom I turn for editorial help a n d collaboration in the publication. Robbie Dunton's talented organizing a n d pubLicizing ability place shape a n d guidance to the project. Lois Allen-Byrd a n d Robbie share t h e substantial task of fine tuning the Newsletter to conform to the subtleties of the English language. This task is both painstaking and time-consuming, although it is one they perform beyond distinction. A. J . Popky, with his computer graphics ability a n d down-to-earth common sense, actually produces the Newsletter. I alsowouldliketo thank Ron Martinez, Assistant Editor, who writes the "Innovative Uses" column, a n d Andrew Leeds, Assistant Editor, who writes the Column entitled "Difficult Cases." Both have put their creative intellect to this project. T h a n k s also goes to Bob Welch, Ph.D., for giving his time as Science a n d Research Editor. The secondgroup that I wish tothank a r e the contributors who have given graciously of their time and clinical knowledge a n d expertise. The demand for all of us to maintain curr e n t information is critical, and, thanks to those who have contributed, we a s a group stand closer to the edge of excellence. I know many of you have p u t up with me saying, "Type that up a n d send it to me," or Francine saying, "Send that to the Newsletter." If you have items of �Massachusetts Pat Penn, Ph.D. "Sam" Foster, Ph.D. Andy Sweet, Ph.D. Pat Hammett, Ph.D. Sandra Paulsen, Ph. D. Dean Funabiki, Ph.D. Howard Lipke, Ph.D. Mike Brenner, MD Me1 Rabin, Ph.D. Elayne Weiner, Ph.D. Marcia Whisman, LCSW William Zangwill, Ph.D. Gerald Puk, Ph. D. Kay Werk, LISW Ray Blanford, MSW Frances Page, Ph.D. Alan Goldstein, Ph.D. Georgia Sloane, MS Carol York, MSW Roger Solomon, Ph.D. interest that you think others in EMDR would benefit from, or questions that you would like to see answered, please put them on a disc and send the disc to me. Your contributions will help keep EMDR a t the edge of excellence. The projects that we are planning are exciting, and they will expand the depth and areas of EMDR utilization. In the November, 1992Newsletter the area of concentration will be interventions with children who have suffered traumatic experiences. These experiences can originate from: family violence, chronic or progressive-degenerative illnesses, natural disasters, accidents, ormolestations. We have a great deal of expertise in defining the problem and using EMDR with adults. We anticipate developing this same expertise with children. To that end we are looking for responses to two questions from those ofyou who work with children. The first question is, after a clinician decides that EMDR would be appropriate for a child, how is this framed (708) 688-1900x4675 for the child; in other words, how is EMDR introduced as a relevant mode of treatment? Eventually our experience base will include this particular "how" for each different age group. The second question concerns how the procedure is actually done for a given aged child. Other helpful information to know would be how recent the trauma is,whatpriortreatment, if any, for the problem has taken place, and what predisposing factors are significant. Thus, the responses should include the following information: age, type of trauma, predisposing factors and prior treatment, presentation of EMDR, and the actual use of the procedure. vention and maintenance of positive mental health. This type of primary prevention will have long standing effects on those we treat following a critical incident. There wdl not be the loss of our humanness from the usual succumbing to the effects of physical illness, nor from the drop into the more long standing effectsof PTSD. Excerpts from Roger Solomon's paper from the EMDR Conference (April 3, 4, 5, 1992) will be highlighted. Roger is nationally known for his work in critical incident stress debriefing, and thepopulation with whom he works includes: police officers, railroad engineers, firefighters, and paramedics, all of whom during sometime in their careers are exposed to critical incidents. Roger largely deserves the credit for the introduction of EMDR into that area of specialization. The Newsletter has been a great pleasure to produce and it has brought me into contact with some very exceptional people. I look forward to meeting more of you through the network meetings and through my travels with EMDR. I also look forward to your participation in the Newsletter. Please send in your articles andcasevignettes; putting your thoughts in writing will help you with your own ideas and will enrich others through reading them. [If possible, please submit mater i a l o n a n IBM floppy disc.] Thank you, David Fenstermaker, Editor. -. , .. - . .,. . ,, , " : _, ." 7 .. ., . . ." ? >2 . . . .- 'm # . .. , . '.-: '. ,". ::FROMWRTHLESS,,. , y' :t':: TO;~WORWG.~ ;.:...:: 5;:_.,-~&~&&r~m& ~cj'w,>; .: ." ' .. ,:'".&rkeley a ,'2: 1 'I,. I ; .', ,**.. The Newsletter of January, 1993, will be premiering work with critical incidents. It will be a review of work within the immediate aftermath of a trauma and the role EMDR can serve in Critical Incident Stress Debriefing. This brings the role of EMDR within the scope of the primary mental health directive in this country, which is to encourage primary pre- * , .. , . ; , ',< , z,.. I . '". :. ' . .*:>: , ;, ., , .. *,. ' .. ' ,, : ' ., .'.i..K. . . ' . , . . . . .' . . :. . Julie, age 40, came to therapy depressed and feeling "stuck." She was married to a verbally, and, a t times, physically abusive man, and had recently quit her job. As a child, she had been verbally abused and beaten �by an emotionally removed andcritical father. She was intelligent and had basic strength and humor. After one individual session, she joined my women's group, with one ofher main goals being to start working again. She was referred to an agency that does vocational counseling for battered women. At her eighth group meeting, Julie came in very discouraged. She and her vocational counselor had decided that she was resisting in her work search, and Julie felt that she would need therapy "every day for a long time" to overcome this block. I asked her what was standing in her way, and she said she felt " worthless." I then asked her if she was willing to doEMDR, and she agreed. This was her first and only session of EMDR, which lasted approximately twenty minutes. I wdl describe what transpired. I asked Julie to close her eyes and remember a time in her childhood when she felt worthless. She did this without telling me the incident, but gave it a high SUDS level. As the EMDR progressed, her parents became physically smaller and she grew larger. I then asked her to bring herself to a scene with her husband. At first she felt frightened. Then, as the eye movements progressed, she was dancing around the table, running away from her husband, saying "na, na, na." In the next scene she was living alone, feeling peaceful. I then asked her to bring this peaceful feeling to a job interview. She came out of the interview feeling "great." I asked her to take the "great" feeling to the original scene with her parents. She did this, and the session ended with Julie glowing, saying she "hadn'tfelt this way in years," not since she lived alone before her marriage. Julie returned to the next group meeting having spent the intervening time intensively searching for a job, and feeling somewhat realisti- cally discouraged by her lack of results. She had also made the decision to have separate friends and to do what she wanted, despite her husband's disapproval. She reported two dreams, which I consider to be continued processing of the EMDR procedure. One dream was of a volcano about to erupt. Julie said it wasn't a scary dream, and she saw it as a message that a change was coming in her Life. I saw it as her considerable strength and energy beginning to burst through, but did not offer this interpretation. The second dream was very bright, in color, and occurred the night after we did EMDR. It was simply of her as a child in her room upstairs over the garage, where her father was always working. She would be nasty and rebellious in an attempt to get his attention. She saw that she used a similar behavior with her huband, and that she goaded him to hit her. She thought she did this soshecould have a reason to leave the marriage. At Julie7'snext group meeting, she told us she had several job prospects and might have to leave the group. The following week