Saturday, November 27, 2021

Comments by Kerry Pinnisi

Showing 20 of 20 comments.

  • Actually, I’m with you – using EMDR as exposure and desensitization absolutely works. I believe BLS can help in some cases depending on client preference, and whether that’s because of placebo or because it does in fact act on the amygdala is immaterial (let’s not forget that placebos have real benefit!).

  • I’m glad to hear this person is thinking this through so carefully!

    -I would do EMDR with someone tapering or withdrawing “as tolerated”. Basically, if the client is able to successfully use grounding skills and support to return anxiety to tolerable limits during sessions, and if they are able to keep themselves physically safe between sessions, they will then have the ability to participate in treatment fully enough to report on whether it is effective for them. Trauma work of any kind is by nature activating and/or triggering, and a person will need structure, support and skills in place before beginning. With that accounted for, EMDR is unlikely to do harm.

    -I hope that any licensed therapist is aware of the challenges of taper and withdrawal! Whether this is the case in practice, I’m not able to say. I also don’t have any knowledge of what studies may have been done on EMDR and withdrawal, or personal experience with such clients.

    -I believe EMDR and other trauma protocols stand a chance to help anyone who is able to meaningfully understand and participate in the program, stay safe while doing the work (inside and outside of the office), and is motivated to give it a try.

    -As for withdrawal causing trauma, I want to add a disclaimer that these are off the cuff thoughts – I’ve never had this question before! I welcome any other points of view here. With that said: Withdrawal is pretty freakin sucky (you can feel free to quote me on that), physically and mentally. It may cause old traumas and anxieties to surface – sometimes LOUDLY. If someone is unable to keep themselves physically safe as a result of these symptoms, this can put someone at risk of experiencing new trauma. However, in and of itself, I would not define withdrawal as trauma. Withdrawal is essentially putting us at the mercy of our own thoughts and bodies, and I would say that interaction with others or the environment is necessary for an experience to be classified as trauma (even in the case of suicidality, the environment becomes physically involved if things progress out of the realm of thought and into action). What do you think?

  • What works for sure is having a system to talk about trauma deliberately and safely. In a few cases by client request, I’ve done “EMDR inspired trauma treatment” (there’s no technical name for this), which is essentially using the same procedure but without the BLS. (It’s important to understand BLS as one among many elements that make up EMDR.) Anecdotally, it’s just as effective. I’m not a researcher (and therefore I’m not the best person to point you towards the work of others), but many of my clients describe profound healing.

    Usually, to describe BLS, I’ll say out loud something like “It’s there to use if it helps you. The idea is that it will help your amygdala stay calmer as we go. You’re the best reporter of what’s helpful to you, and if it doesn’t feel good, let me know.”

  • Great thoughts, Steve – understanding each person individually must be done as well as we can manage, or we are lost. The efficiency beast of insurance systems and the “hammer meet nail” narrowing of medicalized perspectives both can make this more difficult. My best therapy is done when I remember that the client and I are both making progress on a neverending road to understand them and the way we are together. Managed care wants to pretend this road has an end.

  • After reading just this article, it looks to me as though Locational processing is a way of assisting someone in using grounding skills. In the short term, this can help someone calm down from overwhelming feelings, which is critical, but without additional elements added this intervention is unlikely to produce long term change on its own.

  • Thank you Elahe, and I agree – the healing people gain through this modality (and other trauma treatments) can be profoundly life changing, and shifting the stigma in any and all ways we can manage is some of the most important work we can all do.

    I believe this is inherent in what you write, but to make it explicit, I would not use EMDR to target the treatment of psychosis, as psychosis is not trauma. (I use the term “psychosis” to describe an experience of reality that differs from aggregate perception, which can happen for folks with schizophrenia as well as other conditions.) Very often in our culture, psychosis can put someone at risk of trauma, and there is a significant line of thinking that trauma can induce psychosis, but they are not the same.

    Psychosis that is significant enough that it prevents meaningful communication about the structure of the treatment itself will rule out being able to participate in EMDR. Less structured trauma therapies may be more effective for this kind of client (which is out of my area of practice so I won’t comment further there). If a client is dedicated to using EMDR in particular, they will need to first utilize other therapies for psychosis before this will be an option, analogously to how someone with intolerable levels of anxiety will need treatment to bring anxiety within tolerable limits before EMDR can proceed.

