By Jeff Dwarshuis LMSW ACSW
Eye Movement Desensitization and Reprocessing (EMDR) was developed by Francine Shapiro in 1989 and is used as a method of treatment for Posttraumatic Stress Disorder (PTSD).
Over time, researchers and therapists expanded the use of EMDR to include several other mental health diagnoses besides PTSD. It was discovered that not only did EMDR eliminate the impacts of acute memories leading to PTSD, but it also eliminated the negative impacts and irrational self perceptions caused by bad memories and bad experiences in general. This is particularity true with individuals who have a history of repeated abuse or repeated traumatic incidences causing Complex Posttraumatic Disorder.
With this discovery, EMDR treatment could be applied to depression, anxiety, relational problems, performance problems or any problem or mental health diagnosis that was caused by negative life experiences. Due to the complexities of many of these problems, EMDR treatment needed to include other suggestions besides the EMDR Protocol such as cognitive therapy, psychoeducational reading or communication exercises.
The treatment of child abuse, particularly adults who were abused as children, requires a broad application of treatment as well as an understanding of child development, relational attachment and the EMDR Cognitive Interweave.
Ambivalent Attachment
Ambivalent Attachment is an unhealthy relational pattern developed in abusive families. Every person is born with the instinctual desire to connect with their caregivers. Since this desire is an instinct and not a behavior it cannot be eliminated. It is a constant part of living that must be managed. If a parent is consistent and creates a reasonably safe environment, the child will learn to connect with the parent without fear. If the parent is abusive, the child will respond with another instinct of pulling away or recoiling. If this continues over time the child will develop a relational pattern of using both instinctual drives and their relationships will consist of a drive to connect but an instinctual and at times unnecessary reaction of recoiling. This relational pattern is called “Ambivalent Attachment”.
The Locus of Control Shift
The Locus of Control Shift is a process where a child takes on an irrational negative cognition to maintain a sense of emotional and situational control over an uncontrollable situation. For example, imagine a young girl whose parents suddenly separate and the father leaves the home. Because of her age and limited capacity, the girl is unable to fully deal with the hardship of emotional loss that occurs. To ease this process the child will tell herself, for example, that her father left only because she was not a good enough girl and that if she behaves better then he will return. She creates and holds the negative self concept of “I am not good enough” and begins a pattern of perfection or excessive work to gain some control over an uncontrollable situation.
At this point the child in this example develops a central problem that comes with child abuse. To maintain control and justify ongoing overwork or perfectionism she must shift or believe that she is not good enough. This is the development of a negative cognition that is both harmful yet serves a purpose of emotional survival. Either she needs to hold onto the negative self concept or face the old reality of feelings of overwhelming loss that came with the absence of her father. This negative cognition, like all cognitions, are subconscious leaving the girl, young adult and woman with a confusing set of self-destructive behaviors that seem to have no purpose or proper explanation.
EMDR Preparation
EMDR treatment consists of first completing a client centered assessment and diagnosis followed by the listing of negative contributing memories. Often a Cognitive Ranking is helpful to measure self-esteem and to list any negative contributing memories to self-concept.
When listing EMDR target memories it is important to include the memories that are the earliest and that cause the greatest negative reaction. Clients do not have to list all memories of abuse if they follow these steps. Memories are thematic and often successfully completing one early and most intense memory will also reprocess other related, later memories. In order to do this, however, the earliest and worst memories need to be addressed. If only later or less traumatic memories are done, then the earlier and more severe memories will not be reprocessed simultaneously.
Also, during the set up for the memory the client does not need to discuss the details of what happened in the memory and the therapist does not need to know what happened in the memory in order to do the treatment. The client simply needs to imagine the traumatic picture. Communication with the therapist about the memory can be done by using key words that the client knows represent the memory and then allows therapist and client to discuss, set up and reintroduce the memory when it is time to apply the protocol.
