The EMDR Podcast

In foundational EMDR Therapy training, we instruct you to just let things go where they go. For relatively healthy people (the people we initially trained you to work with), this is the best and most effective way to work. A large part of what healing is for people with a fair amount of adaptive information is seeing the connection between the various categories of wounding that they have experienced. Encouraging things to go where they may need to go can create the possibility of insight during healing for your healthier clients. It can perhaps promote broader generalization.

The problems can come when we leave the training and try to implement the “let things go where they go” in clinical settings with clients with very little adaptive information and a very small window of tolerance. Things tend to want to go straight off a cliff. Then, EMDR Therapy doesn’t seem like it’s a magic wand that simply dissolves whatever memory we point it at. It may seem like a match that sets the papers on the desk on fire, then the curtains, then room, then the house, then the neighborhood, and then half of Chicago like in the 1870s. It’s easy for you—the therapist—to trace the origin of this burned-out catastrophe back to the match that started in your own hand. Clients having retaumatizing experiences inside EMDR Therapy is the main reason why therapists and clients disengage from using it.

So, if EMDR Therapy isn’t a magic wand with clients with severe and complex trauma, what is it? Where is its magic? The core of the AIP model is that we can connect old stuck information into right-now existing adaptive information, assuming we have enough of it in the areas where it is needed. I use the boat and fish metaphor throughout the EMDR Podcast to describe how the memory content needs to connect to the existing adaptive information. Metaphorically, you cannot land a whale of a memory into adaptive information the size of a canoe. If that’s the magic—connecting stuck information to positive information—that’s also where its limit is found.

If the pathway of healing in EMDR Therapy is that maladaptive stuff has to connect to existing adaptive stuff, here are some questions to ponder. When would your client with complex trauma have had the opportunity to develop this adaptive information? I realize that in Phase One, we are focused on assessing the client’s wounding. Can you see why attempting to assess the client’s fund of adaptive information is also an essential Phase One task? How can you know for sure how much adaptive information a client with complex trauma has? You can’t. But, what can you know, in general about your most pervasively traumatized clients? People with complex trauma have been stuck in survival processes that may have kept them from developing much of the needed adaptive information. We can also know that their wounding is complex, typically spans many developmental eras, and contains many of the worst things that can happen to a human on this planet. In short, assume a small boat when it is clear that their oceans are filled with monsters. There is typically an inverse relationship between the two. I’m just going to suggest that you already knew this. Even before your EMDR Therapy training. It’s easy to misunderstand the kind of magic that EMDR Therapy is.

The healthiest clients we will see were resourced well by life—hundreds of thousands of positive experiences helped them develop much of the needed adaptive information to do EMDR Therapy well. Being born to people who knew how to love right and consistently and having the experiences over and over of nurture, agency, visibility, protection, importance, and guidance literally installs adaptive information into your human nervous system. It’s easy to believe the lessons in the nostalgia of your earliest experiences. And it’s easy to believe the lies. For well-resourced clients, EMDR Therapy is like a magic wand. For everyone else, it is not. The Adaptive Information Processing Model explains clearly why this is the case.

So, if we are in the position of having to connect large chunks of difficult information into small amounts of adaptive information, then we need to develop skills and strategies to do that more effectively. You make adjustments and accommodations already for your severely traumatized clients in what you already do with them. If there is hesitancy to make reasonable adjustments in EMDR Therapy, then you may be operating from the assumption that EMDR Therapy is a magic wand for all clients, thus it should be conducted exactly the same way for every client on your caseload as though it is some type of spell or incantation. We have already muddied these waters. Also, you don’t employ this type of rigidity in any other approach to therapy that you do… why do you do this in this approach? Probably because that is how you were trained. Rigid adherence to any protocol that is blind to the actual human nervous system in front of you isn’t trauma-informed practice, it’s trying to push your diversely shaped clients through some type of machine. As I’ve argued elsewhere, we need our interventions to match the shape of the client’s nervous system. The need to make modifications based on sound clinical judgment is written into EMDRIA’s definition of EMDR Therapy. Remarkably little of what I’m saying here is controversial.
Here are some places I would suggest reasonable adjustments to standard protocol when working with clients with severely complex trauma. In each of these, I’m going to explain why Dr. Shapiro wanted us to do things in a certain way and why (based on the AIP model), it makes clinical sense to at least consider making some adjustments based on the nervous system of the client you are working with.

