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eye movement desensitization and reprocessing

There’s nothing small about trauma

By Bethany Bray June 24, 2021

When talking about trauma, Hillary Cook, a licensed clinical professional counselor (LCPC) with a solo private practice in Boise, Idaho, has a saying that she often imparts to clients: It’s as possible to drown in a puddle as in the depths of the ocean.

Trauma is often lumped — some would even say oversimplified — into “big T” or “little t” categories. Big T trauma encompasses what many people think of when they hear the word trauma: large-scale, life-shattering events such as living through a war or natural disaster. Little t trauma includes more common events such as pet loss, work stress, parenting struggles or racial microaggressions, which on the surface may seem smaller. However, trauma is a complex issue, and all traumatic events — no matter how big or how small they may appear to others on the “outside” — have the potential to negatively affect clients’ mental health.

Cook, like many counselors who specialize in trauma, has seen clients who minimized their little t, everyday traumatic experiences or failed to even recognize them as traumatic. Even when clients seek counseling because they recognize that something is causing them distress and disrupting their life, they sometimes are unable to pinpoint or verbalize why, she says. Others may harbor feelings of shame or insecurity about how they feel. Cook has often heard clients, unsure of whether their experience warrants counseling, preface their stories by saying, “I don’t want to waste your time.” 

Cook, a member of the American Counseling Association, has also worked with clients who dismissed their traumatic experiences by stating, “I didn’t go to war,” “It wasn’t violent” or “I don’t know why this is bothering me.” She explains to these clients that the sticking point is not the traumatic incident itself but rather how it is stored in their brain. Counseling won’t take that traumatic memory away, but it can change how it is stored, enabling the client to carry it in a less painful way, Cook explains.

Providing psychoeducation is a critical first step when working with clients who have experienced little t traumas, says Debbie Millman, a licensed professional counselor and director of a trauma therapy practice in Madison, Wisconsin. It is helpful to explain to clients the depth and breadth of trauma, which can range from something catastrophic or systemic, she says, to “someone who didn’t get picked for the kickball team [in childhood] and it cut deep, and they still dwell on it today.”

“I see trauma as anything that affects how you see yourself or feel now. No matter how big or small it seems, it’s worth revisiting that [in counseling],” notes Millman, an ACA member.

She helps clients understand the importance of recognizing and addressing trauma — even everyday ones — with the following illustration: Trauma is like pushing a ball under the surface of the water in a swimming pool. You don’t know where it’s going to resurface, but it always will. The same rule applies to trauma: You can’t keep it buried; it will always resurface. The key is to process it.

Jessica Tyler, a professional counselor licensed in Alabama and Georgia, considers trauma to be “any experience that shifts your perspective on self, others or the world.” For one person, that experience might be tied to surviving a horrific car accident. For another person, it might trace back to feeling humiliated when they were called on by their first-grade teacher to read something aloud in class. The important point to communicate is that all of these experiences are valid, she says.

“I am very adamant [with] my clients that it serves no one to compare suffering,” Tyler says. “Suffering is suffering is suffering is suffering, and if we stop comparing the validity of our suffering, we can get to work on how these experiences can expand us as individuals versus define us and our worth.”

What lies beneath

Everyday trauma can dovetail with grief and loss, attachment issues, racial or cultural issues, panic attacks, self-esteem struggles, depression, suicidal ideation, eating disorders and many other challenges that clients present in counseling. For clinical practitioners, the key is not to take those presenting concerns at face value because unprocessed trauma may be a contributing factor or even the root cause, says Susan Gabel, an LCPC at a trauma-focused group practice in the Chicago suburbs.

If a client comes into counseling with symptoms of social anxiety, for example, clinicians should not limit their counseling work to addressing those symptoms or viewing the client simply as socially anxious, because then they may miss some of the larger reasons behind those symptoms, Gabel explains. 

“There can also be things that they won’t identify as trauma, such as a parent who was invalidating,” she continues. “It’s not a big T trauma, but if you add that up over and over and over again, they internalize it, and it becomes a powerful negative cognition of how they view themselves and expect people to respond.”

Low self-esteem, conflict avoidance and people-pleasing behaviors can be common among clients who have experienced trauma, Gabel notes. Because of this, practitioners must be mindful that clients may exhibit people-pleasing behaviors in therapy toward a counselor. This behavior can show up in a number of ways, she says, including when clients are not completely honest in sessions because they want to agree with their counselor, avoid conflict, or tell the counselor what they think the counselor wants to hear. These clients may also apologize frequently during sessions. 

Gabel points out that this fear of conflict can stem from clients having people in their life who had a pattern of responding negatively to their needs or feelings. Thus, they may reflexively expect that response from others, including their counselor.

“For a lot of people, [trauma] tends to lean into larger issues, including their views of themselves, views of others and fear responses,” says Gabel, an ACA member who holds two trauma certifications. “Difficulty with assertiveness can [indicate] a pattern of having relationships where their needs were not met, or they needed to appease or do what the other person needed.” 

Tyler, an assistant clinical professor and coordinator of the clinical mental health counseling program at Auburn University, notes that a client’s self-talk can also yield clues that the person experienced trauma in their past. Drawing from the work of North Carolina licensed clinical mental health counselor Candice Creasman, Tyler urges practitioners to listen closely for a client’s “wounded inner child,” which Creasman defines as the voice of their unhealed hurts. Exploring how this voice influences a client’s beliefs and decision-making can reveal the lived experience that generated the client’s problematic thoughts, Tyler explains.

“In my experience, this typically appears as the inner critic that we, as counselors, hear in a client’s hostile and harsh self-talk narrative,” says Tyler, an ACA member who counsels adult clients at a private practice in Columbus, Georgia. “In clients, this can also appear as anger, frustration, [or] controlling or needy behavior in therapy. The wounded inner child tests their therapist’s [ability] to show up with care, acceptance and compassion despite [the client’s] behaviors. This inner child is often the impulsive and risky part of a client that ‘acts out’ despite the potential for adverse consequences.”

Gabel often hears clients use language about feeling worthless, being “never enough” or assuming they are a bad person. Counselors can learn more about a client’s history, she says, by challenging those negative beliefs in counseling and asking when and where the client first heard those statements.

Gabel and Cook also note that somatic complaints can indicate that unrecognized trauma lies beneath a client’s presenting concern. Cook finds this especially true for symptoms that clients have explored with a medical specialist — such as hives with an allergist — without any cause
being identified.