she did not show up, and I learned by phone that she had found work and had to start immediately. I offered her therapy at another time of day, thinking she still had issues in her marriage to work out. She said she wanted to take a break from therapy for now. Since then, I have heard from another group member that Julie is happy with her job, and she was enjoying the attention she receives from the men she works with. Thus, Julie ended therapy completing her major goal of fmding work after only ten sessions, but only two sessions after one EMDR procedure. I consider the extreme brevity of the procedure and the rapidity of the results due, in part, to Julie's underlying strengths. However, without EMDR, I am certain she would have been stuck and depressed for quite some time. TWO BOOK REVIEWS by Andrew M. Leeds, Ph.D. h t a Rosa, CA Memow in Mind and Brain: What Dream Imaeem Reveals by Morton F. Reiser, M.D., Basic Books, 1990 . Mindworks: Time and Conscious Ex~erience by Ernst Poppel, Harcourt Brace Jouanouich, 1988 Originally published as Grenzen des Bewu btseins. What is the relationship between memory and consciousness? Can Freud's theories coexist with modern neuroscien tific knowledge? What is the role of emotion in organizing memory and in recruiting stored images during REM sleep? The book jacket from Morton Reiser's, Memorv in Mind and Brain (1990), offers us the lofty promise that the widely acclaimed author of Mind, Brain, Bodv "once again brilliantly integrates data from neuroscience, psychology, biology, artificial intelligence and psychoanalysis to answer key questions about how the brain works." In his book, Reiser takes us on aclear if pIodding journey through the trenches of Freud's interpretation of dreams to the furthest edges of research on cognitive neuroscience. He takes the position that toun1ock"the safe deposit box" containing "the secret of dreams" we need two keys. The fnst key opens a "fde cabinet containing neurobiological and cognitive neuroscientific information about memory." The second key unlocks the fde containing clinical psychoanalytic information about memory. In Section I1 of Memorv in Mind and Brain, depth psychologists, especially �psychoanalytic followers of Freud, are given a detailed review (more than 60 pages) of Freud's "Dream of the BotanicalMonograph." Thepurpose of this lengthy exercise is to present psychoanalytic support for Reiser's central thesis on the organization of memory: "Sensory residues in the mind are organized by affect and arranged a s nodal memory networks" @. 92). Non-analystsare likely to readsection I, with its overview of Reiser's dual-track approach to understanding memory, a n d then skim through most of Section 11. For those who like their science served open faced, Section 111 of Memorv in Mind and Brain gives us adetailed summary ofempiricalstudies in cognitive neuroscience. This summary focuses on a search for specific evidence to support Reiser's central thesis on affect a s a n organizing principal of memory. Animal rights activist's should beware; Reiser reviews some painstaking animal research by Mishkin and Appenzeller (Scientific American, 1987) on one trial object recognition. This extensive research project maps out the pathways in the brain by which "imagery units [are] routed, processed, s t o r e d , r e t r i e v e d , reassembled, a n d reperceived in wakingstates andin dreamingsleep" @. 103). This section is a n excellent review of how images are processed in the brain and is well worth careful reading. For those interested in the theoretical model underlying Eye Movement Desensitization a n d Reprocessing (EMDR), part IV of Reiser's book examines the evolutionary role of REM sleep. Reiser reviews Jonathan Winson's research on REM in the mammalian brain. An article by Winson published in the Scientific American ("The M e a n i n g of Dreams," Scientific American, 11, 1990, pp. 86-96) s u b s e q u e n t to Memorv in Mind and Brain was referred to on page 4 of the EMDR Network Newsletter (1991, Vol. 1, No. 1). In this article, Winson pre- sents his thesis that Theta rhythm passing through the limbic system during REM sleep provides a means of efficiently processing and formulatingsurvival information, thereby reducing the amount of cortical tissue needed to a reasonable brain size. Reiser also reviews several other recent theories on REM and the neurological purpose of the dream state. Reiser is refreshingly c a r e f u l throughout the book to distinguish between hypothesized nodal memory networks (organized by affect) and their underlying neural nets. He began conceptualizing nodal memory networks in the early 1980s, a s a theoretical construct to help integrate psychoanalytical and psychophysiological ideas on anxiety. The platform for these hypothesized nodal memory networks is the involvement of neural nets in the processing of images. These neural nets represent actual biological circuitry. For example, every cell in a neural net of the striate cortex "may be a member of a hundred constellations each consisting of a thousand cells" (p. 163). Reiser's careful discrimination between these conceptual poles helps the reader to retain confidence in the boundary between scientific research andmetaphor, which other authors sometimes overlook or deliberately obscure. Reiser closes with a n attempt to revise Freud's model of dreaming and bring it into conformity with the cognitive neuroscience he reviews in the book. In his epilogue, Reiser calls for further interdisciplinary research to carry forward the integration of psychoanalysis and neuroscience. He mentions the work of Shevrin and Dickman to correlate data on unconscious effort with evoked sensory brain potentials a s one of the few examples of exploratory work in this exciting area of research. Whether we feel the attempt to revise Freud's theory of memory and dreaming is successful, or is even worth his elaborate toil, Reiser's integrative work is a valuable introduction and reference on the neurophysiology of image processing a n d advances our understanding of perception, memory, and dreaming in a significant and i n t e h gible way. Ernst Poppel's Mindworks: Time and Conscious E x ~ e r i e n c (1988) offers a e wide-ranging, but very different exploration of neurophysiology by focusing on our experience of time. Poppel d e k h t s in demonstrating that our conscious experience of duration a n d events is entirely constrained by the physiological limits of perception of which we generally remain completely unaware. Poppel, a vivid and entertaining, strongly dualistic neuroscientist, a.%iiated both with the Massachusetts Institute of Technology and the Medizinsiche Psycholope in Munich, focuses here on the "temporal illusions" of consciousness. Poppel's recurrent theme is that the brain consists ofvarious sensory processing mechanisms, only some of which ever reach our consciousness. He believes that the neurologically imposed limits of our conscious perception serve to protect us from a flood of sensory stimulation that would otherwise overwhelm us and leave us incapable of any integration of perceptions into consciousness or organized behavior. Yet Poppel is quick to point out that although some sensory perceptions a r e excluded from consciousness, they still exert a multitude of influences on the unconscious. In Chapter 19, "The UnconsciousGrey Area of Consciousness," Poppel expands Freud's simple model of the conscious, unconscious, and preconscious into a three dimensional grid of past, present, and future forms of consciousness, a s well as adding terms for five other types of consciousness including infraconscious, paraconscious, and extraconscious. He does not limit his focus to our sense of time; other chapters explore "Pleasure a n d Pain-Missing Border �to the Emotions," "Is Consciousness Contingent on Language," and "On the Gradual Formation of Ideas in Talking." Part of the impetus for reviewing Mindworks came from an interesting aside Poppel makes in Chapter 13, "The Limitless Consciousness of Dreams," where he examines Freud's belief that dreams are "the royal road to knowledge of the unconscious" @. 118). Here Poppel states, "The question is, to be sure, whether one can, or ought, to interpret dreams at all" @. 118). He then gingerly approaches the thesis that dreams might be meaningless, advancing arguments in support of the notion, but without insisting on it. One ofhis arguments is that "the phases of sleep in which the dreams occur have a purpose only before birth. After birth, they are superfluous" @. 