The Problem with Too Much Memory Content

We need memory content to come, but we need it to come at a digestible and tolerable rate. If it doesn’t, the client may flood their basement and we may spend the rest of the session dealing with the mess of that initial big wave of distress that may or may not include a shut-down response. The distress that comes and that we are encouraging the client to notice needs to come inside the client’s window of tolerance. All of the noticing that is productive in EMDR Therapy happens in the present. The ability to be and remain present requires a tolerable range of distress. If the client spends the whole session reexperiencing the trauma as it happened (rather than its resonance in the present), that is typically a retraumatizing and confirming experience. Healing happens when we have experiences different from the expectation in the bad memory, not when they are identical to them. Distress coming in small enough pieces that allow us to stay present with our current experience may be disconfirming enough for this memory reconsolidation work to occur. In short, clients have to experience the memory differently than the experience of a flashback. We need to help clients activate, but not over-activate. We need to also appreciate that complex trauma, when activated, doesn’t want to come out in easily digestible pieces. We may need to help clients activate, but not over-activate. Here are just a few strategies to help clients do that.

Strategies Related to Memory Selection

One of the most sensible ways to help clients manage distress, particularly in the first few targets we work on, is to start with smaller targets that do not connect to a lot of adjacent content. Dr. Shapiro is right that if we start with Mt. Everest, everything after that will feel like a small hill. However, my clients are not Olympians. From that AIP lens, you cannot connect Mt. Everest to adaptive information the size of a walnut. We need to appreciate that there are 200 dead bodies on Mt. Everest right now. If we need to tackle Mt. Everest (and we do), we better start with some smaller hills first. This guidance is not controversial when working with complex trauma. It’s guidance that Dr. Shapiro makes about half a dozen times in her core text when working with clients with complex trauma.

Working with memories that may be more recent, less connected to the whales of attachment wounding and other identify-impacting themes, is a great place to start. With really complex clients, we may start with the person who pulled out in traffic in front of them two weeks ago, an ex-partner a few partners ago, or a car accident in which no one was seriously hurt. This can allow the client to test the fishing gear. Helpful information about the client’s nervous system, including clues about the client’s ability to tolerate larger amounts of distress in future targets are often revealed. If difficulties emerge, even with small targets, that is not failure. It is information. That information is essential to the client’s recovery.

Even if we start with a smaller memory, is it possible that other memories may want to connect? Yes. And with reasonably healthy people, we want to let them come assuming there is time and enough window of tolerance. But, just because memories want to come, that doesn’t mean that it’s always a good idea to let them. Remember that many, many, memories may be stored in individual memory networks of people with complex trauma. The body gets activated and lots of memories may want to come, almost like being drawn by the magnet of the body activation. Some memories will want to come because they have the same body feel. Again, we need memory content to come, but we need it to come at a digestible rate. If you are already hooked to a 700lb tuna and you are in a 10-foot canoe, does it make sense to then hook onto two whales and five sharks? In the AIP lens, we can only land a fish that our boat can support.

Helping clients decide what memories to let in is an important exercise in client agency. My metaphor for this a barbeque grill in the backyard. The grill may spread smells all through the neighborhood and lots of neighbors may want to come, but it’s your house and your grill. They don’t get to simply burst in your door, walk across your living room, open the sliding door to your yard, and open your grill and eat your food. It’s your door. You get to decide who comes to this party. With clients with complex trauma, I am helping them contain the memories that want to come when they are already struggling with the fish they are hooked onto. Again, we need distress to come, but it needs to come at a digestible rate and intensity.

To complicate matters, transformational trauma therapies often work best when we are working with an individual representative memory. But with clients with complex trauma, there is a strong tendency to pivot to the theme. For instance, a memory that involves cognitions about lovability can quickly pivot to the client trying to figure out if they are lovable. It’s easy for clients to pivot from an individual memory to something existential. Here is an example: Think about the last time you had heartache at the end of a relationship that may have ended in a way you didn’t anticipate or want. At the peak of that heartache, you were probably thinking of other instances of heartache. They may have very similar body feels. Imagine how easy it is to pivot from an individual memory of heartache to the existential questions: Why does everyone I’ve ever loved hurt me? Am I ever going to find love? It is completely understandable that the nervous system would go there. But, can you appreciate that EMDR Therapy isn’t a Magic 8-Ball. It’s not good at resolving most themes as a whole and it rarely resolves existential questions. Healing can help the existential questions lose a lot of their urgency, but it’s easy to start with an individual memory and wind up in a goose chase of trying to figure big things out. With clients with complex trauma, I often send them back to target when we bump against the broader theme or the existential edges of human experience.