Both physical responses and unresponsiveness can be connected to unprocessed trauma. Carrying any kind of tension in the body, including headaches, stomach troubles or sensations such as feeling a tightness in the chest, can be signs of untreated trauma, Gabel says. At the same time, past trauma can cause a client to talk about an experience that would typically elicit an emotional response in a disconnected or unemotional manner, she says.

If left unprocessed, little t trauma can become problematic in myriad ways, Tyler says, and treating it requires counselors to go beyond symptom management with clients. For example, a client’s self-protective behaviors could manifest as codependency and people-pleasing in romantic relationships to validate their security and worth as a person. This can make the client vulnerable to partners who are controlling, manipulative and even abusive, Tyler explains. 

“Focusing on behavior modifications and symptom management may bring short-term relief for a specific life situation. However, I find that clients often have difficulty applying these coping skills to new challenges that emerge in their lives,” Tyler says. “I have found more success in therapy when I can identify the cognitive key, or core beliefs that filter how a client sees and reacts to the world, others and themselves. This cognitive key may serve as a survival measure at first — [for example] avoidance, mistrust, perfectionism — but over time can create barriers to the client living a thriving life. … If a cognitive key can be discovered in therapy, the client learns how to adjust that ‘filter’ and see the world, others and themselves in the most flexible, rational way.”

Tyler illustrates this process through an example of a client who experiences panic attacks whenever she is away from her small child. The client may find relief after a few sessions if the practitioner focuses on breathing exercises, medication management and mindfulness with the individual. This may look successful on the surface, Tyler notes, but the root cause of the client’s distress remains unaddressed.

Instead, Tyler says, she would take a deeper look at the underlying issues by using Socratic questioning. This process helps the client “discover a long-held core belief that ‘I only feel safe when I am in charge,’ [which] can give us important data to work with to help address the client’s filter that goes beyond mothering and extends to other parts of her life,” Tyler says. “Here, I find the most potent change in clients.”

fran_kie/Shutterstock.com

Handle with care

Regardless of whether a client has experienced big T or little t trauma, the brain is interpreting what happened as harmful to the client in some way, Cook explains. What matters is not how “bad” the event was but how maladaptively it was stored in the brain.

“The type of trauma, or how bad it was, doesn’t change the approach [in counseling]. What the client needs will change the approach,” Cook says.

She advises considering whether the client has adopted healthy or maladaptive coping mechanisms or if the client has a strong social support system. If not, the counselor should focus on those aspects before diving into deeper work to help the client process the underlying trauma, she says.

The clinical practitioners interviewed for this article use a variety of techniques, including brainspotting, eye movement desensitization and reprocessing (EMDR), hypnosis, internal family systems (IFS) therapy and cognitive behavior therapy (CBT), to help clients who have experienced trauma. These practitioners stressed, however, that counselors should focus on self-regulation and social connection with clients and establish coping mechanisms before deploying techniques to process clients’ trauma. This is especially true with clients who have experienced everyday trauma and do not recognize the effect it is having on their presenting concern.

As a licensed mental health counselor who specializes in trauma work, Christine Smith has an extensive toolbox of coping mechanisms to equip clients with depending on their needs. Coping mechanisms not only help clients with emotional regulation but also instill containment skills they can use to manage their feelings and carry on with everyday life after heavy counseling sessions that deal with raw or troubling memories, she explains.

“People tend not to use their coping skills until their hair is on fire,” Smith says jokingly. She works with clients to instead ensure that coping skills become part of their everyday life, sometimes even assigning them as homework in between sessions.

She encourages clients to keep a list of coping mechanisms they find helpful on a piece of brightly colored paper in a visible spot in their home, such as the refrigerator door or bathroom mirror. She also recommends that they move this list around periodically, so they don’t begin tuning it out.

“Coping mechanisms themselves are trauma work in a way. I tell clients, ‘We’re going to do safety, safety, safety until you are rolling your eyes, and then we’re going to do it some more.’ If you don’t have a good foundation [before doing deeper trauma work], you’re building a house of cards,” says Smith, an ACA member with a solo private practice in Saratoga Springs, New York. “The best coping mechanisms are the ones that are so integrated in a client’s life that they don’t think of it as coping.”

Smith says this early work helps forge a therapeutic bond with clients and offers the practitioner a chance to ask questions that plant seeds about a possible connection between a past experience and the discomfort that caused the client to seek counseling. Questions such as “When was the first time you felt like that?” can help both the counselor and the client begin to make connections, she adds.

Gabel agrees that coping skills should be tailored to a client’s individual needs. Deep breathing or mindfulness may be helpful for some clients, whereas others may need to work on skills that they haven’t fully developed, such as interpersonal communication or problem-solving skills, because of their trauma history.

When starting trauma work, Cook often uses EMDR and hypnosis for immediate relief of nightmares, flashbacks and intrusive thoughts to help clients find stability. Only afterward do they unpack trauma and other related issues such as grief.

Millman begins trauma work by talking through clients’ life timelines, making note of events that shaped them and have stuck with them. She also devotes significant time to doing case conceptualizations and asking clients about their strengths, personality and likes/dislikes. This helps her with gaining a holistic understanding of the client and forging a therapeutic bond, she says.

Similarly, Cook recommends asking questions that help to paint a picture of a client’s framework, including their social supports and how they deal with intense feelings. Knowing more about a client’s background might also inform counselors about cultural and racial issues that can dovetail with everyday trauma that is systemic in nature.

Millman notes that it can be helpful to encourage clients who have experienced trauma to maintain “emotional margins” around each session. This means not rushing to a counseling session from work or after picking their children up from school. Instead, she encourages clients to engage in calming rituals, such as having a cup of tea or doing some deep breathing exercises, before and after sessions.

Millman, a doctoral student in the counselor education and supervision program at Liberty University, also advises counselors to keep trauma clients in mind when outfitting their office spaces. She emphasizes the importance of being intentional about what counselors expose their clients to. For example, having fashion or health magazines in the waiting room could potentially be triggering for clients whose trauma histories or related behaviors are connected to body image or disordered eating. Instead, Millman suggests striving to create an atmosphere that is warm and calming.

“All counselors have to be prepared to come across trauma; it’s at the root of so many mental health concerns and disorders,” Millman says. “Everyone needs to have some trauma-informed care training [and] be aware of what triggers clients and what phrases or buzzwords you might be using that could be problematic for someone. Especially in regard to race, be aware of the words you’re using. Getting culturally competent, trauma-informed care is really connected to [addressing] the daily trauma that people are facing right now.”

