Francine Shapiro Library ~ EMDR Bibliography

Francine Shapiro Library - EMDR Bibliography Links

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Your Results - you searched for the keyword Psycholgical Defenses 46 Results

1. Leeds, A. (2012, June). Affect phobias in EMDR therapy - developing affect tolerance capacities in client and clinician [Fobias afectivas en la terapia con EMDR -‐ El desarrollo de habilidades para la tolerancia afectiva en el cliente y el clínico]. Presentation at the annual meeting of the EMDR Europe Association, Madrid, Spain.

Language: English

Format: Conference

Abstract:
Affect phobias may also be described as psychodynamic or dissociative defenses or as ego state conflicts. When patients present with affect phobias and fail to progress with standard EMDR procedural interventions, EMDR therapy can still be effective when clinicians have the conceptual knowledge and perceptual skills to recognize these defenses, and when they can make use of a flexible set of advanced EMDR procedural stills for responding. EMDR trained clinicians must also confront their own affect phobias and psychodynamic conflicts as they experience a range of responses to their work with patients including countertransference and vicarious traumatization that can disrupt their ability to make use of their conceptual, perceptual and procedural knowledge and skills. This presentation provides an overview of concepts from Short-Term Dynamic Psychotherapy (STDP: McCullough, 1997, 2003) and the Theory of Structural Dissociation of the Personality (TSDP: van der Hart, Nijenhuis & Steele, 2006) and identifies procedures from Knipe (1999, 2003, 2005, 2008, 2009, 2010a, 2010b, 2010c), Mosquera (2010, 2011), Mosquera and Gonzalez (2010), and Leeds (2001), which clinicians can employ with cases involving affect phobia. We will also consider how clinicians can be sensitive to and mitigate the potential impact of their own affect phobias in their clinical work.

Las fobias al afecto también se pueden describir como defensas psicodinámicas, disociativas ó como conflictos del estado del yo. Cuando los pacientes presentan fobias al afecto y no avanzan con las intervenciones siguiendo los procedimientos de EMDR habituales, EMDR aún puede ser efectivo cuando los clínicos gozan del conocimiento conceptual, así como las habilidades perceptivas para reconocer dichas defensas y cuándo puede servirse de un conjunto flexible de habilidades de procedimiento de EMDR para responder [ante ellas]. Los clínicos formados en el uso de EMDR también han de afrontar sus propias fobias y conflictos psicodinámicos a medida que pasen por una variedad de respuestas a su trabajo con pacientes, incluidas la contra-‐transferencia y la traumatización indirecta que pueden perturbar su capacidad para aprovechar sus conocimientos y habilidades conceptuales, perceptivos y habilidades. La presente ponencia ofrece una visión del conjunto de los conceptos de Short-‐Term Dynamic Psychotherapy (STDP: McCullough, 1997, 2003) [psicoterapia dinámica breve] y de Theory of Structural Dissociation of the Personality (TSDP: van der Hart, Nijenhuis & Steele, 2006) [teoría de la disociación estructural de la personalidad] e identifica procedimientos de Knipe (1999, 2003, 2005, 2008, 2009, 2010a, 2010b, 2010c), Mosquera (2010, 2011), Mosquera y Gonzalez (2010) y Leeds (2001) que pueden aplicar los clínicos en casos de fobia al afecto. También se contemplará cómo los clínicos pueden estar sensibles ante el impacto potencial de sus propias fobias al afecto y cómo mitigarlo en su trabajo clínico.

Keywords: Affect Phobias

Accuracy Verified: Yes

2. Greenfield, R. (2010, October). The assessment and psychotherapy of a dissociateve adult man with complex PTSD. Presentation at the 27th Annual Meeting of the International Society for the Study of Trauma and Dissociation, Atlanta, GA.