118). Poppel's theory is that in the absence of sensory stimulation (especially visual stimulation), REM activity serves toprepare the fetalbrain to be fully functional at birth. Poppel's theory of dreaming as existentially empty will probably leave mostpsychotherapists unimpressed. His theory of the post-natal dream seems to reflect his deep discomfort with the "irrationality and unreality" of the dream, which perhaps we can forgive in Poppel, the neuroscientist. Yet, his theory of the prenatal dream as providing "off-line" stimulation for the developing brain seems extremely useful and congruent with observations of lifespan changes in REM activity. Poppel points out that, "The number of the paradoxical sleep phases decreases continuously from [a maximum in] the uterine period, through infancy and childhood, up until adulthood @p. 118-119). Those who have become familiar with Jonathan Winson's research on the evolutionary role ofREM in the marnmalian brain are likely to discard Poppel's explanation of why dreamingcontinues after birth: "There was no particular evolutionary reason to delete the phases in which dreaming occurs after birth. They were simply left over, after having accomplished their prenatal task of preparing the brain. They could remain left over, because they did not interfere with anything in particular" @. 120). We can kindly set aside Poppel's suggestion that dreaming serves no purpose above the level of stimulating neural circuits and still retain his theory of the pre-natal dream as serving the evolutionary purpose of preparing the visually deprived fetal brain for adequate sensory functioning a t birth. Poppel's theory of the pre-natal dream can be accommodated within the same evolutionary perspective that Jonathan Winson proposes for the post-natal dream, that of assisting the brain in processing survival related sensory information. Mindworks: Time and Conscious Experience, in spite of its dualistic limitations, is a worthwhile explanation of some fascinating research on the neurological basis of perception and the limits of conscious experience. Even ifhe sheds no light on the meaning of unconscious perceptual processing, as Reiser does in Memorv in Mind and Brain, Poppel still reveals and reminds us of the illusions of conscious perceptual reality and gives us an intriguing glimpse of the mechanisms of the mind. NETWORK UPDATE Clifford Levin, Ph.D. National Network Coordinator Mental Research Institute Pal0 Alto, CIA , ".. . ?-* * " The EMDR Conference on April 3rd5th was an unmitigated success with an attendance of about 160 participants. AU of the presentations were of high quality and the primary complaint heard was, "How can I attend two workshops at the same time?" On Friday, Scott Nelson and I presented a full day workshop on the uses of EMDR with partners of survivors of incest. Unfortunately, thatmorning I woke up with absolutely no voice, apparently a case of laryngitis. The hotel was kind enough to equip us with some high quality microphones, so I was able to whisper in an amplified fashion during the morning session. However, I was scheduled to make a two hour presentation in the afternoon. Now you might think that I am about to report that I used EMDR on myself and my voice miraculously returned. Well, I cannot admit to this. However, a t lunch I had a large portion of Hunan Bean Curd (a very spicy Chinese dish) a t a small restaurant near the hotel and the miracle happened. My voice did return enough to complete my presentation. The point of this story is that the whole conference was blessed in this fashion. No matter what the problem, a solution was found and everything ran in an exceptionally smooth manner. The true miracle here was the unbelievable efforts put in by Robbie Dunton, A.J. Popky, and Eirin Gould, who made it all look easy. Thanks a lot guys. The highlight of the conference was the Keynote speech given by Ron Martinez a t the Saturday Banquet Luncheon. Ron is a paraplegic and a guiding light and source of inspiration to all of us who know him. His speech was autobiographical in nature and focused on his recovery from a teenage diving accident which resulted in his paralysis. There was hardly a dry eye in the room by its completion; I know I had a good cry (thanks to Francine for a shoulder to cry on). Our deepest appreciation and gratitude go to you, Ron, for your dignity and character, which puts all of our petty difficulties in perspective. I think we were all changed for the better. During this year, we are beginning to plan an expansion of the Network �to include regional organizations with quarterly Network meetings, much like those we have here in Northern California. As we get these regional organizations in place, we will be sending videotaped highlights from the Northern California quarterly Network meetings. The Special Interest Groups a n d Study Groups are putting an incredible amount of work and effort into developing protocols and procedures for a wide variety of DSM 111-Rdiagnostic categories, and it is important to have this information available to other EMDR practitioners. Lastly, I would like all of you to consider writing for this Newsletter. I speak with dozens of EMDR trained therapists every month and hear stories about such wide ranging topics a s emergency room applications of EMDR to formal research studies in the planning stages with PTSD Vietnam veterans with a dual diagnosis of alcohol or substance abuse.You all have something important to say, even if you don't know it. Please send us your articles about EMDR successes, mixed results, and failures. We aU are anxious to learn. Thank you for your participation in the EMDR Network. I think that we all have the belief that we are involved in t h e c u t t i n g e d g e of tomorrow's world of psychotherapy. . . . . . . .. . .............. .. : . VARIATION IN.,,, J ' .. , : .".'.'..MOVEMENTS. :. ' ' Ruth h w l a r Grainger, PhiD.. . . .-- . . . . . \ 1 ~,", . . .. . . .. . ."..i. . , ..................... ,.. . :. '... . ..". .- -, .. In working with a young woman with multiple personality disorder, diagonal eye movements brought about almost immediate abreactions. (In fact, the first time that EMDR was emerged.) EMDR has been used a t almost every session, each time with the client-preferred diagonal direction. Sometimes it induces abreactions, a n d sometimes only anxiety management. For the past two sessions, with the advice, consent, and watchful eyes of 12 already integrated alters who have arranged to be able to talk with the therapist a s desired, a change in the direction of eye movements has increased the speed and thoroughness of reprocessing. One individual, who is trained in kinesiology,describedhis use ofthe "infinity sign" and its apparent integrating effect on his clients. I utilized a variation of the "infinity signn with a multiple personality client. I began with small figure eight hand movements, progressing to larger sweeps (6 feet in length), and then decreased the size of the movements again. The client has reported that this type of eye movement has caused a feeling of greater peace and control in the multiple system, with a sense of speeded up reprocessing toward mental health. Several clients who have done abreactive work with EMDR now use circular or half-arc movements to relax the body andslow the mind in order to fall asleep. This therapist has noted that sleep comes almost immediately when engaging in circular or infinity movements. For example, after one session of EMDR, an 83 year old client with life-long insomnia reports awakening briefly only twice during the night a s opposed to a history of doing so every 30 to 60 minutes. Research needs to be conducted on the efficacy of the various directions and shapes of EMDR movements a s they relate to myriad symptomatology. , ..