Digging deeper

In counseling sessions, a client’s past trauma will “come up when it needs to come up,” Millman says. For some individuals, that will happen right away, and it will come out “like a volcanic eruption.” For other clients, it may be a year into therapy before they’re ready to talk about it. But when they do, Millman says, she “can almost feel the relief in the counseling room,” especially for clients who associate feelings of shame with their trauma. “It’s like a weight has lifted, disempowering that hold it has over [them] now that someone else knows about it and can carry it with [them],” she says.

In trauma work, Smith adds, it’s not uncommon for clients to broach a traumatic subject by saying, “I’ve never told anyone this but … ” When that happens, Smith tells the client she is honored that they trusted her with this information.

“I try not to ever forget how much courage it takes to walk into a therapist’s office,” Smith says. “I try and be really encouraging, positive and respectful of that and recognize the wins that they have that other people aren’t going to recognize.”

Smith finds that work that focuses on emotional regulation can be especially helpful for this client population. In some cases, this involves simply talking through and processing interactions and events clients have experienced since their last counseling session. It can be helpful to “move at a glacial pace,” slowly unpacking an incident the client found distressing down to the minutiae, Smith says. This allows the client to identify the exact moment they started to feel triggered and lost the use of their self-regulation skills. Then, the counselor and client can talk about what the client could do differently the next time this type of scenario arises.

EMDR can be particularly helpful to work through troubling scenarios and feelings with clients who may not recognize a past experience, such as little t trauma, as the root of their discomfort, Cook says. However, these clients will be able to name the challenge that caused them to seek counseling, such as relationship trouble, work stress or panic attacks. EMDR allows the practitioner to target and heal clients’ distressing feelings and triggers without having to relive the trauma that lies underneath, she explains. The beautiful thing about EMDR, Cook says, is that it allows the practitioner to target a distressing pattern that the client is experiencing, which, in turn, targets anything else that is in that neural pathway, including related trauma.

During EMDR, the client engages in bilateral stimulation, such as rhythmic tapping, while talking through a scenario with the practitioner. The process rewires the client’s brain and creates a new neural pathway, revising the pattern into one that is free of distress, Cook says.

EMDR allows clients to “see themselves in a scenario in a different way and imagine how they want to feel … without having to go through it” and relive the trauma, she explains. 

This was the case for an adult client whose presenting concerns involved relationship issues and anxiety related to dating. Cook was able to use the client’s specific anxieties surrounding first dates as a target in EMDR. Cook guided the client to talk about the details of how they felt during their worst dating experiences. 

“All of a sudden, it went much [further] back, and we realized there were some parenting issues [involving verbal abuse] from many years ago in childhood,” Cook recalls. “It was really hard for them to hear at first. There was a lot of denial, [saying] ‘that’s not trauma.’ But then I used an illustration: If you could imagine a small child that’s not you and this was happening to them, how would you feel? Then it sunk in, and they realized how awful it was.”

Cook continued to use EMDR, as well as CBT, to focus on the client’s self-worth and to build healthy boundaries. This therapeutic approach built up the client’s coping skills so that on dates, they were able to focus more on the other person and be less “in their head,” Cook says. When the client worried less about what the other person was thinking about them, they were able to instead focus on finding connection.

EMDR, along with a combination of other therapies, was also helpful for a past client of Tyler’s whose presenting concerns were low self-esteem and anxiety. As they began to unpack things in counseling, the client also disclosed a history of self-harming behaviors and chronic suicidal ideation.

“She was successful in her career yet presented with chronic and relentless self-talk that was significantly cruel and self-blaming. Everything was her fault and everything terrible that had ever happened to her resulted from her failures; she was convinced that she was unlovable and worthless,” recalls Tyler, who co-presented the session “Trauma-Informed Care: Working With Trauma-Related and Survivor Guilt” at ACA’s Virtual Conference Experience in April.

In counseling, Tyler gently probed with questions to identify where and how this client learned such hypercritical self-talk. The client reported that it was simply “something she had always done,” Tyler says.

Tyler gently challenged this thought with psychoeducation that infants are not born with self-hatred; it is something they learn from their environment. Through that lens, she explained to the client how life experiences may reinforce negative beliefs and feelings of rejection. Over time, the client was able to reprocess several early childhood and adolescent experiences that she had previously believed were “not traumatic enough” to cause her mental health to dip to its current state, Tyler recalls.

“However, in examining these experiences through the lens of how young, vulnerable and impressionable she was as a child, it made sense how one thing spiraled into another, which then turned into years of confirmation bias,” Tyler says. “Using a careful combination of EMDR, CBT and IFS, she communicated with her younger self and realized that, in reality, being worthy was her birthright and that she was allowed to make mistakes and learn from them just like everyone else. Moreover, every time she damaged herself emotionally or physically, she betrayed that younger version of herself that was not adequately protected from the harm and toxicity of others.”

This change occurred gradually over one year of counseling. Eventually, the client’s self-harm and suicidal ideation ebbed, Tyler says, and she adopted a lens of “gratitude for the younger versions of herself who endured — and her present adult self who now had the control and power to make choices to nurture and soothe her along the journey of life’s challenges.”

Not so little

Gabel thinks it is more helpful to view client trauma on a spectrum rather than sorting experiences into either “big T” or “little t” boxes. She urges counselors to keep an open mind, regardless of how severe a client’s experience may — or may not — seem.

“Little t traumas can add up and hold a lot of power. Complex, relational trauma can be little t’s that add up and become overwhelming,” Gabel says. “A lot of times [counselors] are trying to make logical sense of it — if this [experience] is affecting [the client], it must be connected to a past event (e.g., peer conflict as an adult and past bullying as a child) — when in reality, that’s not how our brain wiring works. It doesn’t always make logical sense.” 

Smith also encourages counselors to keep an open mind about what qualifies as traumatic. Something that on the surface appears to be a smaller trauma, such as the death of a pet, can be a huge loss to someone who didn’t have healthy attachments growing up, she notes.

“It’s not up to me to decide what’s a small t trauma versus a large T trauma. Something that’s small might be linked to something that’s not so small,” Smith says. “What I’m looking at is someone who has experienced some kind of disruption or loss that they’re having trouble getting over. You and I could have the exact same experience, and you might come out unscathed, and I might really suffer, and we don’t always know why that is. … Just keep yourself open and curious [in counseling sessions]. My clients are my greatest teachers, and if I listen very carefully, they know exactly what they need to heal.”

