Table of Contents
Foreword xiii
Preface-Stepping Up to the Plate xix
Acknowledgments xxiii
1 Who's Sitting Opposite You? 1
The Therapeutic Relationship-Back to Basics 1
What Does the Client Need? 3
Secondary Gain 5
Dissociative Disorders 5
Cautions 6
Legal Issues 6
Pre-EMDR Questionnaire 8
Case Study: Introducing Emma 10
Is EMDR Suitable for the Client? 13
Impact of the Past 13
The Top Ten 13
Creative Exploration 14
Assessment Tools 17
Presenting Problems 19
Goals for the Future 19
Treatment Plan 22
Frequently Asked Questions 23
Learning Summary 25
Resources 25
1.1 Carl Roger's Core Conditions 25
1.2 Suicide Ideation and Intent 26
1.3 Brief Suicide Counseling Process 28
1.4 Mapping Exercise 29
1.5 Identifying Symptomatology Using the Film Script 30
2 Fail to Plan-Plan to Fail 33
Identifying and Practicing Appropriate Coping Mechanisms 33
Hyperarousal 35
Hypervigilance 35
Staying Grounded 38
Safe Place 39
Explaining EMDR Theory 39
EMDR in Simple Terms 42
How Much Preparation Is Enough? 45
Frequently Asked Questions 51
Learning Summary 52
Resources 52
2.1 Mental Mobilization 52
2.2 Levels of Arousal 53
2.3 Informed Consent Form 54
3 Complex Trauma and the Need for Extended Preparation 57
Complex Trauma 58
Challenges to the Therapeutic Alliance 60
Difficulties Regulating Emotions and Impulses 61
Alterations in Self-Perception 61
Somatization 62
Alterations in Perception of the Perpetrator 62
Alterations in Relations With Others 63
Alterations in Systems of Meaning 63
Resource Building for More Complex Trauma 63
Methods 63
Resource Building 66
Other Strategies 67
Manipulating Images and Movies 67
Working With Clients Who Dissociate 69
Dissociative Disorders 70
Identifying Dissociative Disorders 72
Frequently Asked Questions 73
Learning Summary 74
Resources 74
3.1 Script for a Guided Visualization 74
3.2 The Rewind Technique 76
4 From the General to the Specific-Selecting the Target Memory 79
A Belief by Any Other Name 80
Finding the Root of the Problem 82
Pressure Cooker 83
Gardening 83
Pyramid 83
Preparing for Desensitization 84
Choice of Dual Attention Stimulus 84
Stop Signal 86
Providing Clear Instructions 87
Metaphors for Managing High Affect 90
Negative Cognitions and the Target Memory 91
Floatback 93
Completing the Baseline Assessment 96
Image 96
Positive Cognition 98
Validity of Cognition Self-Report Scale 100
Emotions 101
Subjective Units of Disturbance Scale 101
Physical Sensations 103
Does It All Fit Together? 103
Working With Different Levels of Awareness and Articulation 104
Frequently Asked Questions 106
Learning Summary 107
Resources 107
4.1 Example Script 107
5 Opening Pandora's Box 109
Therapist Anxiety 109
Desensitization 111
Abreactions 113
Blocked Processing 117
Cognitive Interweaves 120
Frequently Asked Questions 124
Learning Summary 126
Resources 126
5.1 Working With Guilt 126
6 Moving Out of dark Places 129
Installation 129
Body scan 130
Closure 132
Reevaluation 137
Symptoms 137
Changes 138
Surfacing Material 139
Treatment Plan 139
Frequently Asked Questions 144
Learning Summary 145
Resources 145
6.1 Information Sheet for Clients: What You MAY Experience After an EMDR Session 145
6.2 Example Log 147
7 You Matter Too! 149
Catherine's Story (Part 1) 150
Helper's Response to Working With Trauma 150
Situational Factors in the Development of Secondary Trauma 154
The Nature and Intensity of Workload 154
Poor Support Mechanisms 155
Supervision Access and Appropriateness 155
Conceptual Framework 157
Compassion Fatigue and Secondary Traumatic Stress Disorder 157
Vicarious Trauma 158
Burnout 158
Interventions 159
Personal Interventions 159
Professional Interventions 160
Organizational Interventions 162
Catherine's Story (Part 2) 162
Learning Summary 163
Resources 163
7.1 My Action Plan 163
7.2 Secondary Trauma Scales and Inventories 163
7.3 Healing Activities 164
Appendix A Theoretical Background to the Adaptive Information Processing Model 165
Client Presentations 165
Memory Networks 167
Adaptive Information Processing 168
Case Conceptualization 169
The Three-Pronged Approach 170
Appendix B The Eight Phases of the EMDR Standard Protocol 173
Phase 1 History Taking 173
Phase 2 Preparation 173
Phase 3 Assessment 173
Phase 4 Desensitization 174
Phase 5 Installation 174
Phase 6 Body Scan 174
Phase 7 Closure 174
Phase 8 Reevaluation 174
Appendix C Further Information and Advice 177
Appendix D Clients' Experiences of EMDR: In Their Own Words 179
Goals and Expectations 179
Reasons for Choosing EMDR 180
Preparation and History Taking 180
Client Anxiety 180
Desensitization Experience 181
Making Connections and Insights 181
Moving Forward 182
The Therapeutic Relationship 183
The Outcome of EMDR 183
Appendix E Glossary of Terms and Acronyms 185
References 191
Index 197