Language: English

Format: Conference

Abstract:
This paper presents the assessment and four year psychotherapy of a Hispanic man with Complex PTSD and Dissociative Disorder NOS. The patient’s history of childhood sexual abuse caused significant disruptions in normative developmental processes causing what van der Kolk (2005) posits as a Developmental Trauma Disorder. Based on Shapiro’s (2001) adaptive information processing paradigm, the patient’s memories of extensive childhood sexual victimization became blocked from resolution from adaptive memory networks, becoming embedded in the emotional brain and activated by the 9/11 tragedy. This stimulated an array of PTSD and Dissociative symptomatology. In treatment he verbalized and chronicled his experiences of 9/11 and memories of severe childhood sexual abuse, establishing a narrative of victimization, helplessness, and confusion about his sexual orientation (Gardner, 1999). Furthermore, there were episodes of dissociation revealing the possibility of alters. Attempts to access adaptive networks using EMDR protocols were thwarted by intractable defenses. The patient’s desire to return to work was offset by his entitlement to Social Security Disability that was initially denied. Working through my concordant countertransference (Racker, 1968), I ultimately accepted his wish for SSD, which he obtained on appeal based upon my symptom-specific evaluation. The patient transferred to a clinic that accepted SSD.
Participants will be able to : ♦♦ identify the developmental derailing effects of childhood sexual abuse on normative developmental processes. ♦♦ assess how childhood trauma(s) that are repressed or dissociated are invoked by trauma(s) in adulthood through associative memory networks causing Complex PTSD. ♦♦ apply methods of working with patients dissociative defenses in psychotherapy.

Keywords: Case Study Developmental Trauma Disorder

Accuracy Verified: Yes

3. Knipe, J. (2008, June). The CIPOS method -- procedures to therapeutically reduce dissociative processes while preserving emotional safety. Presentation at the annual meeting of the EMDR Europe Association, London, England.

Language: English

Format: Conference

Abstract:
It is well documented (Maxfield and Hyer, 2002) that the 8-phase EMDR model is highly effective for clients who are troubled by disturbing memories. However, clients who are dissociative often have great difficulty in maintaining present orientation and the "dual attention" that is a necessary condition for processing. Dissociative clients are highly vulnerable, during the EMDR Preparation, Assessment and Dissociation Phases, to becoming disoriented and overwhelmed by the surprising intrusion of dissociated parts that bring intensely disturbing images and other information. Since, with these clients, there is a greater risk of non-therapeutic dissociative abreaction, it is very important to counter this risk with an increased emphasis on safety and containment of affect. In this presentation, I will describe two procedures that can be helpful in making the healing power of EMDR available to clients who have this kind of vulnerability. One is the BHS (Back of the Head Scale), a procedure that can be useful in assessing a client’s moment-to-moment level of dissociation during a traumafocused EMDR session. The other is the CIPOS (Constant Installation of Positive Orientation and Safety) procedure, which is a method of slowing down processing, and carefully containing and controlling the emergence of potentially overwhelming post-traumatic material. These methods will be illustrated with video segments of a therapy session.

Keywords: Back-of-the-Head Scale BHS CIPOS Method Contant Installation of Present Orientation and Safety Emotional Safety Psycholgical Defenses Targeting

Accuracy Verified: Yes

4. Korn, D. (2001, June). Clinical applications of EMDR in treating adult survivors of childhood abuse and neglect. Preconference presentation at the annual meeting of the EMDR International Association, Austin, TX.

Language: English

Format: Conference

Abstract:
This workshop will focus on integrating EMDR into a phase-oriented recovery plan in treating adult survivors of childhood abuse and neglect. EMDR applications with the full range of trauma-related syndromes, including simple and complex PTSD, Borderline Personality Disorder and Dissociative Disorders, will be addressed. Treatment planning and pacing will be discussed in view of presenting problem, attachment style, defenses, and self-capacities. In recognition of clients' rigid, maladaptive schemas, poor impulse control, dissociative tendencies and limited affect tolerance, strategies for modifying and supplementing standard EMDR protocols will be explored, Significant attention will be devoted to integratring EMDR ego strengthening and resource development protocols into all phases of treatment.