The Cognitive Interweave
The Cognitive Interweave was developed as an added technique to the EMDR Standard Protocol to increase the speed of reprocessing as well as helping a client who seemed to not be moving through the EMDR reprocessing. The Cognitive Interweave is based on a researched clinical description of steps needed to complete in order to psychologically overcome a traumatic event. The technique has three parts – Responsibility, Safety and Choices. The Cognitive Interweave is generally suggested as a method to use sparingly since the idea of EMDR is to allow the client to move uninterrupted through reprocessing. However, this technique is perfectly suited for individuals who have been abused since its three steps line up with the complications found in both Ambivalent Attachment and The Locus of Control Shift. For that reason, it can be used with each memory of child abuse.
The three parts of the Cognitive Interweave are introduced to the client by the therapist during the EMDR Standard Protocol. At determined times during EMDR processing, the therapist asks questions to elicit the client’s thoughts and imagery of responsibility, safety and choices as they apply to the memory. These questions and client responses during EMDR reprocessing both assure and facilitate the process of completing what is needed to do to eliminate the negative impacts of memory and address some of the specific difficulties people face who live with these traumatic experiences particularly self-blame, fear and helplessness.
Responsibility
People abused as children often hold negative self-beliefs to avoid the feelings of loss associated with child abuse. This thinking causes the person to believe they are responsible for the abuse. The first part of the Cognitive Interweave is to help the client reprocess the abusive memory while rationally exploring the idea of responsibility.
After the client begins EMDR and moves through 2-3 sets of eye movements on a targeted memory, they are usually in touch with the negativity of the memory. At this point the client can be asked “As you see this picture, who is responsible for the negative emotions you feel right now?” Often clients will blame themselves so the therapist should then ask – “As a child on that day did you want to experience this situation?” The client is then able to identify the responsibility of the perpetrator. Then 2-6 sets of eye movements are completed while concentrating on the responsibility of the perpetrator for creating the problem. This recognition lifts the sense of responsibility and then allows the client to eliminate or give up their longstanding negative self-perception and control that is found in the Locus of Control Shift. Between the sets of eye movements following the client often will then begin to express their rational emotional reaction of anger rather than the anxiety, guilt, or fear that comes with accepting irrational blame. Clients also will be confronted with a strong sense of loss that they have been avoiding since the initial traumatic event.
Safety
The second step of the Cognitive Interweave is Safety and this step helps the client to deal with feelings of loss and fear. At this point in the session the therapist can say to the client – “See a picture of yourself walking out of your Safe Place and imagine that you go into that negative picture and talk to that young child as if she is your own daughter and you help her to feel safe.” The client does 2-5 sets of eye movements on this picture. Generally, after 2-5 sets of eye movements the client experiences comfort, safety, validation, love and bonding that overtakes the sense of abandonment, fear, loneliness and discomfort that maintains the relational pattern of Ambivalent Attachment. The person has experienced for the first time being able to hold and believe these positive things while thinking about the bad memory.
Choices
The third step of the Cognitive Interweave is Choices and this step helps the client deal with rational power and emotional separation. After safety is completed the therapist says to the client – “Recognizing the responsibility of the perpetrator and having that safety with you, imagine that the young girl in that negative picture makes choices for what to do with that situation and she can do anything she wants.” This method is a new and significant experience for the client since they are for the first time able to rationally process their power over the situation while feeling safe and recognizing the perpetrator’s responsibility. Often clients will report imagining finding a place of safety, calling authorities or going through the aggressive response of fighting against the perpetrator and winning.
The use of the Cognitive Interweave is a highly effective EMDR technique that allows clients to maintain a cognitive and emotional distance from the negative impacts of abuse that have caused symptoms particularly those found in Complex Posttraumatic Stress Disorder. This and creates an ability to eliminate symptoms and rationally perceive the management of a satisfying and joyful relationship.
Resources
Cognitive Therapy – Basic and Beyond by Judith Beck (1995)
Cognitive Therapy for Challenging Problems by Judith Beck (2005)
The Trauma Model – A Solution to the Problem of Comorbidity in by Colin Ross MD (2000)
Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures by Francine Shapiro PhD (2001)
EMDR as an Integrative Psychotherapy Approach: Experts from Diverse Orientations Explore the Paradigm Prism Edited by Francine Shapiro PhD (2002)
Getting Past Your Past: Take Control of Your Life with Self Help Techniques from EMDR Therapy by Francine Shapiro PhD (2012)