 

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Referring and co-treating

The nonprofit organization Mental Health America offers an online mental health screening each year on its website. In 2020, nearly 2.5 million people took the screening, and past trauma was second only to loneliness as the most reported cause of mental distress.

This data illustrates what many counselors see in their daily work: Trauma is ubiquitous and can have a profound effect on mental health. With that in mind, clinical practitioners must be mindful of when a client’s trauma goes beyond their expertise. The counselors interviewed for this article stressed that trauma is a complex issue and clinicians who do not specialize in this realm need to be ready to seek additional training or supervision, consult with colleagues or refer clients for specialized trauma work.

Seeking outside help is especially important when a client is no longer making progress with their counselor, says Hillary Cook, a licensed clinical professional counselor in Boise, Idaho.

A strong, trusting therapeutic relationship is crucial in trauma work, Cook notes, and a referral doesn’t necessarily mean this bond is broken. Clients can continue to work with their original counselor while being co-treated by a specialist. In this scenario, the client would need to grant permission for the two clinicians to consult with each other.

“We can’t be all things to all people,” agrees Christine Smith, a licensed mental health counselor who specializes in trauma work at her private practice in Saratoga Springs, New York. “If a counselor doesn’t have specialized training in dealing with some of the more complex trauma issues, don’t be afraid to refer out.”

Consult Standard A.11. of the 2014 ACA Code of Ethics at counseling.org/ethics for more on the ethical guidelines surrounding the referral process.

 

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Action steps to learn more

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Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The high cost of human-made disasters

By Lindsey Phillips March 1, 2018

The stories of the aftereffects of human-made disaster have become all too familiar: a refugee forced to make a dangerous journey to find a new home; the soldier deployed thousands of miles from home for months at a time; the person who finds his or her world turned upside down when a shooter enters the room and begins firing. It’s not surprising, then, that according to a report by the American Psychological Association, in 2017, 60 percent of Americans felt stressed about terrorism and 55 percent felt stressed about gun violence.

In addition, refugees fleeing war-torn countries have created an international crisis, and, among other things, they aren’t getting the mental health care they need. The International Medical Corps found that 54 percent of Syrian refugees and internally displaced populations in Syria, Lebanon, Turkey and Jordan suffered from severe emotional disorders, including depression and anxiety.

The increase in human-made disasters raises a question for counselors and others: Does the type of disaster — natural, human-made or technical — affect the severity of the trauma or the counseling approaches used to treat it? Devika Dibya Choudhuri, an associate professor at Eastern Michigan University, says sufficient research indicates that when human agency is involved, the disaster has a more traumatizing effect. Although natural disasters are traumatizing, there is often a huge response of communities taking care of one another, which tends to be a restorative factor, she explains.

“With human-made disasters … the aftermath is also conflicted,” says Choudhuri, a licensed professional counselor and American Counseling Association member who presented at the ACA 2017 Conference & Expo in San Francisco on group interventions in the aftermath of violence, terrorism and dislocation. “Most [refugees’] … traumatizing stories are not just [about] the original trauma. … The journey after is so profoundly traumatizing as well because not only are they ungrounded from the loss of home, but then all of these additional wounds are made. There is no safety anywhere, as opposed to that sense [after a natural disaster that] people are coming forward to help.”

Rebuilding trust, regaining control

Choudhuri, who worked with Cambodian and Bosnian refugees in the 1990s and has worked with Iraqi and Karen refugees since the 2000s, points out that survivors of human-made disasters are fighting on two fronts: struggling to survive in their environment and engaging in an inner conflict where the original strategies for survival during the trauma are no longer helpful. Thus, when it comes to trauma and human-made disasters, counselors should focus on restoring a client’s sense of control, not safety, she advises.

Hannah Acquaye, an assistant professor of counseling at Western Seminary in Portland, Oregon, works with refugees from war-torn countries such as Afghanistan and Iraq and parts of Africa. She finds that for refugees from countries where neighbors are fighting neighbors, the trauma is unique in terms of feeling a sense of betrayal. If the person holding the gun and causing the devastation is someone they know and used to play with growing up, then the trauma becomes especially troubling, she says. “It affects the way they trust people … and makes it harder to build a community back,” explains Acquaye, an ACA member whose research focuses on refugee trauma and growth.

Thus, rapport and trust are crucial for survivors of a human-made disaster. According to Mark Stebnicki, professor and coordinator of the military and trauma counseling certificate program in the Department of Addictions and Rehabilitation Studies at East Carolina University (ECU), empathy and listening are critical elements of establishing rapport and gaining the trust of these clients.

Establishing a therapeutic alliance can be problematic, however. Counselors often learn to build a therapeutic alliance by offering warmth and connection and by encouraging clients to tell their stories, Choudhuri points out. But for individuals who have experienced a “traumatizing offense through human agency … the betrayal and abandonment and loss of trust during the process gets triggered by the very warmth of the connection,” she explains. Counselors will often experience that after making a connection and getting the client to open up, the client never shows up again or ends up in the hospital, Choudhuri says.

Before uncovering the trauma, counselors must help rebuild and ground clients so that they will have resources to address the trauma, Choudhuri argues. “Rather than creating a therapeutic alliance, it’s about rebuilding the kinds of ways in which people can take care of themselves so that they don’t require the therapist to do that,” she explains. In fact, she advises that counselors should work with survivors of human-made disasters as if they will have only one session together. The first few sessions should focus on techniques that will help clients function in case they don’t return, she says.

One way counselors can help clients become autonomous is by providing them with tools to regulate their emotions. Somatic and emotion regulation techniques allow survivors of human-made disasters to notice their triggers on a sensorial basis and use their brain to counter this negative trigger, says Choudhuri, a certified eye movement desensitization and reprocessing (EMDR) therapist. In a sense, their brain becomes an ally, rather than an obstacle or hindrance, in their recovery.

One of Choudhuri’s clients suffered trauma after being held captive and tortured for several days. Smelling the cologne worn by one of his captors would trigger the client. After identifying this sensorial trigger, Choudhuri set out to counter it. She discovered that the client found lavender essential oil calming, so she directed him to take in the lavender scent anytime that he encountered the smell of cologne. The process works on two levels, Choudhuri notes, because “it’s addressing the sensorial piece, but it’s also giving control back [to the client].”