-%< I ( I . LZ r DIFFICULT CASES Andrew M. h d s , Ph. D. .. ' ' Petaluma, CA +, % - . -. Have you experienced atypical responses to EMDR, lack of progress, even outright therapeutic failures? You a r e invited to submit your challenging clinical problems to "Difficult Cases." "Difficult Cases" wiU be a regular column in future EMDR Network new letter^. Your proposed solutions a r e welcome, but are not necessary. Remember, you are not the only one encountering these problems. Please send submissions, which may be anonymous, to: Andrew M. Leeds, Ph.D. 621 Nikki Drive Petaluma, CA 94954- 1528 (707) 763-9973 [If possible, submit material on an IBM 5.25 floppy in ASCII or M S Word.] . *. A - , .. - a I 5- I " - . - . INTERNATIONAL UPDATE -. . ' '"~r&&Shapiro, Ph.D. , Mental Research Institute' Palo Alto, CA Planned presentations for 1992 include three proposals submitted to the International Society for Traumatic Stress Studies (ISTSS) annual conference. One panel would include four Directors of PTSD programs within the Veterans Administration Medical Centers: Neal Daniels, Ph.D., VAMC Philadelphia; Howard Lipke, Ph.D., VAMC North Chicago; Roy Richardson, Ed.D., VAMC Tomah, WI; a n d Steve Silver, Ph.D., VAMC Coastesville, PA. AU staffs are using EMDR a s the treatment of conducted with this client, two here- choice for chronic PTSD with excel- tofore unknown, cult-induced, alters lent results. Research is planned at �three of these facilities. Dr. Silver is also compiling statistics on the use of EMDR throughout the VA system. Joan Barron a t Dayton, Ohio, has also inaugerated an EMDR electronic mail group on the VA electronic bulletin board, open only to VA personnel who are trained in EMDR. Access information is available elsewhere in this issue. Regardless of what we thought of the Vietnam War, the nineteen-year-olds who were sent to fight it are still suffering today. The first Vet I ever treated taught me that he was suffering because of his nobility, empathy, andcompassion. Liberation from his pain was due largely to self-acceptance. I saw him again, over four years later, and he has maintained the EMDR treatment effects. Now we just need the research to bear it out in the scientific literature. Anotherpanelproposedat the ISTSS conference would include Byron McBride, Ph.D., of the L.A. Sheriffs Department psychology staffon critical incident treatment, Nancy Baker, Ph.D., also of the L.A. Sheriffs Department on treatment of sexual harassment stress reactions and the linkage to earlier sexual abuse history, and Scott Nelson, Ph.D., of the Mental Research Institute on the treatmentof partnersof sexualabuse victims. . . -.r rr r , . . - 1 -I <* '" .'* " ._ EMDR REFERENCES Boudewyns. P.A.. Stwertka, S.A.,Hyer, L.A.. Albrecht. J.W.. & Sperr. E.V. (August. 1991). Eye Movement Desensitization for ITSD of Combat: A Pilot Study. Paper presented a t the APA annual convention, San Francisco. CA. [Article submitted for publication]. Hedstrom, J. (1991). Anote on eye movements and relaxation. Journal of Behavior Theraov and k e r i m e n t a l Psvchiatrv, 22.37-38. Kleinknecht, R. (in press). Treatment of post-traumatic stress disorder with eye movement desensitization and reprocessing. h a 1 of Behavior Theraov and Ex~erimental Psvchiatrv. Lipke, H.J. & Botkin, A.L. (in press). Brief ,case studies of eye movement desensitization and reprocessing (EMDIR) with chronic post-traumatic stress disorder. Psvchotheraoy. Marquis. J.N. (1991). A report on seventy-eight cases treated by eye movement desensitization. Journal of Behavior Theraov and Ex~erimental Psvchiatry, 22, 187-192. Neilson, Tore (1991). Affect desensitization: A possible function of REMs in both waking and sleeping states. Sleeo Resear&, 20. Puk, (1991). Treating traumaticmemories: A case report on the eye movement desensitization G. procedure. Journal of Behavior Therapy and Experimental Psychiatry. 22. 149-151. Rothbaum, B.O. (1992). How does EMDR work? Behavior Therapist, 15,34. Shapiro. F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2. 199-223. Shapiro, F. (1989). Eye movement desensitization and reprocessing procedure: A new treatment for post-traumaticstress disorder. Journal of Behavior Theraov and Exoerimental Psvchiatrv, 20 211-217. Shapiro, F. (1991). Eye movement desensitization & reprocessing procedure: From EMD to EMDR--a new treatment model for anxiety and related traumata. Behavior Theranist, 12. 133135. Shapiro, F. (1991. September). Eye movement desensitization and reprocessing: A cautionary note. the Behavior Theraoist. 14. 188. Wolpe, J. & Abrams, J . (1991). Post-traumatic stress disorder overcome by eye movement desensitization: A case report. Journal of Behavior T h e r a ~ vand Experimental Psvchiatrv, 22, 39-43. Also planned are presentations a t the American Psychological Society (Presidential Symposium) and the International Society of Trauma Counselors. dently confirm efficacy. Thanks to those of you who did. Gerald Puk, Ph.D., gave a presentation entitled, "Using EMDR with Motor Vehicle Accident Trauma," a t the Eighth Annual Symposium of the American College of Forensic Psychology this April in San Francisco. The presentation wasvery well received and a number of EMDRtrained clinicians in the audience verified his positive reports. It does a great deal to allay scepticism when members of the audience indepen- Alan Goldstein, Ph.D., the Director of the Agoraphobia and Anxiety Treatment Center of the Department of Psychiatry, Temple University, has launched an EMDR study on the treatment of panic disorder. He will be presenting preliminary data a t the EMDR Symposium we are presentingat the Fourth World Congress of Behavior Therapy in Australia this July. Also presenting, besides myself, are CMLevin, Ph.D., on the treatment of partnersofabuse victims, and Robbie Dunton, M.A., on treatment of learning disabilities. Independently presenting a supportingpaper a t the conference on EMDR for the treatment of PTSD is Kevin Vaughan,Ph.D., of Hornsby KuRing-Gai Hospital of New South Wales. In another exciting event, Jonathan Winson,Ph.D.,Department of Neuroscience, Rockefeller University has completed his preliminary research on the brain mechanisms underlying EMDR's effect. An article has been submitted for publica- �tion and we willsendcopies along as soon a s possible. Dr. Winson recently sent me a copy of an article published in 1954 that he had unearthed, which reported the observation of rhythmical nystagmus in therapy patients and which posited a connection between this eye-movement phenomenon and thought processes. We have included that article, along with Dr. Winson'sUThe Meaning ofDreamsV from Scientific American, in the present packet. Clearly as past and present research dovetails in support ofEMDR, wecome closer to full acceptance. NIMH has just approved large-scale research of EMDR a t the Augusta, GA, VAMC. A copy of the pilot data presented to APA was included in the 1991EMDR article packet. The well-respected statusof the researchers and positive results of the pilot data were, I am sure, supplemented with the widespread reports of clinical success among the VA system in the field. Many thanks to all of you who have been vocal in your support. As you know, NIMH grant money is hard to come by these days. On the down-side, there have been a number of published attacks of EMDR. You all know of Cory Hammond, Ph.D., and his use of EMDR without training on two MPD clients. His attack on EMDR as a "California f a d appeared in the newsletter of the American Societvfor Clinical Hwnosis (ASCH). A copy of his attack, along with the reply from the EMDR Professional Issues Committee (EPIC), was sent to all 1991 EMDR Network members. EPIC'S reply was printed in the next issue of the ASCH Newsletter, but unfortunately, simultaneously, there appeared a n attack by Drs. Metter and Michelson, whoreported the same results as Hammond, stating that the effects of EMDR were linked to "emphatically" signally "No" to theclient through the lateral hand movement, e k . , and any successful effects were temporary and the results o f clever manipulations." They also stated that they had been trained by me. In actuality,I had trained them, but it was before I realized exactly what I neededto teach (i.e., guidelines for vulnerability, selection, pacing, rapport, ek.). I also tried to supervise their whole institute by myself, and they only had one experiential trial; therefore, I was unable toobserve many of the participants. I have written a response which should appear shortly in the same newsletter. We are sending it, together with theattack, in the present article packet. While the experience has been painful, it has underscored the need for training the way that it is now done, with extensive supervision. Another attack appeared in the last issue of the Behavior T h e r a ~ i s t . In the last EMDR Newsletter, I reported to you that I had been invited to give a three-hour workshop a t the annual