When a Low SUDs May Not Be Ecological

The full text of this episode is available on the EMDR Podcast here: https://emdrpodcast.com/2023/12/13/lettingthingsgo/ The script for the videotape approach mentioned in the podcast is here: https://emdrthirdweekend.com/posts/videotape-approach-script-with-complex-trauma-phases-three-and-four

A child's toy metaphor for the need to adjust your interventions to the nervous system you are working with.

When a SUDS of One, Two, or Three May Not be Ecological You are technically correct, quoting Dr. Shapiro in EMDR Therapy when you say that a SUDs of one can be ecological if it “sounds right.” Shapiro's example of an Uncle who died. Shapiro worked with really healthy people and what’s in a one with her clients may be different than what’s in a one or a two with clients with really complex trauma. With really healthy people, you can go to installation if the SUDs is a one if it “sounds right” and the debris will likely get cleared up in Phases Five and Six. You may be tempted to say that because I’m working with a complex client, a two is pretty good. Especially if we are starting at an eight to ten SUDs. And it is. Yes, we don’t want to make the perfect the enemy of the good. However, a lot can be hiding in that one or two with a client with complex trauma. If I had $5 every time the client said that the SUDs was a one, two, or three and it wasn’t going to go lower and it immediately went lower once they noticed it, I’d be able to go on a nice vacation. Out of the country. It’s simply good practice to identify what makes it that one, two, or three and ask the client to notice it a few rounds. And you know what happens, 97%+ of the time? It goes lower within a few sets of the client saying that it isn’t going to go lower. And yes, there are ways to do this respectfully what the client says to you, but also lets them fully and adaptively resolve that memory. Really good things happen when clients fully and adaptive resolve memories. Generalization occurs. Installation isn’t junky. Body scan isn’t leaving debris. A one or a two may also be an ember that may ignite other things between sessions. Don’t want to run the marathon and then sit in the lawn chair within sight of the finish line. If we can, finish it. Get your time. Get that race in the books. Whatever it is that makes it a one, two, or three, or whatever it is that makes the Validity of Cognition a five or six, notice that and it is highly to movie in a positive direction… unless it’s about something in the future or about other things from the past. That’s not your target. We’re in the business of resolving memories, not whole themes all at once and we don’t work in the past and the future at the same time. We have the future prong and future template for that. What is it that makes it a two? Notice that. If it doesn’t go lower, that’s okay. But it’s also okay to notice whatever that two is a few rounds before you assume that it’s good enough for this client on this day.

You May Do the Least Reprocessing with the Clients Who Need it the Most

Full text of this episode is at: https://emdrpodcast.com/2023/11/29/parts-work-is-central-to-emdr-therapy/

• The Impulse to Want to Avoid Causing Harm • Working with Trauma is Like Working with Lava • Confessions about Difficult Sessions • Most Basic Training Programs Can’t Train You to Work Effectively with Severely Complex Trauma in EMDR, You Will Need to Learn the Nuances of this On Your Own, But There is an Enormous Amount of Help Out There • Normalizing Mistakes and Missteps • The Real Risks of Not Doing Trauma Work with Clients • We are the Only Professionals on the Planet that Can Do This… Whose Job it is to Do This • It’s Like Everything Else… You Learn to Do This by Doing This • The Really Good News About EMDR Therapy: It Breaks in a Very Limited Number of Places • When Clients Struggle, There is Information in that Struggle • You can Dip Your Toe into Every Phase of EMDR Therapy • You will Develop More Trust in the Process • You will Get Better at Intuiting when the Client is Stuck and Strategically and Effectively Intervening • Not Everyone is Prepared to Do EMDR Therapy Right Now: We Can Help them Prepare