Choudhuri also finds that traumatic resilience is important when working with survivors of human-made disasters. Many resourcing and grounding techniques that counselors use can also make clients more resilient in the face of ongoing trauma, she notes. For example, Choudhuri finds the container technique helpful for her clients: She tells clients to think of a container with a secure lid (e.g., a jar, a jewelry box) and then to use that container to mentally store the parts of the trauma that get in their way and prevent them from moving forward.

Group work is another resource that can help survivors of human-made disasters rebuild a sense of trust. At the same time, Choudhuri says, “group work is really challenging, particularly for [people] who have had human-made disasters, because other human beings are a source of threat [to them].”

In fact, Choudhuri is careful to avoid touching clients who have been hurt by other human beings. Instead, she teaches clients how to give themselves a comforting touch. For example, she uses the butterfly hug method (clients cross their hands over their chest and alternately tap their hands to a heartbeat cadence) while she facilitates thoughts of being safe and loved. This technique works well with children and is one that clients can do themselves when they are upset, she adds.

Rather than asking individuals to share their trauma in groups, Choudhuri suggests having them process it in a way that allows group members to provide comfort to each other, thereby helping restore a sense of control, trust and efficacy. For example, counselors could have individuals teach each other how to engage in deep breathing. “It allows for people to feel empowered to … not just be on the receiving end but also on the giving end,” Choudhuri explains, “and then they’re giving something that they themselves are learning, which helps them learn it better.”

From Stebnicki’s perspective, groups not only allow counselors to identify people who need more individualized treatment but also provide a safe space to verbalize and normalize survivors’ feelings (e.g., anxiety, depression, grief, sleeplessness) about an event and prepare them for the forthcoming weeks. “If you get [clients] to open up and share feelings [in a group], then the group itself is your own best source of support because they can normalize what that scary event was like,” he says.

Bridging cultural differences

Stebnicki acknowledges that working with people who are culturally different from the counselor can be challenging. Clients who are refugees, immigrants and asylum seekers may pose an even greater challenge because American counselors are often far removed culturally from individuals from war-torn countries such as Syria and Afghanistan, he adds. But successful treatment relies on understanding clients’ cultures and how they heal, he asserts.

In some cultures, counseling as generally practiced in the Western Hemisphere doesn’t exist, so counselors shouldn’t force clients to share their stories, Acquaye says. Instead, counselors should focus on providing a safe, supportive environment and inform clients that they are in the moment with them, she advises.

Stebnicki, a member of both ACA and one of its divisions, the Military and Government Counseling Association, says that he distinguishes between civilian and military responses to human-made disasters. “Military is a culture unto itself,” he says. “Military personnel experience person-made disasters differently in that instead of detaching, isolating, running and going into shock like civilians do, they adapt and survive, and they aggress … [not] stress.” Unlike civilians, who typically respond to a shooting by running away, military personnel are generally running toward the gunfire, he points out.

At the same time, civilians and military personnel experience similar physiological, psychological and emotional responses to human-made disasters. However, military personnel also experience ongoing trauma stressors (such as multiple deployments) and generally do not undergo the full range of posttraumatic stress disorder (PTSD) symptoms until after their deployment or military service ends, Stebnicki says. Thus, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders “measures PTSD, but mainly in civilian life because it doesn’t take into account this … repeated exposure to trauma which military [personnel] are exposed to,” he argues.

In addition, military personnel often cannot easily take advantage of mental health services in the same way that most civilians can because of the stigma that military culture places on it, Stebnicki says. Using these services can sometimes put their security clearances at risk, cause them to get demoted or have others in the military lose faith in them and their ability to lead, he explains.

Despite these difference, many counselors try to treat military personnel as civilians and do not recognize the distinctions between civilian and military mental health, Stebnicki says. To help address this issue, he developed the certificate in clinical military counseling at ECU. The course trains professional counselors on some of the unique cultural differences in diagnosis, treatment and services for members of the military.

Making meaning of human-made disasters

In the face of a human-made disaster or a large-scale political event, people often feel helpless, like a small cog caught in a big wheel, Choudhuri says. In such cases, the counselor’s aim is not to help clients find an answer to existential/spiritual questions of why the disaster happened but to help them figure out a meaning to these events that they can live with, she says.

Meaning making should also involve some degree of personal growth, Stebnicki notes. He says that counselors can determine whether clients have experienced posttraumatic growth by their actions: Are they taking their medications? Are they going to counseling? Have they reconnected socially? If the answer is no, then there is no growth, he says.

The counselor’s job, Stebnicki contends, is to provide tools and resources to help clients take responsibility for finding meaning and growing from the trauma. However, he points out, growth is painful, so counselors must prepare clients to take small steps toward identifying ways of feeling safe and ultimately finding meaning.

Acquaye actively celebrates her clients’ small victories because she believes it encourages them. She had one client who was a refugee who was depressed because she didn’t know how to communicate in her new culture. Acquaye asked her to try to leave her apartment each day and walk around for five minutes. When her client was successful, Acquaye jumped up and down in front of the woman to celebrate her progress. Taking this small step forward helped her client begin to sleep regularly again, Acquaye says.

Choudhuri looks for ways to address clients’ despair without trying to change their beliefs about what happened. She finds EMDR helpful because it allows people to process internally without having to give the counselor details about their trauma. At the same time, clients are able to arrive at a meaningful narrative about their experience. “It may not be my answer, but it’s their answer,” Choudhuri adds.

Choudhuri provides an example of a Syrian refugee who participated in EMDR therapy that involved drawing and processing his trauma. At the end of the session, he said that regardless of the terrible things that had happened to him, he realized that every night has a morning. “It wasn’t that he got an answer or that he had a solution,” Choudhuri says, “but he got what he needed — hope.”

For many clients, spirituality plays a large role in meaning making. If the client’s and counselor’s spirituality differ, then the counselor should find common ground to discuss spirituality, Acquaye advises. The majority of her clients are Muslim and Acquaye is Christian, so in session, they discuss the general concept of God and who is in control of everything. “We can’t explain why people do what they do, but we can hold on to somebody who is greater than people and know that some good may come out of that,” she explains.

Self-care and counselor fatigue

Clients’ stories of trauma, suffering and loss can take a toll on counselors, resulting in counselor burnout, compassion fatigue or empathy fatigue. The cumulative effect of seeing multiple survivors of human-made disasters and other traumas can start to deteriorate counselors’ spirit to do well and damage their own wellness, Stebnicki notes. For that reason, counselor self-care must become a priority when working with survivors of human-made disasters.