Keywords: Borderline Personality Disorder Child Abuse Dissociative Disorders Ego Strengthening Neglect Posttraumatic Stress Disorder PSTD Resource Development

Accuracy Verified: Yes

5. Knipe, J. (2009). Dysfunctional positive affect: To assist clients with unwanted avoidance defenses. In M. Luber (Ed.), Eye movement desensitization (EMDR) scripted protocols: Special populations (pp. 451-452). New York: Springer Publishing Co.

Language: English

Format: Book Section

Keywords: Avoidance Defenses Dysfunctional Positive Affect Protocol

Accuracy Verified: Yes

6. Ravaglia, G. (2003). E.M.D.R. e percorso analitico [EMDR and path analysis]. Gianfranco Ravaglia.

Language: Italian

Format: Other

Abstract:
Le tesi sviluppate negli scritti di questo sito rinviano a vari indirizzi psicoterapeutici che convergono nel considerare i disturbi psicologici come esiti di atteggiamenti difensivi intenzionali, anziché come "effetti" di "cause" intrapsichiche o ambientali. Il cliente in analisi non è quindi considerato un malato da curare, ma un soggetto che ha costruito le sue difese e che per questo può anche cambiare. Il lavoro analitico verte sul chiarimento delle convinzioni irrazionali su cui si fonda la strategia difensiva della persona e sull'esplorazione dei vissuti profondi non integrati nell'infanzia perché sentiti in tale epoca come intollerabili. Il lavoro analitico si basa sull'idea che i sintomi, gli atteggiamenti difensivi ed anche molti atteggiamenti considerati normali costituiscano una risposta ragionevole nell'infanzia, ma irrazionale nella vita adulta, al dolore. Il bambino evita il dolore, mentre l'adulto può accettarlo perché dispone di risorse che nell'infanzia non aveva. Il lavoro analitico ha come obiettivo l’elaborazione delle esperienze dolorose attuali e dei vissuti dolorosi del passato. Non “cura” i disturbi psicologici, ma serve a renderli superflui; consente quindi alla persona in analisi non solo di "star meglio", ma di modificare l'atteggiamento complessivo nei confronti della sua esistenza. Dal 2000 ad oggi questo sito è cresciuto includendo ogni anno nuovi lavori. Per ogni saggio indico la data della prima pubblicazione; indico anche quella dell’ultima revisione solo nei casi in cui parti significative sono state aggiunte.

The arguments in the writings of this site refer to various addresses psychotherapy converge in considering the results of psychological disorders such as defensive intentional, rather than "effects" of "causes" intrapsychic or environmental. The customer analysis is therefore not considered a patient to be cured, but a person who has built his defenses and that this may also change. The analytical work focuses on clarifying the irrational beliefs underlying the defensive strategy of the person and the exploration of deep feelings are not integrated in childhood because at that time felt as intolerable. The analytical work is based on the symptoms, the defensive and many considered normal behavior in childhood constitute a reasonable response, but irrational in adult life, the pain. The child avoids the pain, while the adult can accept it because it has resources that childhood did not have. The analytical work has as objective the development of painful experiences of current and past painful experiences. Not cure psychological disorders, but serves to make them redundant; then allows the person in analysis not only of "getting better", but change the overall attitude towards its existence. Since 2000 this site has grown to include new works each year. For each test indicates the date of first publication, also indicates that the last review only in cases where significant parts have been added.

Keywords: Path Analysis

Accuracy Verified: Yes

7. Knipe, J. (2008, Maart). EMDR en sterk wordt vastgehouden psychologische verdedigingsmechanismen het voorkomen van directe toegang tot bewuste en doelgerichtheid van de post-traumatisch materiaal [EMDR and strongly held psychological defenses preventing direct conscious access and targeting of post-traumatic material]. Presentatie op het derde congres van de Vereniging EMDR Nederland, Amersfoort, The Netherlands.

