emdr renewal...and beyond day two

1. emdr renewal...and beyondday two • with Andrew Seubert, LPC, NCC • ClearPath Healing Arts Center, Mansfield, PA • www.clearpathhealingarts.com • email: seuberta@mac.com

2. today’s goals • Review Day 1: questions and cases • Authentic identity: our ultimate clinical goal • Extending EMDRwithin a phase model • Ego state work • Attachment repair • Cases

3. From Dr. Seuss Today you are you, This is truer than true. There is no one alive Who is you-er than you.

4. T H E W O R L D x x x x x x x x False fronts Identitites Frozen images Roles

5. Walt whitman From this hour I ordain myself loss’d of limits and imaginary lines.

6. dissociation

7. what lies beneath • In the face of trauma, protective avoidance is the need and dissociative strategies are the mechanisms of achieving that protection • Ego states as dissociative strategies • A part or state of consciousness - especially when there is an obvious and entrenched mind/body/emotion split. • The ego state both contains and protects against the dissociated pain

8. Trauma and Dissociation • New definition of “trauma” • The “wall”, pain cannot be digested • A “part” is born - state of consciousness • Purpose: protection against pain and survival • Looking with part-ial vision - narrow focus of awareness

9. preparation - Ego states • Gestalt Polarity work: Perls, et al • Ego State Therapy: Watkins and Watkins • Healing the Heart of Trauma and Dissociation: Forgash and Copeley. • Internal Family Systems: Richard Schwartz • The Haunted Self: Van der Hart, Nijenhuis, & Steele • Feeding your Demons: Tsultrim Allione

10. Internal family systems • The Self - • Exiles - carry the dissociated pain • Managers - cope with emotions • Firefighters - emergency preservation of dissociative barriers

11. Structural Dissociation • Primary dissociaton: ANP separated from EP (PTSD) • Secondary dissociation: EPs (defensive action system) split (DDNOS) • Tertiary dissociation: ANP splits (DID)

12. Dissociative Continuum Ego States Spacing Out DID DDNOS

13. Ego States • The states in the union - normative flow • The part takes over the whole • Forgetting who you really BE - lost identity. Lost Self. • Ego state becomes the new identity • Avoids pain, creates suffering

14. ED Parts Work/Tasks • Make contact with source of ED • Understand that part • Appreciate its purpose • Educate - old strategies no longer working; ED education; space/time orientation • Collaborate in giving a new job description • Find and support healthier parts - trauma treatment

15. What now? Adult CSS Ego States HP

16. Contact • You can’t change what you don’t know • What you ignore, avoid or cave in to will eventually control you. • The conference table • Spontaneous contact with parts: the “easy flow” approach

17. ego state basics • To recognize and dialogue with “parts” • To discover the purpose, desires and common pain of each part - becoming known. Understanding leads to compassion. • To create common goals: new job descriptions. Avoid making ES the enemy. Therapeutic relationship needs to become more important. • To create collaboration that will move client towards desired goals, including trauma resolution.

18. Educate • Education of the stuck part: trauma-informed • Through the eyes of the beholder: “we see the world (and ourselves)not as it is, but as we are.” All-or-nothing thinking. • Education takes place within the relevant ego state

19. conference room experience • Choose a repeated negative reaction to a person or situation. Negative thoughts about self? Feelings? Body sensations? • Tune in to your breathing • Imagine an internal conference room. Notice details. • Invite the part(s) of you that are involved with that negative reaction into the room.

20. experience - 2 • Ask: Do you know who I am? How old are you? What is your purpose? What do you want me to understand about you? • Thank that part for showing up. Perhaps tell him/her what she needs to hear from a loving adult. Express your intention to keep in touch, if that fits for you. • Ask that part to leave and bring yourself back from the experience.

21. attachment injury and repair

22. Attachment repair • Re-parenting - supplying the missing pieces. As adult self, reparenting when attachment injury leads to absence of adaptive skills and self-acceptance needed for processing. • core self, nurturer, protector (S.J. Schmidt), • Life Span Integration (P. Pace) - moving forward in time • Imaginal Nurturing - April Steele • Self development required to manage trauma work

23. attachment strategies • Attachment history required. Can’t repair what you don’t understand • Contacting younger aspects of Self via conference room, body or emotional clues, memories, photos to determine what is missing, needed. • Bring adult capacities and other resources back in time to younger part. It begins with recognitionand rescue (R&R). • Bring younger part forward in time - bridging

24. Attachment experience • Find a memory from childhood which still impacts on you negatively - hurt, sadness, anger, guilt, shame • Decide what the child you once were needed to hear and/or needed to experience (words, a hug, eye contact, etc) • Go back in time and visit that child in the painful situation • Introduce yourself and deliver what the child needed at the time. Possibly become the child and take in what was just said (therapist can summarize what client just said to the child). • Ask if it is okay to bring the child forward to present time. Bring the child to present place or resource place. • Visit with that child each day.

25. the unforgiven

26. Trauma Processing - phases within a phase • Ego State attention and attachment repair continue • Present - immediate need to take the edge off • PAST: trauma history, especially related to ED • PRESENT: triggers, conditioned situations, body image • FUTURE: templates of positive behaviors • FUTURE: potential places of relapse

27. Healthy Parts case study - S.G. • 5 - sexual abuse on father’s lap • High SUDs and nausea • Develop nurturer, protector, spiritual self • Support child in having a voice in past time • Bring child to resource place in present time • Next session: nausea and sadness at 2/3 • EMDR - sadness at ecological 1/2 • Sadness over my leaving for a month • PC - “I’m innocent and strong” at 7 twice. Body scan clear.