Stebnicki differentiates between empathy fatigue, a term he coined, and other fatigue syndromes such as burnout and compassion fatigue. He explains that empathy fatigue results from a state of physical, emotional, mental, spiritual and occupational exhaustion that occurs as the counselor’s own wounds are continually revisited through a cumulation of different clients’ stories of illness, trauma, grief and loss.

The major difference between these types of fatigue syndromes is that empathy fatigue has an added spiritual component, Stebnicki notes. Horrific experiences such as genocide and torture go beyond the range of ordinary human experience and affect the mind, body and spirit, he explains. Thus, it is crucial that counselors are properly trained to be empathetic and compassionate, he says. In addition, because people experience and define spirituality in their own individual ways, counselors must understand their clients’ views of spirituality to assist them in cultivating hope and psychosocial adjustment to their trauma.

Acquaye acknowledges that she didn’t initially realize how much the stories of her refugee clients would affect her. If counselors are struggling with counselor fatigue, they need to seek help to avoid harming their clients, she advises. “It’s not about me. … If I claim I’m an advocate for my refugee clients, then I should get over myself and ask for help, so I’ll become a better person for them,” she says.

Choudhuri says counselors must also guard against making another common mistake. Because refugees often have little meaningful support, they are incredibly grateful when they do receive it, and there can be a danger in that for counselors. “If [counselors] work long enough with [refugees], it gets really easy to feel like a savior,” Choudhuri admits.

“One of the things that trips [counselors] up is this belief of indispensability — that there is nobody else, so I have to keep doing it even if I don’t want to,” Choudhuri adds.

She also finds that working with clients who have survived a human-made disaster can bring out something of a competitive nature in counselors: They assume (often incorrectly) that if the client can deal with the trauma, then they can too because they are the counselor.

Among the possible signs of counselor fatigue syndromes that Stebnicki notes are having diminished concentration, feeling irritable with clients, feeling negative or pessimistic, and having difficulty being objective or compassionate. “We’re good as counselors at giving advice to others and helping facilitate self-care strategies, but we don’t do it ourselves. We need to take our own best advice and get help,” he advises.

Stebnicki has found peer support helpful when dealing with fatigue syndromes. He and other colleagues meet once or twice a month to vent and share their stories. In fact, he notes that it is common to have ongoing peer support on-site for counselors and first responders at large-scale human-caused disasters. These support groups allow counselors to discuss what they saw, how it affected them, how they are responding and how they are going to overcome it, he says.

Acquaye is thankful for her supervisors and own personal counselor who help her guard against burnout. “I have to remind myself all the time that I’m not God … so I can’t carry my client because sometimes the stories are so heavy that you can’t sleep at night,” she says. She realizes that carrying the burden of her clients’ stories will serve only to make her negative and ineffective as a counselor.

Many counselors are drawn to working with refugees because they want to help, but before jumping in, Acquaye says, counselors should understand what their strengths and limitations are. “Ask yourself [if] you have enough strength for the kind of stories they will throw at you. [If not], it doesn’t mean you are not good enough. It just means that that is not your area,” she says. “When it comes to refugee work … you are going to go through the trauma yourself, so you have to ask yourself, ‘Do [I] have what it takes to go through that?’”

Lessons learned

How can counselors prepare to handle the specific needs of survivors of human-made disasters? “Training to be trauma informed becomes key. … There shouldn’t be counselors coming out of counseling programs who don’t have a basic understanding of trauma,” Choudhuri asserts. Yet, she finds that counselors often report not knowing how to deal with trauma and disaster mental health.

Choudhuri thinks that one area of disaster mental health where training needs to improve is clinical competency. Often, counselor educators aren’t practitioners, which can be problematic because they don’t see the chronic nature of clients’ issues and thus don’t prepare adequately, she contends. She argues that counselor educators should stay clinically active — perhaps even working with survivors of human-made disasters — to keep their finger on the pulse of what is happening.

Of course, Acquaye admits that counselors are never likely to have all of the training they need to handle disaster mental health straight out of school. Many of the skills must be learned on the ground. She recounts a time when despite her training on refugee trauma and posttraumatic growth, a client’s story scared her to the point that she was shaking. She had to remind herself that even though she had no idea how to treat the client’s many issues on the spot, she needed to start by listening to the client and then figuring it out as she went along by researching and assessing the client’s needs.

What people consider to be trauma or traumatizing changes over time, Choudhuri notes, so the symptoms that veterans displayed after the Vietnam War are not the same ones that soldiers returning from Afghanistan and Iraq have displayed. Today, counselors also have to take into account the fact that there is more aggression digitally, and digital aggression distances people from the trauma, she adds. For example, drone warfare has changed the rules of war, allowing people to kill from a distance. This makes killing more impersonal and affects the mental health of drone pilots differently.

“As conflict becomes handled differently, [so does] the kinds of betrayals and ways in which people can be hurt electronically. … [People’s] sense of danger and risk become different than if somebody broke into [their] house. They’re related, but they’re different,” she says.

One mistake that counselors often make when working with clients is expecting a more intense early disclosure of the traumatic incident, Stebnicki says. Stebnicki worked as a member of the crisis response team for the Westside Middle School shootings in Jonesboro, Arkansas, in 1998. In the aftermath, he witnessed a counselor go up to a student, take him by the shoulder and almost shake him to force disclosure of what the student had just experienced. Counselors must remember that everyone heals at his or her own rate, so survivors of human-made disasters may not want to discuss their experiences immediately after the event, he says.

Stebnicki has also found that people’s experiences vary based on their proximity to the disaster’s epicenter. “We all differ in stress and trauma in terms of the pattern, the frequency, the exposure, the magnitude/intensity. So, in other words, we all turn our stress response on differently,” he says.

In working with refugees, Choudhuri has learned that counselors can’t assume to know the trauma. One of her clients had been married off by her parents while in the refugee camp to a man who raped her. Was the worst part of her experience being in the refugee camp, losing her home or being raped? Choudhuri discovered that for the client, it was that her parents didn’t love her enough to have chosen a better husband for her.

“It wasn’t the violence that drove her from her home, it wasn’t the destruction of her life as a schoolgirl, and it wasn’t even the brutality of her experience in the marriage,” Choudhuri says. “It was the sense of being betrayed by her parents.” Thus, counselors should remember that the focus of the work is not about the trauma but about the client, she adds.