Language: English

Format: Conference

Abstract:
Een specifieke EMDR procedures die nuttig is met cliënten die zich sterk hebben gehouden psychologische verweren die bewuste directe toegang te voorkomen en de gerichtheid van post-traumatische materiaal is volledig te verklaren met uitgebreid gebruik van video-materiaal met de gerichtheid van de verdedigingswerken van vermijding (bijvoorbeeld vermijden van zeer verontrustende herinneringen , vermijden van verantwoordelijkheden, te vermijden in de vorm van uitstel), idealisering van het zelf (bijv. narcistische karaktertrekken van bijzonders en het recht) en de idealisering van anderen (bv. verlangen naar een verloren geliefde, of trauma-obligatie gehechtheid aan een dader). Vaak zijn cliënten die depressief bent en anderen die te idealiseren opereren vanuit een kern eigen ego staat van schaamte, en tijdens deze zeer praktische workshop leert u hoe jammer soms kan worden opgelost met behulp van gerichte en EMDR-methoden.

A specific EMDR procedures that is useful with clients who have strongly held psychological defenses that prevent direct conscious access and targeting of post-traumatic material is fully explained with extensive use of video material showing the targeting of defenses of avoidance (e.g. avoidance of extremely troubling memories, avoidance of responsibilities, avoidance in the form of procrastination), idealization of self (e.g. narcissistic traits of specialness and entitlement) and idealization of others (e.g. longing for a lost lover, or trauma-bond attachment to a perpetrator). Often clients who are depressed and who idealize others are operating from a core self ego state of shame, and during this highly practical workshop you will learn how shame can sometimes be targeted and resolved using EMDR methods.

Keywords: Psychological Defenses Targeting

Accuracy Verified: Yes

8. Gonzalez, A., Seijo, N., & Mosquera, D. (2009, August). EMDR in complex trauma and dissociative disorders. Presentation at the annual meeting of the EMDR International Association, Atlanta, GA.

Language: English

Format: Conference

Abstract:
EMDR can be safely used during the stabilization phase in a group of severely traumatized patients, not only to install positive elements, but to process dysfunctional elements (not necessarily traumatic memories, but patient-therapist relationship problems, defenses, symptoms, dissociative phobias, etc.). To postpone standard protocol until the patient has been prepared to do it in the standard way implies that the patient must resolve many of their problems without the help of EMDR processing. We will try to “think in EMDR” about severe dissociation, rather than directly apply foreign theories to EMDR work. Protocol modifications include progression, fractionation, synthesis and direction.

Keywords: Complex Trauma Dissociative Disorders

Accuracy Verified: Yes

9. Paulsen, S. L. (2004, September). EMDR master series - II: Ego state therapy and EMDR: Activating, modifying and containing dissociated neural networks. Invited master series lecture at the annual meeting the EMDR International Association, Montreal, Quebec Canada.

Language: English

Format: Conference

Abstract:
Chronic childhood trauma may lead to chronic dissociation which in turn produces a highly conflicted self-structure. Since conflicted self systems may not process smoothly in EMDR, it behooves practitioners to assess for degree of dissociation and other “red flag” indicators prior to EMDR. To work with clients with conflicted selves, the practitioner needs a means to access disowned parts of self. Although Ego State Therapy (EST) is based upon psychoanalytic theory, it is not slow as psychoanalytic treatment is. EST is a way to rapidly access internal structures, mediate conflicts, navigate around defenses and mobilize resources. Therefore EST is ideal as either: 1) a cognitive interweave in EMDR looping; or 2) as part of a preparation for clients in the high end of the dissociative continuum (the ACT-AS-IF approach). This workshop will illustrate case formulation and EMDR preparation and processing using the concepts above.

Keywords: Ego State Therapy Master Series

Accuracy Verified: Yes

10. Korn, D. (2013, May). EMDR the next generation: Finding your way in the dark [L’EMDR et la nouvelle génération: Trouvez votre chemin dans l’obscurité]. Presentation at the annual EMDR Canada Conference, Banff, Alberta CAN.