conference of the Association for the Advancement of Behavior Therapy, in which I would be exploring the EMDR model. While most participants were, as usual, intrigued and laudatory, a few came with the idea that they would be trained. When I explained that it could not be done in that length of time, and that client safety factors were involved, they insisted, and one person even informed me that client safety factors were secondary to scientific advancement and should not concern me! While I recognize that there is a lot of pressure to do otherwise, I feel that each of us has a responsibility to uphold the standards of our profession. I fail to see how responsible therapists and researchers can disregard warnings and simultaneously obtain informed consent from their clients and subjects. When EPIC and the majority of clinicians trained in EMDR inform me that our training program is unnecessaq,I'lllisten, but otherwise. On that note. I like this to be the last time I mention the issue in the Newsletter. The attack a n d rebuttal are included in the present packet. Any others wlll be forwarded to you without comment, a s they are received. If you think we a r e doing anything incorrectly, I want to hear about it from you. Likewise, if you think we are doing it well, or have suggestions. However, ifyou see an attack in print you donot agree with, please feel free to respond on your own. Anything I write, a t this point, has limited impact. Once again on the up-side, the first EMDR Conference was a huge success. Over 160 people were in attendance and the overall evaluations were sensational. Clinicians were here from practically every state, Canada, and about a half dozen from Australia. I was particularly happy to see the high calibre of the presentations. Each clinician interfaced h i s h e r own area of expertise with EMDR and the directions, observations, innovations, and insights for each area covered were extraordinary. Also fruitful were the continued observations from clinicians in the audience. I t left me feeling that EMDR is indeed in good hands. I floated through t h e three days repeating,"We have the best people around us." Needless to say, it was personally very gratifying as the culmination of five years of work. We have included in this Newsletter the EMDR areas covered in the conference, the presenters, and access telephone numbers. For anyone interested in pursuing a particular topic, I suggest direct contact. We a r e planning the next EMDR Conference for March 5,6,7, 1993, at the Sunnyvale Hilton. 1 will again hand select the topics and presenters, so suggestions are welcome. During my final keynote address, 1 included a list given to me by Dave Wilson, Ph.D. He said that when he �NETWORK MEETINGS Sandra "SAM" Foster, Ph.D., California Network Coordinator (415)965-8988 1992 EMDR Network Schedule Saturday, June 27th Saturday, September 12th Saturday, November 14th 9:30am to 4:OOpm LESSONS FROM GEESE The Network meetings are held at the SunnyvaleHilton, 1250 Lakeside Drive, Sunnyvale, California (408) 738-4888. SCHEDULE 9:30- 10:OOam Registration & coffee 110:OO-11:30am Special Interest Groups (SIG) meet to share new information. 1 l:30-1:OOpm Lunch [We suggest a second SIG meeting during lunch.] 1 1 l:00-4:OOpm first read it, it reminded him of what. we were trying tocreate. I have been requested by many present a t the Conference to include it in the Newsletter, so here it is as well: General meeting. Presentations by SIGs and Francine. Our 1991 quarterly Network meetings have been a success as a forum for sharing new applications of EMDR, learning about the latest research results, andobserving talented colleagues demonstrate innovative twists with EMDR. EPIC (EMDR Professional Issues Committee) The EMDR Professional Issues Committee is pleased to announce that our response to the Cory Hammond article was published. Each of you should have received a copy of this response (as well as Cory Hammond's letter) in the packet of articles that were mailed earlier this year. EPIC has also decided to write a column for each Newsletter that will focus on professional issues, ethical concerns, or unique situations that you may have encountered in your practice. You may submit any of the above (anonymously if you choose) to Lois Allen-Byrd, Ph.D., 555 Middlefield Road, Palo Alto, California 9430 1. We continue to meet the second Wednesday of the month and have been considering a number of issues in and out of the committee. Some of the situations that have been brought to our attention include the following: suitable minimum background and training required to participate in the workshops, appropriate supervision and the context within which EMDR will be used, informed consent, protocol for EMDR presentations, possibility of training and personnel committees, review of ethical complaints that have been dealt with informally, issues of client safety, and when it is appropriate to use EMDR. If you have any professional issues, conce;ns, or questions, please contact one of the following committee members: Lois Allen-Byrd, Ph.D. (4 15) 326-6465 Joan Fish, MS (4 15) 327-2051 Ferol Larsen, Ph.D. Jennifer Lendl, Ph.D. Virginia Lewis, Ph.D. Marguerite McCorkle, Ph.D. (415) 326-6896 (408) 244-7942 (415) 326-8752 (415) 3224884 Roger Solomon, Ph.D. (206) 943-8987 1.As each bird flaps its wings, it creates an "uplift" for the birdfollowing. By flying in a "V' formation, the whole flock adds 7 1% greater flying range than if the bird flew alone. LESSON P e o ~ l e ho share a common di- w rection and sense of community can get where they are going quicker and easier because they are traveling on the thrust of one another. 2.Whenever a goose falls out of formation, it suddenly feels the drag and resistance of trying to fly alone and quickly gets back into formation to t a k e a d v a n t a g e of the "Lifting power" of the bird immediately in front. F.S.- When I first read this I thought,"What about individuality, inspiration, taking the initiative, etc." Absolutely, and. . .] LESSON If we have as much sense as a goose, we will stay in formation with those whoare headed where we want to go (and be willing to accept their help as well as give ours to the others). 3.When the lead goose gets tired, it rotates back into the formation and another goose flies a t the point position. LESSON It pays to take turns doing the hard tasks, and sharing leadership - with people, as with geese, we are interdependent on each other. F.S.-The conference was about expanded leadership in proven areas of expertise.] 4.The geese in formation honk from behind to encourage those up front �to keep up their speed. LESSON We need to make sure our honking from behind is encouraging- and not something else. F.S.-Please!!-All suggestions and observations are welcome, but please contact me directly regarding negative judgments or attacks. While misinformation and rumors run rampant, they sewe no useful purpose] 5. When a goose gets sick or wounded or shot down, two geese drop out of formation and follow it down to help and protect it. They stay with it until it is able to fly again or dies. Then they launch out on their own, with another formation, or catch up with the flock. LESSON Itwe have as much sense as geese we too will stand by each other in difficult times as well as when we are strong. And so, as always, we are in a mixture of good times and difficult times. However,the Conference showedme, once again, what good company we are keeping. WORKING WITH PERPETRATOR- IDENTIFTED EARLY CHILDHOOD ABUSE S U R W O R W r y Wildwind,LCSW Albany, CA In using EMDR with early childhood abuse suwivors, I often find more resistance and denial than with clients who experienced later abuse. Also, the weakened egoof the patient allows for slower progress through intensely affect-laden work. The technique I have been using seems to help with this kind of patient. I assume that the resistance includes introjects of the perpetrator, as well as the denial and covering mechanisms usually seen. I also assume that fear of abandonment, as actually experienced during sexual abuse, emerges along with the memories, since the memory retrieval negates the internalized image of the perpetrator as a source of positive identification and supplies. This "image destruction" can only take place gradually, using cognitive bridging to avoid overwhelming identity diffusion and anxiety. Therefore, when the resistance emerges