There is so much to say here. Broad overview. Each point could easily be a chapter. Very little of this is mine, the metaphors are mine, but this is a collection ways of seeing that are helpful for me in understanding where clients get stuck in reprocessing, why, and what might be helpful in getting them unstuck, and what we subsequently do with that information. When clients encounter difficulties in any phase of EMDR Therapy, that isn’t failure and it isn’t evidence that you have done something wrong. It’s important information about the client’s nervous system and means of survival. That information needs to come so that we can use the lessons in it in the service of the client’s recovery. We train you to stay out of the way, but if a client is stuck, your obligation is to try to help them get unstuck. EMDR Therapy with a client with complex trauma is a complicated task. We’ll explore some of the reasons why and how you might intervene when someone is struggling. How do you know when someone is stuck when they have really complex trauma? Sometimes it is ambiguous. Because they are often connecting something big with a small amount of adaptive information, the metabolization can be slow. Questions to ask. Clients can be stuck in high anxiety near panic that won’t shift, clients can be stuck in a shutdown response (100 amp breaker), they can be stuck in the big existential loneliness of childhood (particularly if working on an attachment wound), they can be stuck trying to figure something out that is existential, or they can be stuck noticing on channels that just aren’t productive right now (thoughts, memory, etc), where things aren’t moving and shifting and changing. Defining looping. When someone is stuck, they are probably stuck in a perspective. Office shortcut metaphor. Interweaves help clients change their perspective. Ideally, when we intervene, our interventions should match where the client is stuck. We shouldn’t just randomly throw something out. Car metaphor. They are not sure what their role in this dance is. Blocking beliefs. Hopefully, you will pick up on these in your Phase Two. Phase Two is the canary in the coal mine for blocking beliefs. What is a blocking belief and why is it a problem? Too big of a target too soon. The target memory is an attachment wound. Why attachment wounds are about everything. What might you do. Long resonance after sessions is common when not working with attachment resources. If the core of EMDR Therapy is activate a piece of difficult stuck information, notice what comes, while the brain gets a left-right stimulation, let’s evaluate potential stuck places. Activate: Are they activating in ways that are tolerable? Is the activation from the memory or from an agenda? Are they allowing too much memory content to connect too soon. We need memory content to come, but we need it to come at digestible rates. Notice. Noticing is the bright yellow line in the center of the EMDR road. Is the client noticing? Does the client know how to notice? We may need to be very clear about what noticing means. The difference between being aware and noticing clearly. Left-Right Stimulation. Always a possibility that switching bilateral may be helpful. Stuck in guilt, shame, blame, or responsibility. Appropriate and not developmentally appropriate types. Assessing for adaptive information, clues in Phase Three. How is your relationship with your client? The relationship is a key component in what is effective in EMDR Therapy. How is your client’s parts relationship with you and your parts? Did you ask consent to work on this memory, attempt to address concerns, and listen to a concerned part when that part has an agenda different than yours? If you didn’t, their parts are likely already aware of this quality in you. Working with a system always easier than pretending that you are not working with a system.

Many new EMDR therapists misunderstand where the magic is in EMDR Therapy. Trainings and training practicum experiences often send the impression that simply following the script is likely to result in memory resolution with the vast majority of clients. EMDR can be seen as a kind of magic wand that allows us to go up to almost any person and “dink” their memory. Some trainees may be left with the impression that most of the magic in EMDR Therapy is in the bilateral alone. While this is a key part, I describe it elsewhere as one of the three wheels of the EMDR tricycle. It takes all three wheels. Otherwise drummers would be the healthiest people on the planet. And, they are not. EMDR Therapy is a combination of activation, noticing, and left-right stimulation, but what is happening in EMDR is perfectly described in the Adaptive Information Processing model. This combination of elements helps connect old stuck information into right-now existing adaptive information… if you have enough of it. And Shapiro is very clear that if you do not have enough of the needed adaptive information for the target that you are connected to, there is nothing in the Eight-Phase Protocol that is going to generate the missing information. I have used the metaphor of a boat fishing in an ocean. The boat is the needed adaptive information and the fish you are hooked onto is the memory. You can’t land a bigger fish than your boat. You don’t simply get a bigger boat because you are hooked to a big fish. You have the boat you launched with today. Again, the magic of EMDR Therapy is that you can metabolize almost any old stuck information into existing adaptive information and we do this by using the Eight-Phase Protocol. Inside that understanding contains the logic and the worldview to account for when this therapy doesn’t work. Many of the episodes in this podcast focus on this core understanding of the Adaptive Information Processing model. It explains almost everything beautiful in working with clients who have adaptive information the size of a cruise ship and almost everything challenging in working with clients whose adaptive information is the size of a leaky intertube. This understanding explains why parts work is an important element in what we do as trauma therapists. It explains why we need to support adaptive information about what it means to have been born human. And, why our resources need to involve more than a few core mindfulness skills when working with clients with pervasively traumatized nervous systems. This understanding is the foundation, I think, to doing EMDR Therapy really well with clients with complex trauma—who have been saturated with the tasks of surviving, rather than bumping against the world and learning who they are, what they’re worth, and how they deserve to be treated.