Choudhuri has also observed that although disaster mental health professionals have developed ways to work with people immediately after a disaster, they often fail to implement this guidance back home. She argues that counselors don’t respond to the ongoing, everyday disasters happening in their backyards — the microaggressions and microassaults that wear people down as they try to overcome obstacles of systemic racism, chronic poverty, violence and substance abuse — in the same manner as they respond to large-scale events.

“If we can point to the singular event, we can be horrified by it and [respond] with compassion and helping, but when we live in it, we numb ourselves … to it because we feel helpless,” Choudhuri says.

“It’s difficult because we all want a place of safety … so it’s easier to go away somewhere and work on [disaster mental health] and then come back [home] and be safe,” she points out.

Counselors need to resist the urge to let trauma and disaster response fade into the background because of the discomfort these events can generate, Choudhuri argues. Instead, they must keep disaster mental health in the foreground and help rebuild communities and individuals affected by disasters, including those less obvious disasters happening in counselors’ backyards.

 

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Lindsey Phillips is a freelance writer and UX content strategist living in Northern Virginia. She has a decade of experience writing on topics such as health, social justice and technology. Contact her at lindseynphillips@gmail.com or through her website at lindseynphillips.com.

Letters to the editorct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

EMDR for the co-occurring population

By Jeanne L. Meyer May 29, 2014

In my work with clients with co-occurring mental health and substance use disorders, it became clear to me early on that most have experienced trauma in their lives — trauma that they must resolve to achieve and maintain a healthy recovery.

These traumas are sometimes categorized as little “t” or big “T” traumas. Big “T” traumas include childhood sexual, physical or emotional abuse, natural disasters, war experiences, severe car accidents and rape. Little “t” traumas can be just as damaging, especially because they tend to occur over time and build on each other. This complicates the overall effects of the trauma as well as the trauma treatment. Some examples of little “t” traumas include ongoing emotional abuse or neglect, experiences of shame, being humiliated and being bullied. Incidents involving racism, sexism or homophobia could be classified as either big “T” or little “t” traumas depending on the severity. These traumas might involve one or two distinct incidents, or be more complex, ongoing experiences. The result is a primary belief that the world is not safe. In some cases, individuals who are traumatized learn to expect pain, dishonesty and betrayal from the people they love the most.

In the case of clients with addiction, even if they have not experienced trauma prior to the onset of their disease, they most likely have experienced violence, rage, betrayal, abuse (sexual, physical or emotional), incarceration, homelessness or a whole host of other negative experiences while using alcohol or other drugs.

There are two clinically appropriate strategies for treating posttraumatic stress disorder (PTSD) with people in substance abuse recovery. One strategy is to address the trauma or abuse immediately as the client enters the beginning stages of recovery. The other is to wait until the client’s ability to achieve and maintain abstinence has stabilized.

How do we know which strategy will be successful? Ultimately, the client is the one who knows. If the ability to maintain abstinence from alcohol or other drugs is precarious or impaired due to memories, suicidal ideation or self-harm, it is essential to treat the cause of these symptoms from the beginning. For these clients, recovery will likely remain elusive until their trauma is addressed. If the client is relatively stable, however, waiting until the later stages of recovery is indicated. Clients who are pressured into addressing their trauma issues before they are ready are likely to relapse into active addiction.

According to recent brain research described in Uri Bergmann’s 2012 book Neurobiological Foundations for EMDR Practice, when someone experiences an event or multiple events that cause intense fear, it can change the neural pathways, or maps, in the brain. Whenever something is experienced as a reminder of the trauma, clients can relive that trauma, making them afraid of certain places, tones of voice, objects or even other people with certain body types. Smells can also trigger intense anxiety and fear. The repetitive experience of anxiety and fear can result in panic attacks, health problems, chronic pain, sleeping difficulties and eating difficulties. The individual eventually becomes self-centered, focusing so much on self-protection that there is little objectivity or ability to have empathy for others. This makes every relationship unstable.

eyeThe good news is that several proven therapeutic techniques, including eye movement desensitization and reprocessing (EMDR), can alleviate symptoms stemming from past traumas. EMDR uses the mechanism by which information from frightening and horrifying events is processed into memory and stored in the brain. By manipulating the brain’s intrinsic information processing scheme, a practitioner can help clients release themselves from the intense hold those memories have on them. EMDR combines sensory bilateral stimulation (visual, auditory or physical sensations) with emotional memory and the underlying belief system to lessen the intensity of the experience. It does not erase the memory, but it can reduce or alleviate many of the associated symptoms.

The mystery of EMDR

It is not known precisely how EMDR works, but various research studies have verified its effectiveness in the treatment of trauma. Twenty-four randomized controlled (and 12 nonrandomized) studies have been conducted on EMDR. Most of these studies address simple rather than complex trauma. For a list of these studies, visit the EMDR Institute website at emdr.com and click on the “Research Overview” link under the General Information tab.

In developing EMDR, Francine Shapiro postulated that PTSD is caused by a disruption in the adaptive information processing system. Because the fear and helplessness experienced by clients stays attached to the memory of the traumatic event, it creates havoc in their lives. It is as if the trauma is continuing to happen to them. Because it is still occurring neurologically, it cannot be processed as a memory.

EMDR changes the configuration of the neural connections or map of that event, detaching the dysfunctional physiological and emotional components so that it becomes a more manageable memory. This helps the client “let go” of the past because the neurons are literally letting go of some connections and replacing them with new ones.

In my experience, EMDR is the fastest, most effective and least intrusive way to help clients release trauma, regardless of whether it stems from childhood abuse, sexual abuse or assault, accidents, disasters or combat, and regardless of whether it is the result of a single event or multiple experiences. I have also seen EMDR reduce or eliminate chronic pain, headaches, fibromyalgia and cravings for alcohol and other drugs. One of the best things about EMDR is that it doesn’t require clients to retell their horror stories. In my view, when people don’t have words to describe what they are experiencing, don’t remember the original incident, have somaticized their pain or are too emotionally raw to put the experience into words, it is essential to offer treatment that does not require verbalization.

 

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The eight phases

To practice EMDR, a clinician must have a master’s degree, counseling experience and the proper EMDR training. Although the process may seem simple to an outside observer, it requires both an understanding of how the brain and emotions work with trauma and a specific protocol. As shown in the table below, there are eight phases of treatment.

We’ll use “Carrie” to highlight how each phase of the EMDR treatment protocol might be carried out with a client.

  • History taking and treatment planning (Phase 1): This is used in most counseling therapies. The therapist and client review biopsychosocial history and trauma history, assess client resources and strengths and determine the frequency and level of any dissociation symptoms. The therapist will suggest different targets and strength-building skills depending on the overall emotional stability of the individual.