during sets focused on the sexual abuse, and the resistance takes the form of remembering the positive things the perpetrator did for the patient, or the fear of giving up the positive image of the perpetrator, I ask the patient to focus on the positive things exclusively, to see all of them together. In the next set, I ask herhim to make a strong, beautiful container, a box, jar, something safe and pretty, and to see all the positive, loving aspects of the perpetrator placed inside that container. I remind the patient that only those things that the person did that hurt the patient are left outside the container. I can then ask herhim to refocus on those hurtful things that happened and, if angry feelings come up, they are only a t the "bad part" of the person whois soloved andneeded chological differentiation from the mother. In cases such as these, I help the patient notice how s h e h e is different from the perpetrator. A patient with MPD recently repeated during several sets, "She's big, I'm little. She's a woman, I'm a boy." Later he said, "I'm not her!" with great excitement. He then could remember more fully what had occurred and feel more free to feel his anger about it. This has also helped with feelings of shame and guilt that seemed very global. In general, the issue of identity change seems central to helping people whose earliest identities are merged with those of the people who hurt them most. Often, in workingin the area of resistance, feelings of confusion, fear of the work, fear of not recognizing one's self, and fear of ending up permanently damaged by the knowledge gained are all expressions of identity loss anxiety. Helping our patients to contain this anxiety until it is naturally resolved can make a great difference in whether the patient can tolerate complete treatment. * . Later, when the person has worked through most of the horror, rage, and sadness, often a sense of inner emptiness emerges. That is when I ask herhim to recall the container, and, this time, to sort through it to see what qualities of the perpetrator now feel positive. After one set, I ask the person to choose those qualities shehe wishes to be like. Often, there are a few that the person can still feel good about. There is often a need to do both cognitive work and EMDR regarding the sense of emptiness and the anxiety that emerges with a shift in identity. With very early childhood molest, abuse, or abandonment, I have found another kind of resistance. Perhaps the patient h a s identified very strongly with the perpetrator, or the molest began before there was psy- .- ' CASE STUDY Liz Mendom-Weitman,LCSW . . San Jose, CA -,v # A ten year-old Hispanic boy was referred by his mother for outpatient psychotherapy. The mother described her son as having been depressed since the father abandoned the family over five years ago. The depression was now worsening, although the mother could not identify any new stressors. The boy was described as having little or no interest in pleasurable activities, doing poorly academically, experiencing significant weight loss, panicking each morning about leaving home for school, complaining of stomachaches every morning, and having sad affect. Additionally, the mother was distressed that the boy had an intense phobia of eating in public and �I. I 1992 ANNUAL EMDR CONFERENCE , - . i: s t , Topics and Presentem CHRONIC DEPRESSION Landry Wildwind, MSW Albany, CA CREATIVE USE OF METAPHOR Carol Erickson, MFCC, BCD Berkeley, CA CRITICAL INCIDENT TRAUMA Roger Solomon, Ph.D. Olympia, WA COMBAT-RELATED PTSD N. Chicago, IL Howard Lipke, Ph.D. DISSOCIATIVE DISORDERS David Fenstermaker, Ph.D. San Jose, CA EATING DISORDERS Los Gatos, CA Jean Bitter, Ph. D. EMDR TARGETS IN SEX THERAPY Leonard Loudis, Ed.D. Denver, CO LEARNING ISSUES AND CHILDREN Pacific Grove, CA Robbie Dunton, MA PEAK PERFORMANCE "Sam" Foster, Ph.D. Mt. View, CA Jennifer Lendl, Ph.D. San Jose, CA PARTNERS OF SEXUAL ABUSE SURVIVORS Clifford Levin, Ph.D. Palo Alto, CA Scott Nelson, Ph.D. Mill Valley, CA PRINCIPLES OF GUIDED IMAGERY Emmett Miller, Ph.D. Menlo Park, CA SMUAL ABUSE Rita Belton, MA San Rafael, CA San Jose, CA Eirin Gould, MA San Rafael, CA Brooke Passano, MA SUBSTANCE ABUSE Norva Accornero, MA Los Gatos, CA Robert Kitchen, MA Hayward, CA Andrew Leeds, Ph.D. Santa Rosa, CA Palo Alto, CA Virginia Lewis, Ph.D. THEORETICAL CONVERGENCES Andrew Sweet, Ph.D. Aurora, CA TURNING LOSSES INTO WINS Ron Martinez, Ph.D. Burlingame, CA IMPORTANT NOTICE! V.A. NETWORK: An EMDR mail group exists on the V.A electronic bulletin board. It is necessary to have access to FORUM to get to the mail group--this is obtained a t your local station. This is open only to V.A individuals who have completed EMDR training.For enrollment,send a copy of training certificate with access name and address to: JOAN BARRON, MN, RN, CS (118) V.A. Medical Center 4100 West Third Street Dayton, Ohio 45428 (513) 268-651 1, ext.2678 I 1 FTS Phone-950-2678 1 refused to do so. He complained of mother was now threatening toplace "picturingvomit" each time he tried him out of the home due to the severe to eat. The boy's stated goal of treatrestrictions and burdens placed on ment was "to stop thinking about her for the past five years. The boy throwing up." He alsoaskedforhelp was seen in individual therapy and " tonotfeelsick every morning, even the mother was seen in collateral though I'm not really sick." His sessions.EMDR was implemented in ' 12 the standardized procedure. The initial treatment focus was the client's distressing memory of an incident at age five when his brother had vomited on him in a restaurant. He reported that it was this image that intruded on him each time he ate food. The boy identifiedfeeling "very scared" (SUDS 9-10) when imaging this memory. He also held onto his stomach where he felt the anxiety, focused on the picture, and the cognition "I'm scared." By the end of the procedure, he reported no longer feeling fear when recalling this memory. At the start of the second and final EMDR session, the boy reported that he was now concerned with a more recent memory of vomiting he had witnessed in a public restroom. (This had not been reported in the first session). The EMDR procedure was implemented again. By the end of the session, the boy reported feeling "fine" and no longer scared by this memory. The positive cognition, "It's over. I can feel good now when I eat," was installed. In the subsequent psychotherapy visits, the boy's mother reported the following changes: the boy's affect was brighter, he was spontaneously showing an interest in others, and reporting to his mother that he was now eating a t school and at daycare. The boy was also no longer crying in a panic upon awakening or complaining about stomachaches in the morning. The mother also reported that she was no longer considering out of home placement for her son. The boy, in interviews separate from the mother, giggled appropriately, smiled spontaneously, showed a bright affect, boasted of eating in public, denied fear of eating in restaurants, and described himself as "feeling happy." Adhtionally, his mother shared that the daycare director no longer found the boy to be irritable or fearful, and that he was showing an interest and enthusiasm in helping her set the table to eat and in other activities in the home. Her reported observation to the mother was "he is Wte a M e r e n t child." �1992 TRAINING SCHEDULE LEVEL I BASIC TRAININGS Sponmorm Apr. 11/12 Philadelphia, PA Radisson Hotel Philadelphia Auport Alan Goldstein, Ph.D. (408) 372-3900 Agoraphobia & Anxiety Treatment Center Temple University Medical School May 30131 Honolulu, HI Hilton Hawaiian Village Sandra Paulsen, Ph.D. Pacific Institute of Behavioral Medicine June 616 San Jose, CA Sunnyvale Hilton Francine Shapiro, Ph.D. Sep. 12/13 Chicago, IL Holiday Inn Crowne Plaza Northbrook, IL Howard Lipke, Ph.D. (708) 688- 1900x4675 Director, Stress Disorder Treatment Unit N. Chicago Veterans Admin. Medical Center Sep. 19/20 New York, NY h e w s New York Hotel William Zangwill, Ph.D. Gerald Puk, Ph.D. Sep. 25/26 San Francisco, CA Radisson Inn S F Airport Francine Shapiro, Ph.D. Oct. 314 Seattle, WA Radisson Seattle Auport Roger Solomon, Ph.D. Washington State Patrol Oct. 9/10 Los Angeles, CA Auport Marina Hotel Ron Doctor, Ph.D. Cal State Univ., Northridge Oct. 11/12 Denver, CO Holiday Inn Denver S E Andy Sweet, Ph.D. Oct. 16/17 Miami, FL Miami Purport Marriott Ruth Knowles