A shocking amount of talk online about EMDR and grief goes against everything we know about both. This episode highlights effective ways to use EMDR with grief-saturated targets.

In EMDR Therapy, the pathway for healing is that stuck information has to connect to right now adaptive information.  The process that facilitates that linkage is the Eight Phase Protocol. You can connect almost any old and stuck maladaptive information into right now existing adaptive information. But, a lot of what we know about complex trauma is that clients lack adaptive information.  They were too busy surviving to figure out who they are, what they value, how the deserve to be treated… and they need enough of it for the difficult stuff to connect to. The Boat and the Whale Metaphor The boat is the amount of the needed adaptive information that is have accessible right now.  The fish that you want to hook and land is the trauma.  You cannot land a fish bigger than your boat.  However, you can get a bigger boat by catching smaller fish.  You can also build a bigger boat through developing relationships—including the therapeutic relationship, through parts work, through resourcing, by expanding the window of tolerance, through psychoeducation [particularly psychoeducation about what it means to be born human], and through a wide assortment of other means. Implications of this metaphor: If we can only land what we have space in boat to fit, we should consider both the size of the memory (as best we and the client can intuit) and the amount of accessible adaptive information. If we have adaptive information the size of a canoe and this is the first time we are in the ocean, we should consider testing the gear before we go trying to hook whales.  It is really easy to capsize in a canoe. Developmental trauma targets, targets about identity, and targets where we’re the abuser in the memory tend to be the whales of memory, particularly when we’re first starting. If the client has a small boat, we will be lucky to land whatever we hook... even if we are trying to catch something small.  If the client is already connected to a mid-size shark, does it make sense to also hook onto multiple whales and multiple other sharks?  Again, our boat size does not change based on what we hook onto.  The boat size we launch with is the boat we have.  Clients overheat on the memory channel in EMDR when too much memory content is coming into awareness or when that content is coming in at an intensity beyond our capacity to metabolize through noticing.  EMDR Therapy was not particularly developed for complex trauma.  It was developed using people who have adaptive information the size of cruise ships.  And how did they get that cruise ship?  By life Phase Two resourcing them really well.  If you have adaptive information the size of a cruse ship, I know that you can hook and land almost every fish in your ocean.  That’s the privilege of the non-pervasively traumatized… your ocean is not filled with monsters.  People in canoes… their oceans are filled massive monsters.  Finding something small enough to land in your existing boat with complex trauma can be a challenge. The Mount Everest Metaphor Shapiro says that if we tackle the mountains of memory first, everything after that will feel like a small hill.  And, she is right if you have adaptive information the size of mountains.  Again, clients with complex trauma have very little adaptive information.  You cannot metabolize a trauma the size of Mount Everest into adaptive information the size of a walnut.  You simply can’t do it. Also, if you’re not an Olympian, Mount Everest is a terrible place to start.  The are over 200 dead bodies on Mount Everest right now because it’s too dangerous to remove them.  And, if you need to tackle Mount Everest, you had better tackle some smaller hills then some smaller mountains first. To be fair, Shapiro acknowledges that with complex trauma we do want to work with smaller and more recent memories first, but many people graduating from EMDR foundational trainings misunderstand the nature of the magic that is EMDR.