How your clients with complex trauma interact with the memory matters. Again, we need memory content to come, but we need it to come in digestible rates and intensities that match the right-now window of tolerance. First, I don’t want the client to be in the memory. I want the client to be in the present glancing occasionally at that memory. One of the most common forms of dissociation I observe with my clients is that clients are simply too much into the memory and not present enough in this moment to notice deeply. All of the noticing that is productive happens in the present. All healing happens in the present. If the client is mostly processing and narrating on the memory channel with no attention to what they are noticing right-here right-now, I will redirect them to the present. If the client isn’t having a different experience with the memory in EMDR Therapy than what typically occurs in a flashback, I can almost guarantee you that their EMDR experience will be retraumatizing.

Relatedly, I do not want the client to stay focused on the memory the whole time. Clients believe, incorrectly, that they have to constantly push into the distress of the memory. This is a recipe for overactivation for many clients. Again, we want memory content to come, but it needs to come at a digestible rate and intensity. A better metaphor is to take a bite of the memory and notice that bite until it is digested. Then take the next bite. Digest that bite, then take the next. There are strategies for doing this well. These strategies can help promote the distress coming in ways that ripple inside the window of tolerance, rather than saturate and overtop it.

When clients struggle taking digestible bites of the memory, I may use a bean bag in session and invite the client to toss it into the air. I ask the client to think about the memory only when the bean bag is in the air. This serves as a kind of timer to help limit the amount of content and distress that comes into awareness at once. It may take multiple rounds of noticing with bilateral for the distress to dissipate before I encourage the client to toss the bean bag again and get the next piece of content from the memory to notice. Often clients can put the bean bag down and simply think about the memory once the initial big waves of distress are digested and the client struggles to find distress when the bean bag is in the air.

The most common way that I work with clients with complex trauma is using the videotape approach mentioned by Dr. Shapiro in her main text in the section on Complex PTSD. The videotape approach involves some modifications to standard protocol in Phases Three and Four. There are many ways to do it, but the link to my script is in the notes section to this podcast. Essentially, we make the memory a piece of video and walk through each frame of it chronologically, pausing and digesting each piece of distress with rounds of bilateral noticing, and not allowing the video to play forward until the prior distress is largely metabolized. We do this in Phase Four, until the client can play the memory and there is no distress on any channel, then we go to Phase Five and continue with standard protocol.

It may seem that strategies to microactivate the memory will take longer. That’s simply not true with clients with complex trauma. What dramatically slows reprocessing is dealing with overactivation and the problematic parts interactions that come in response to that overactivation.
Many clients will struggle with reprocessing because of the volume or intensity of the memory content coming into working memory in a short time period. In review, these are just some of your options if you notice clients struggling:

• Pick a memory that is more tolerable (especially when the reprocessing phases with new clients with complex trauma)
• Discourage other adjacent memories from coming (especially when the client is right-now struggling to digest the distress they are currently noticing)
• Identify when the client has pivoted from an individual memory to a theme (or an existential rumination) and direct them back to target
• Help clients stay grounded in the present (not dissociated into the memory)
• Encourage the client to interact with the memory a little bit at a time (rather than staying focused on it) by glancing at the memory, using a bean bag as a timer, or using the videotape approach.

When clients struggle working with memory content effectively, there are many, many, strategies that may be helpful. When clients struggle, it is not failure. It is information. Use the information to help identify why they are struggling and modify your interventions to match the information that you now have about your client’s nervous system. Many consultants can help you with this. Almost everything on the EMDR Podcast is about this.

Many newly-trained therapists think that if they do not do EMDR Therapy exactly as they are trained, client harm is likely to occur. We train you rigidly because we want you to understand what you are modifying from… so that you don’t make your own Frankenstein therapy before you even understand what EMDR Therapy is. Now that you understand how to work with a relatively healthy person—which is how we trained you—learn some sensible modifications so that your interventions can match the nervous systems you are working with. Otherwise, you may be cramming your clients with severe trauma into a machine that poorly fits them. And that is not trauma-focused care. And, EMDR never was a machine. You can make sensible modifications and still be doing EMDR Therapy. Often, that’s what doing EMDR Therapy well with clients with complex trauma will require.

The script for the videotape approach mentioned in the podcast is here (joining the site is free): https://emdrthirdweekend.com/posts/videotape-approach-script-with-complex-trauma-phases-three-and-four