28. adjustments/interweaves • Titrating or “fractionating” the memory • Pendulating (Levine) from negative to positive • Return to attachment/reparenting work, during and after phases 3-6, as a form of titrating or "pendulating" the traumata (more use of resources) • Check with ego states before processing

29. B.A. Status • No longer in treatment • Will mostly likely experience some struggle with ED • Only needing occasional visits to Nutrition Clinic • New identity - “I have a voice”

30. The case from hell....orshoot me now....orwhat i learned....

31. What’s going on? • Who is putting up the wall? • The adolescent who also holds pain • Obsessive thinking begins to rule • Maintains eating plan, but constant anxiety and shame • Attempts to take edge off of feeling states fail • Stops medication, uses nutriceuticals. Reinstates cymbalta.

32. Ed and Hardwiring • “There’s one thing you have to know about me!” • Confluence of ego states and adult • Using the back door: “Can you have the fear of fat and still work on lessening some of the old pain?” • The need for healing attachment injury. NC: not good enough/a burden

33. Attachment revisited • Obsessive thinking all controlling. No healthy parts. • Clinical hypothesizing: where did the inability to tolerate teasing begin? Where was the Self? • Traumaphor: relationship with food reminiscent of relationship with father - need for control • Where was mother? More details surface.

34. Jb’s attachment history • One older sister born in Germany • JB born in USA, mother depressed during and after pregnancy, and didn’t want to give birth in USA. Got milk? • Fear of upsetting mother further: “burden” • Fear of triggering father’s unpredictable outbursts and his anxious controlling • No one to talk to. No one who got her. • Sister becomes surrogate mother - and teases JB

35. the “mother lode”sins of omission

36. JB - Work in Progress • In reparenting her infant self, very strong affect • Goal: to strengthen sense of internal support to prepare for dealing with impact of teasing

37. JB - Progress • Re-parent her newborn (NB) self - strong, continuous affect (two weeks). Need for “homework” • Re-parent nursing infant (“not as bad”) • Obsessive negative thoughts - overwhelming • Agrees to increase cymbalta • Can therapy help? Renew goals: attachment injury and quieting physiological hyperarousal (anxiety and shame) when her weight or body comp changes

38. JB - Progress II • Triggers of hyperarousal: eating, using a scale, looking at body in a mirror. • Avoids the challenges of changing those behaviors • After several weeks, reintroduces cymbalta, stops using the scale and reduces the mirror checks.

39. JB - Progress III • Obsessive thoughts less - meds? busyness? • Checks New Born (NB) and infant. “Not allowed to hold her (NB).” • Conference room: “7” - recalls father’s protective anxiety, always doubts self, second-guesses • Re-parent “7” - support her needs/wants; the adult will hold NB and show “7” how. • “7” stays in safe bedroom with NB and infant. Client is “okay for today” with “7”

40. Whereto from here? • After reparenting... • Target: the story of her birth and how her mother had no milk/patience for her • Target: father’s disempowering and anxiety provoking protectiveness • Being teased @ 7 • Other trauma, including eating disorder events

41. JB - Progress iv • Infant needs the attention • 7 feels left out. JB holds her. Strong emotion - sadness • Parts in room. Grief processed first with EMs, then taps. Theme: I’m not important, don’t matter. • JB decides, “Enough for today”. Conscious choice. • Closure by returning parts to bedroom • Remaining sadness reduces from 5 to 2 with LIDS

42. “the Father Lode”Internalizing and separating from father

43. summary • Primacy of relationship and goals that are meaningful to the client • Assume the presence of dissociaton • Ego State approach required • Attachment repair typically needed - reparenting • The importance of a trauma-informed approach

44. the case of mistaken identity

45. T.S. Eliot “We shall not cease from exploration, and the end of all our exploring will be to arrive where we started and know the place for the first time.”

46. the journey home • True identity was lost in a multi-dimensional experience, so it must be regained. • Got hope? • The “desert” experience - leaving home • Good religion and good therapy similar. Both require relationship, guidance, resources and a leap of faith

47. Tools for the journey home • Awareness - the master skill • Listening to our emotional guidance system • Resource and skill building • Ego State Work - working with dissociated states • Short-term successes, passion pursuits (Ira Sacker) • Building up and tearing down - trauma-informed treatment • Experiential therapies: EMDR, creative art therapies, body movement

48. finding home for the first time • As human beings, we must progress from Being, then to doing and having. From the inside out... • The challenge and the reward of freeing oneself from the tyranny of ED is transformation through the reclaiming of who we most truly BE. • The payoff is a fully lived life, filled with connectedness. This is the psychospiritual border. • It is time to stand for who we truly are.

49. love after love - derek walcott The time will come when, with elation, you will greet yourself arriving at your own door, in your own mirror, and each will smile at the other’s welcome, and say, sit here. Eat. You will love again the stranger who was yourself. Give wine. Give bread. Give back your heart to itself, to the stranger who has loved you all your life, whom you ignored for another, who knows you by heart. Take down the love letters from the bookshelf, the photographs, the desperate notes, peel your own image from the mirror. Sit. Feast on your life.

50. Homecoming Today I am me, This is so clear to see. There is no one alive Who is me-er than me.