Blind to therapist (B2T) EMDR Protocol

1. Blind to therapist (B2T) EMDR Protocol Blore & Holmshaw 2009a; b

2. Some uses for the B2T • Clients wishing to maintain or reassert control (e.g. Thompson 1981 Blore 1997, 2005; Blore & Holmshaw 2009b) • Clients experiencing acute embarrassment or shame (Blore & Holmshaw 2009b) • Where there is a risk of vicarious traumatisation of the therapist • In translator-situations where the client is reluctant to divulge material because of fear of real or imagined retaliation ‘back home’ • MoD clients wishing to preserve ‘confidentiality’ and thus not compromise adherence to the Official Secrets Act • Clients with serious speech impediments that may result in stalling the flow of processing

3. Underpinning of B2T • B2T provides a client-centred solution to problems largely of behavioural avoidance • B2T facilitates compliance by ‘meeting the client half way’ • B2T facilitates therapist’s adherence to client-centred work

4. B2T • Phase 1 • Identify non-disclosure as an issue during suitability assessment/ history-taking • Explanation that treatment will not suffer if material cannot be disclosed • Phase 2 • Coach client to recognise change, using simple descriptions • Simple descriptions may need further explanation: • ‘leading’ the client or setting expectations? • Subtlety of change metaphor

5. B2T • Phase 3 • Negotiate a cue word to refer to target image • Check that image is static • If not static then ‘freeze frame’ at most distressing point • Make no attempt to obtain NC, PC or take VoC • Phase 4 • Commence first set: • Notice (cue word) • Notice emotion • Notice where the emotion is located • Process as normal but feedback only ‘change’ or ‘no change’

6. B2T • Phase 4 (cont) • If no change, distinguish between end of channel of association and blocking/looping: • Ask “is (cue word) distressing neutral or positive” (as an experience) • If distressing then assume blocked/ looping • If neutral/positive then two consecutive instances assume end of channel of association > return to (cue word) • If assumed blocked/ looping then: • Use basic strategies (change speed direction modality of BLS). If these don’t work then go to visual interweaves: • ‘morphing’/ stretching image, or two image strategy • Keep repeating until ‘change’ indicated

7. B2T • Phase 4 (cont) • Disclosure may never occur. Disclosure not needed for resolution • If disclosure occurs continue with the standard protocol • PCs tend to emerge spontaneously – don’t ‘make’ PCs happen! • Never attempt to identify a NC retrospectively particularly if obvious from an emerging PC • Phase 4 complete when SUDs = 0 • Phase 5 • Install PCs that have emerged • If still no PC go to body scan (phase 6) • Phase 6 • If no phase 5 then be prepared for further dysfunction material to arise and then return to phase 4 (B2T version)

8. B2T • Phase 7 • Be aware that the incomplete protocol for the B2T protocol may differ considerably from normal • If SUDS not 0 treat as a normal incomplete session and allow extra time for phase 7 • If no PC emerges and/or body scan can’t be completed then treat this as an incomplete session to • Two ‘yeses rule’: • Yes client safe to leave clinic • Yes, client has required resources AND will use them between now and next session • Phase 8 • Reassess as usual, don’t forget cue words if disclosure hasn’t occurred