Grainger, Ph.D. Nov. 617 San Jose, CA Sunnyvale Hilton Francine Shapiro, Ph.D. -ah -?;?LEVELTRAININGS May 15/16 San Jose, CA Sunnyvale Hilton June 19/20 Santa Ana, CA Crowne Sterling Suites July 24/26 San Jose;CA Sunnyvale Hilton Philadelphia, PA Temple University Medical School Dec. 11/12 San Jose, CA Sunnyvale, Hilton I (808) 523-2990 (305) 595-3399 History-taking and specified questioning for focused identification of problem areas Closing down "incomplete" sessions Axis 11 applications Integration of EMDR with cognitive therapy ~issociative other major disorders & Abreactive responses and alternative strategies Working with difficult/resistant clients Integrating "self-control" techniques Treatment of Process Phobias �r Ron Mmtinez, Ph.D. ;&-editor This section will appear in each Newsletter and will present innovative uses/variations of the EMDR procedure that have been discovered by clinicians trained in the method. I would very much appreciate it if any ofyou who have foundnew vwiations on how lo use EMDR, would write these up and send them to me at the address below, so that I can include them in future Newsletters. Though your write-ups can be informal, I would appreciate inclusion of thespecificsteps of the technique, the number of people on which it has been successful, any specific outcomes that you have consistently noticed, and any further comments. Please include your name, address, and phone number, so that I can reach you with any questions. Thank you. Jessie Rappaport, R.C.S.W. ofEugene, Oregon, sent in this observation: He states, "for clients with persistent negative cognitions such as, 'I don't deserve to be loved', where EMDR saccades,cognitive interweave, and allother variation sfail to effectively shift the cognition, he tells the client, 'I would like you to notice, if you would, how you fee1 when I take over the voicing of that belief and say it to you ...." [An example of this would be 'you don't deserve to be loved'.] He does this with eye movements inducedandoften a t this point reports that the client will dramatically shift the polarity when the beliefhas been externalized by hisvoice. The response is often from the positive polarity, such as, 'I have every right to 'be loved' o r 'the heck with you, I'm tired of hearing that', etc. Hestates that with particularlyfragile clients, this intervention must be carefully framed, such as, 'I am taking over the negative voice that is in you1." Please feel free to try this and send in your responses a s to the results you observe. I'd like to share the results of a case in which I combined EMDR and hypnosis in working with a Vietnam vet. The effect was very powerful, and seemed to be impacting the client on a n archetypal level. This 44 year old Vietnam veteran, whom I shall call Tom, was referred to me by the psychiatrist who was his on-going therapist. Both therapist a n d client had heard of EMDR and were hopeful it mlghthelp with Tom's sleep disturbance, flashbacks during which he often became enraged and assaultive, and periods of severe depression. He served in the infantry in Vietnam when h e was 19years old, and engaged in extensive combat a s a helicopter "doorman." Tom had a n uncle, a few years older and "Like a brother," who was also in combat in Vietnam. The uncle was killed in the war, unbeknownst to Tom until several months after the fact. Tom described himselfas changing "from mean to just plain evil" when he learnedofhis uncle's death. At this point, he recognized a deep shift in himself, which I conceptualize a s archetypal in nature. Upon his return from the war, he used drugs, attempted suicide, was hospitalized for depression, and spent time in jail for smuggling, theft, a n d assault. In more recent years, h e has married, had children, and worked a t jobs that typically last 2 to 3 years. He has assaulted his wife, and has assaulted other men when, during a flashback, h e has mistaken them for guerrillas. He described often feeling "swallowed in blackness" (another archetypal reference) and despair. He reported being unable to experience feelings of fear or grief, and wanted help to "humanize" himself. Because of the nature of the fundmg source for this case, we had a maxi- mum of 10 sessions available for our work together. After two sessions of using EMDR in the conventional way, I began to feel that we would not reach our goals in the time available. Tom would lapse into lengthy stories with each memory that surfaced, a n d it was difficult to keep him focused on the EMDR process. At one point h e mentioned that the only time he'd been able to cry about his uncle's death was in a session with a therapist several years ago when he had his eyes closed. Since grieving his uncle's death was something he'd been unable to do and seemed a key issue for him, we decided to try combining hypnosis with EMDR. We met for 90 minutes in each of the next seven sessions. The procedure was a s follows-I induced a hypnotic trance by taking Tom to a "special place" where h e would be able to safely watch a movie of his life. He watched from a "safe distance" and was in "completecontrol" of what he saw. I suggested that his arms and legs would be very heavy, and he easily achieved deep states of trance. I suggested t h a t he r u n the movie back to something about the war t h a t we needed to work on. He verbally reported what he was experiencing, a n d when h e saw something which was emotionally charged, I instructed him to stay with it and move his eyes back a n d forth while I tapped the backs of each hand. I then asked him to report what had occurred, either following that image or installing cognitions a s in a typical EMDR session. In the first session of this combined approach, h e came face to face with the "cold eyes" of his 19 year old self. He began grieving his uncle's death and the losses h e had suffered from the war. Over the next several sessions, t e a r s s t r e a m e d down h i s face throughout much of the process. Imagining his uncle's death, Tom saw his uncle stop him a s a 19 year old from running around with a gun, and convinced him to "come home" �to a family reunion he envisioned. Between sessions, Tom began experiencing longer and longer periods of feeling sad before the familiar rage would return. In one session he experienced intense pain in his body as he grieved his losses - "I was used. I was supposedtoheb1wasn't supposed to be this way." In that session, Tom's 19 year old self told him, "We need to settle this once and for all." It was apparent in the next session that what needed to be settled was "the war, and whether to Live." I asked Tom what choices he saw, and he responded, " Staying in the war, being depressed in my room (a severe depression he experienced upon his return from the war, in which he literally stayed in his room for three months), or killing myself." When I asked him to generate another possibility, he saw his grandmother rocking him, removing his uniform and bathing him. The words he used to describe this were "Grandmother's love can heal my grief and pain." I asked him to give his Vietnam experience a shape, color, sound, smell and feeling, and flush it out of his body. He saw guns flushingout from his feet, with his grandmother pouring water over his head. (This archetypal symbol of baptismlrebirth seemed especially important given Tom's background as a Catholic and altar boy.) In our next session, I instructed Tom to "settle things once and for all" with his 19year old self. I asked him toconcretize his Vietnam experience and flush it out. He saw a dragon emerge from his stomach, enveloping himself and everything else in darkness. (The dragon has been a widely-held symbol of the Vietnam war.) I asked him to find a way to disconnect from it, and he saw his father carrying him away, tending the wound to his belly where he bled from disconnecting the dragon. I suggested he see the dragon in the distance and dematerialize it. He saw it blow up, and knew his 19 year old il self was gone also. I suggested he £l the space that had been emptied, and he saw his mother holding him as he became a baby filled with Light and a feeling of calm.1 instructed him to bring that experience into the present and he saw himself with his wife and the words, "I am more at peace now." As the session ended, I taught him a simple grounding technique to practice as homework to help him stabilize this experience andcounteract the Light-headedness