    Unfortunately, I haven’t read that book, and am not familiar with Paul William Miller! If you read it, I hope you get something out of it.

    Getting ready to do trauma work is usually the longest and hardest part of trauma work! Building attachments, community support, skills to respond to emotions, discovering and addressing narratives and blocking beliefs, and many more factors that can prevent someone from tolerating trauma work can be on the scale of decades or a lifetime (hopefully not, with adequate treatment and treatment systems!) Once trauma work is begun directly, the timescale shrinks to (typically) weeks to months.

  • Hi Sam,

    Thank you for reaching out. The remarkable love you have for your wife shines through!

    Family and friends, and therapists, can all be in therapeutic roles. I believe each of us offers something the others cannot.

    In my view, dissociation is a protective mechanism, and as such is not to be interfered with or targeted directly. Rather, dissociation is a sign that the client is feeling unsafe. “When in doubt, find a way to add safety.” In the moment relief can come in the form of grounding skills such as using one’s senses to interact with objects or the environment (a lot of my clients report relief by focusing on strong sensations like cold ice, peppermint oil, or very sour candies). Deeper healing comes from putting the client absolutely in charge of their pace and when they decide that the walls are ready to come down. And, as always, from connection. From welcoming in the person exactly as they are, defenses and all. It is more like holding seed and inviting a bird to come to your hand, than it is something to “do”. Even the client may most often feel like they do not have any say in when dissociation fades. So, we focus on creating the conditions in which it is ok for this to happen on its on, and do our best to accept and tolerate our own discomfort in waiting.

    EMDR can be done even on blocked memories by helping the client to focus on and process the triggers that happen in the present. I would not attempt this with someone with complex trauma without first doing plenty of preparation work, skill building, crisis planning, identifying beliefs and narratives, relationship building, and lots more.

    Often, folks with complex trauma in the getting-ready-to-process stage can benefit a lot from group therapy, which can provide relationships, community support, learning and validation, and lots more.

  • Pauline, thank you for this important question. I do EMDR with folks who are taking psychiatric medication regularly – perhaps more often than not! My training through EMDRIA (emdria.org) did not teach us to ask clients to taper off of medication before starting trauma work. Other non-EMDR trainings I have attended taught me “medication can be what allows the work to get done”. (Of course, it’s not right for everyone.)

    One of the central tasks of EMDR therapy is keeping anxiety and dissociation “within tolerable limits”, which can be greatly facilitated by medication – and healing will be just as possible and just as robust for that person, if not more efficient. If a person wants to taper off of medication after a course of EMDR, it can often be easier (sometimes much easier) for them to stay off of medication symptom free. I am sorry to hear that you were told otherwise. Certification programs, standardization and communication within the field continue to be challenging.

  • Hi David, I’m not sure whether my reply ever made it to you due to technical reasons. (Apologies if this means it’s now making it to you twice!) Here’s what I wrote previously:

    What a truly fabulous question. Here’s my take: There are only two sets of nerves that send opposing messages to different organs (one example: parasympathetic nerves slow the heartbeat, sympathetic nerves speed it up). However, there are uncountable other forms of sensory input that we can feel – hormones, rhythms of breath and heartbeat (and brainwaves!), amount of food and sleep, whether we’re being touched, energy level, and so many others – and the interaction of all of these data points produces the beautiful, rich and ever changing tapestry of what it feels like to be alive!

  • It’s true that we’re a long way from understanding how EMDR works, and all this article can do is sum up the current leading edges – as well as some better established thoughts on trauma (which has a bigger body of research behind it than EMDR specifically). Currently, we are sure *that* EMDR works for many people, and there is more work to be done to be sure of how.

  • What a truly fabulous question. Here’s my take: There are only two sets of nerves that send opposing messages to different organs (one example: parasympathetic nerves slow the heartbeat, sympathetic nerves speed it up). However, there are uncountable other forms of sensory input that we can feel – hormones, rhythms of breath and heartbeat (and brainwaves!), amount of food and sleep, whether we’re being touched, energy level, and so many others – and the interaction of all of these data points produces the beautiful, rich and ever changing tapestry of what it feels like to be alive!