“Carrie” comes to the clinic requesting help with night terrors and anxiety. While obtaining her background history, it becomes clear she has survived many traumatic events, has few financial or social resources and is currently separated from her abusive husband. She smokes cigarettes, uses marijuana, uses some mindfulness tools and practices breathing techniques to manage her distress and anxiety. The therapist determines it is essential to improve her emotion regulation and distress tolerance skills, along with targeting various symptoms such as her recurring nightmare.

  • Preparation (Phase 2): The therapist explains the adaptive information processing system and how trauma disrupts it. The mechanics of treatment are reviewed. Emphasis is placed on clients nonjudgmentally observing their reactions and awareness, and communicating those observations to the therapist. Rapport is established. Relaxation and self-soothing techniques are taught and practiced.

In Carrie’s case, she is able to best understand the adaptive information processing system with the help of a simple illustration the therapist draws to engage her in the therapeutic relationship. The therapist says, “I will show you exactly what the technique looks like. We can use eye movements, sounds using headphones, or I can tap the back of your hands. Which feels most comfortable to you?” When Carrie chooses eye movements, they arrange the chairs so Carrie and the therapist are facing each other. The therapist holds a pen in front of Carrie and asks, “Is that comfortable? Do I need to change the distance or the pen I’m using? What I will do is wave my pen back and forth, and you follow it with just your eyes.” The therapist does this, and Carrie follows the pen easily.

  • Assessment (Phase 3): The client and the therapist determine exactly what the target is, including any images, physical sensations or memories that are associated with the emotionally loaded material. They rate the intensity of the feelings that are attached using the Subjective Units of Distress Scale (SUDS). An “irrational belief” (as defined by Albert Ellis) is identified by the client as the negative cognition. The client chooses a more reasonable belief to use as the positive cognition and rates the perceived validity of this statement.

In Carrie’s case, she remembers parts of her dream: She is in a dangerous situation with people looking for her; she crawls through a hole in a wall to discover she is in a bunker with gunfire all around her. She rates the fear she feels as she recalls the nightmare at a SUDS score of 9. She identifies her belief when these feelings come up as, “I am never safe.” The therapist asks her what she would rather believe.

Carrie responds, “That I am safe, I guess.”

“Are you safe?” the therapist asks.

“No, not always,” Carrie says.

“But sometimes you are safe.”

“Yes, sometimes I am safe.”

The positive cognition becomes “I can be safe.”

The therapist asks, “How true does that statement feel right now?”

Carrie rates it on a Validity of Cognition (VOC) scale as a 1, indicating it feels “like a lie.”

  • Desensitization (Phase 4): The cognition, the emotion and body awareness are combined with bilateral stimulation. The therapist changes the bilateral stimulation speed with eye movement, tapping and sounds throughout and between sets. A set is composed of a series of bilateral stimulations. For example, moving the eyes back and forth 10 times would represent a set. The therapist varies the length of a set depending on the intensity of the material the client is experiencing. In between sets, the therapist determines that the process should continue by asking the client if he or she is noticing any changes. This pattern continues until the client reports no change between sets and the SUDS score has been reduced to a 0 or 1.

For example, the therapist tells Carrie, “Bring up that memory, crawling through the hole and being in the bunker. Remember the sounds and smells. Notice how your body feels. Allow the thought, ‘I am never safe,’ to float in your mind. Do not try to direct your thoughts. Let your mind wander. Wherever it goes is where it’s supposed to go.”

Carrie watches the therapist move the pen back and forth, causing her eyes to move from left to right rhythmically. After a set of 10 eye movements, the therapist stops and says, “Take a deep breath. Tell me what you are noticing right now.”

The therapist makes a note of Carrie’s response and starts another series of bilateral stimulations. The process continues until Carrie reports several times that she feels “nothing.” When recalling her nightmare, her SUDS score is 0.

  • Installation (Phase 5): The positive cognition is strengthened for the client. The bilateral stimulation is used as the client thinks of the positive cognition. The sets are shorter and slower to allow the positive experience to establish itself. The VOC is measured again until a score of 6 or 7 (“completely true”) results.
  • Body scan (Phase 6): The therapist asks the client to pay attention to the way her body feels from head to toe (or vice versa) and report it.

Carrie notices some trembling in her hands. The therapist uses more sets of eye movements until the trembling ceases.

  • Closure (Phase 7): The therapist ensures clients are safe to leave the session and navigate their way to their next destination. They are guided through self-calming rituals. The therapist explains that the client may feel spacey or very tired for anywhere from one hour up to a few days. Clients are given an assignment to journal their experiences, emotions, thoughts and dreams until the next session.
  • Reassessment (Phase 8): This phase occurs at the beginning of the following session. The targeted material is recalled and the client’s SUDS score is determined. The VOC of the positive cognition is also reevaluated. Any residual processing that occurred between sessions is discussed. If there is a change in either the SUDS or VOC score, it indicates there are more aspects of the target to process.

At Carrie’s next session, she reports the nightmare has not returned. When she remembers it, her SUDS score is 1. The positive cognition, “I can be safe,” is rated at a VOC of 7 (“completely true”).

Conclusion

When I work with a client, I keep meticulous notes about the intensity of the individual’s negative emotions and the perceived validity of the positive cognitions before and after a treatment. I keep this record partly so that I can review it with the client in the future. Many times, the client possesses no memory of having the original problems and emotions. The client still remembers the traumatic incident and has feelings about it, but the incident does not haunt the client any longer.

My experience of utilizing EMDR with clients has been no less than amazing. I continue to be surprised at its effectiveness addressing a number of concerns. It works relatively quickly, and its results are maintained. After the initial setup, it relies on clients’ own processing and therefore validates their experience completely. With EMDR, there is also a shorter period of intense unpleasant emotion that clients experience than with other talk or exposure therapies. It engages the parasympathetic nervous system, leading to relaxation or drowsiness when the process is complete.

Whether EMDR is used at the beginning of addiction recovery or after a period of abstinence, clients are able to manage their recovery more easily and more successfully when PTSD symptoms are alleviated.

 

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Jeanne L. Meyer, a licensed mental health counselor, licensed professional counselor and master addictions counselor, is a co-occurring therapist with Choices Counseling in Vancouver, Washington. She is also a member of the American Counseling Association Trauma Interest Network. Contact her at jmeyer@ChoicesCounseling.org.

 

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