he reported. Tom felt "in a fog" for the next several days, reacting with rage only once when he was rear-ended while driving his car. We spent a session compacting and flushing out the remainderof the war, with him experiencingit rushingpast so quickly that he saw himselfreach out to catch the positives he wished to keep. I taught him to imagine a "personal space bubble" around him, installing that experience with EMDR while he was in trance. As he saw himself inside the bubble, he envisioned his drunk grandfather unable to enter it, but others able to enter a t his invitation. As I brought him forward into the present while still inside his bubble, he saw the old familiar blackness reappear. This time, instead of being engulfed in it, he saw himself moving safely through it. (I saw this as progress in his ability to disidentify from that experience.) The question "Who am I?" emerged for him, and the answer t h a t returned was "Peace." In our final session, Tom reported feeling many internal shifts during the previous week. He frequently saw himself inside his bubble. He noticed a marked decrease in his reacting to situations with hostility, especially while driving. We focused again on the question, "Who am I," andhesaw hisson tellinghim "You're my father." (This marked a shift in archetypal identification from the "young warrior" to the "nurturing older man.") We ended with install- ing, once more, the phrase, "I am more at peace now," with an image emerging ofhim and his family (those Living and dead) together. In a three-month follow-up contact, Tom reported that he continued to feel that our work togetherUchanged something" on a deep level. He was sleeping more restfully at night, dreaming, and reported having his &st "dream" about Vietnam that wasn't a nightmare. He experienced "recollections"about Vietnam, rather than intrusive flashbacks. He had no recurrence of the "blackness"and felt that "bubble" was "still there." In some situations, where he used to be enraged, he said he felt "hurt." He reported being able to experience sadness again. He had begun tomeditate (which he had triedseveral years before, but stopped when memories began overwhelming him), and felt the practice was extremely helpful to him. He recently held a "ritual burial" ofhis uncle, and felt a t peace with his loss. I believe the combination of EMDR and hypnosis in my work with Tom enabled us to accomplish, in a short period, more than we could have achieved with either technique alone. It seemed important for Tom to have his eyes closed in order to move beyond the interference ofhis conscious mind, allowinghim to work on deeper levels. It appeared that we neededto tap his grief in order to defuse his rage. And, in Tom's words, "humanize" him again. As we worked on an archetypal level, I surmised that we needed to restore the ego boundaries ofhis Self, which were probably weak at best as the 19year old who went to war. I hoped that this would allow Tom to disidentify from the "blackness" and the archetype of war with which he hadidentifiedsocompletely, and to begin to develop a new identi ty. �1 CALIFORNIA EMDR STUDY GROUPS @istedGeographically North to South] REDDING Dave Wilson (916) 223-2777 Meets once monthly a t the Frisbee Mansion on East Street in Redding. Discussions, case presentations, videos, role playing,and "troubleshooting." Open to new members. LOS ALTOSlPALO ALTO John Marquis (4 15) 965-2422 (4 15) 852-2855 Dewey Lipe Meets a d hot a t Pacific Graduate School of P s ~ c h o l o g ~ in Palo Alto. Primarily Case discussion. Open to nen members. SONOMA COUNTY Kay Caldwell (707) 525-0911 Meets in Santa Rosa a t Kay's office the fourth Tuesday 12:30 to 2:00pm. Primarily case discussion with some videos and "troubleshooting" of the EMDR procedure. Open to new members. LOS GATOS/SARATOGA/CAMPBELUW. SAN JOSE (408) 354-4048 Jean Bitter Liz Mendoza Meets the thirdThursday of each month, noon to 1:3@m a t Good Samaritan Hospital, Room TC2, in San Jose. Open to new members. Agenda to be determined. MARIN COUNTY SANTA CRUZ Laurel Parnell (4 15) 454-2084 Linda Neider (408) 475-3480 Contact if interested in monthly Friday afternoon meet- Generally meets once Per month on a Friday a t 7:00pm. Primarily case discussion. Open to new members. ings. EAST BAY Edith Ankersmit (510) 526-5297 Meets third Friday a t 7:30pm. Case discussion only. Group is closed to new members, but Edith will coordi- nate any new East Bay group. WOODLAND H I L L S I N O R T H R I D G ~ S T W O O D Ron Doctor (8 18) 992-507 1 Is willing to coordinate a new group. CENTURY CITYISANTA MONICA Robert Goldblatt (2 13) 286-9490 SAN FRANCISCO Is willing to coordinate a new group in the 90067 zip code Sylvia Mills (4 15) 22 1-3030 Case discussion a n d group process. Open to new mem- area for West L.A. people. bers. WEST LOS ANGELES (Zip Code areas: 90230, 90232, 90265, 90292, 90401, 90406, 90291) SAN MATEOIBURLINGAME Renee Cote (3 10) 988-2166 Ron Martinez (4 15) 692-4658 Meets second Monday from 7:00 to 8.30 pm. The group is Is willing to coordinate a new group in one of the above zip open and conducted a s a forum for people to further the code areas. understanding a n d use of EMDR. Case consultation and DOWNEY practice sessions are available. Pauline Hume (2 13) 869-0055 10642 Downey Ave, Downey PAL0 ALTO Is willing to coordinate a new group. Ferol Larsen (4 15) 326-6896 Meets the first Wednesday a t 10:OOam in the conference room of Mental Research Institute (MRI), 555 Middlefield SAN DIEGO Road, Palo Alto. Case discussion. Limited to 10 particiMarcee Sherrill (619) 233-0460 pants. Times to be arranged. ORANGE COUNTY Jocelyne Shiromoto (7 14) 680-0663 Meets one Tuesday a month from 9:OOam to 11:00am 16 �EMDR Newsletter Staff Editor: Contributing Editors: David Fenstermaker, Ph Ron Martinez, Ph.D. Andrew Leeds, Ph.D. Lois Allen-Byrd, Ph.D. Robbie Dunton, MA A J. Popky, CHT Assistant Editors: Publisher: Coordinators CUT Levin, Ph.D. National Network Coordinator: Facilitator Coordinator: Robbie Dunton, MA "Sam" Foster,Ph.D. California Network Coordinator: Submission ~nfoknation ,. , Submission ofgeneral articles can be sent to David Fenstermaker, Ph.D., 4985 Mitty Ave, San Jose, CA 95129-1849.Articles specific to new and innovative uses can be sent to Ron Martinez, Ph.D., 1515 Tmusdale Drive, Suite 215, Burlingame, CA 94010. [Ifpossible, articles need to be submitted on an IBM formatted diskette.] The deadline for the next Newsletter will be August 1, 1992. PLEASE PRINT EMDR 1992 NETWORK REGISTRATION Name: Address: City: SpecialInterest Group: $40 State: Zip : $60 Phone (Bus): Phone (Res): Cost for participating in the Network is $60 for 1992. Membership entitles you to attend the National Network meetings and to receive copies of the EMDR Yewslems andjournal articles published in 1992. [If you are interested in only the Yewslettets and articles, the cost is $40.1 Make check payable to: EMDR Network, 555 Middlefield Rd., Palo Alto, CA 94301, (415) 328-582- TRAINING REGISTRATION FORM PLEASE PRINT Name: Phone (Bus): Address: Phone (Res): City: State: Zip: P r o f . Lic. #: COST: $285.00. Make check payable to: EMDR, P.O. Box 51010., Pacific Grwe, CA 93950-6010, (408) 372-3900 - LEVEL I: Sept. 12-13, Chicago,IL Oct. 9-10, L.A, CA Sept. 19-20, NY Sept. 25-26, S.F., CA Oct. 3-4, Seattle, WA Oct. 16-17,Miami, FL Nov. 6-7, San Jose,CA LEVEL 11: June 19-20,Santa Ana, CA Dec. 11-12, San Jose, CA July 24-25, San Jose, CA If LEVEL11:Your data ofLevel I B a s i c T r a i n i n g : S p e c i a l t y : Additional requests for topics in training: For Level I1 Training please circle one ProficientNery Comfortable [ A B C D E Oct. 30-31, Phil., PA ] ~ncertain/~ncomfortab �TABLE OF CONTENTS WORTHLESS TO WORKING, Edith Ankersmit, LCSW BOOK REVIEWS, Andrew Leeds, Ph.D. Memorv i n Mind and Brain: What Dream Imarrerv Reveals uth Knowles Grainger, Ph.D. Network Schedule LY CHILDHOOD ABUSE SURVIVOR, Landry Wildwind, LCSW ANNUAL EMDR CONFERENCE TRAINING SCHEDULE MDR: Innovative Uses Ron Martinez Ph.D. ALIFORNIA EMDR ST'UDY GROUPS ubmission Information I Please note: The new mailing address and telephone number for EMDR seminar information is: P.O. Box 51010, Pacific Grove, CA 93950-6010 (408) 372-3900. EMDR 555 Middlefield Rd. Palo Alto, CA 94301 El EMDR Network Newsletter POSTAGE � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter Newsletter Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EMDR Network Newsletter, 2(1), 1-18