Language: English

Format: Conference

Abstract:
In this workshop, participants will be taught to use their “true” authentic selves as a resource during EMDR processing, and to work to create a secure, responsive, and positive relational environment that supports change and integration. A number of conceptual “maps” that incorporate and build on various ideas and strategies from other trauma-focused models (e.g., AEDP, IFS, Sensorimotor Psychotherapy, Structural Model of Dissociation) will be introduced. These “maps” are provided to guide case conceptualization and moment-to-moment decision-making within a given EMDR session. Video clips will be used to demonstrate how to track a client’s progress with greater precision, using both verbal and non-verbal markers to determine where the client is on a given conceptual map and what type of interweave is needed to facilitate or deepen the client’s processing. Different types of interweaves will be delineated with a clear description of the purpose or function associated with each. Throughout this workshop, Dr. Korn will engage in spirited dialogue with participants as she presents both didactic and video material. Learning Objectives: • Develop a comprehensive AIP-based case conceptualization treatment plan that will guide their moment-to-moment decision-making during an EMDR session. • Effectively identify the informational plateaus or schema categories (responsibility, safety, control/choice) reflected in a client’s presenting issues, choice of targets, and stuck points. • Utilize dyadic regulation in working with clients with limited affect tolerance and self-capacities, with the goal of maintaining and even accelerating processing within a window of tolerance. • Apply advanced interweave strategies to address blocking beliefs, rigid defenses, and fears about internal experiences (i.e. affect, sensation, urges, fantasies). • Utilize various clinical strategies/interweaves for facilitating the expression of adaptive action tendencies, completing incomplete or truncated actions, and addressing various domains of developmental repair.

Dans son atelier, les participants apprendront à utiliser leur ‘vrai’’ et authentique soi comme une ressource durant le traitement en EMDR et à créer un environnement où la relation soit sécurisante, sensible et positive favorisant ainsi le changement et l’intégration. Dr Korn nous parlera de ce modèle conceptuel des ‘cartes’ qui incorporent des idées et des stratégies qui proviennent de d’autres modèles axés sur les traumas (‘AEDP’, ‘IFS’, Psychothérapie Sensorimotrice, Modèle de la Dissociation Structurelle). Ces ‘’cartes’’ sont un guide dans la conceptualisation de cas et la prise de décision ‘’moment par moment’’ durant une session d’EMDR. Des vidéo clips seront présentés afin de démontrer comment suivre le progrès d’un client avec une grande précision, utilisant des repères verbaux et non verbaux pour déterminer où se trouve le client sur une ‘’carte’’ donnée et quel type de tissage est nécessaire pour faciliter ou approfondir le traitement du client. Objectifs d’apprentissage: • Développer un plan de traitement compréhensif basé sur le modèle TAI –et la conceptualisation de cas comme un guide de prise de décision ‘’moment par moment’’ durant une session d’EMDR. • Identifier de manière efficace les plateaux informatifs ou les catégories de schémas (responsabilité, sécurité, contrôle/choix) qui se révèlent dans ce que le client présente comme difficultés, dans le choix des cibles et les blocages. • Utilisation de la dyade pour aider à moduler l’affect chez les clients qui ont une très faible tolérance émotionnelle avec comme but de maintenir et même d’accélérer le traitement à l’intérieur de la fenêtre de tolérance. • Avoir recours aux stratégies avancées du tissage pour traiter les croyances bloquantes, les défenses rigides et les peurs venant de la ‘’vie intérieure’’ (c’est à dire l’affect, les sensations, les pulsions, les fantasmes). • Utilisation de diverses stratégies cliniques et du tissage afin de favoriser l’expression d’action adaptative, de compléter les actions inachevées ou tronquées et d’aborder différents domaines permettant de ‘’réparer’’ les dommages survenus au cours du développement.

Keywords: AEDP Dyadic Regulation Informatiional Plateaus IFS, Interweaves Sensorimotor Psychotherapy Structural Model of Dissociation Trauma-Focused Models "True" Authentic Self

Accuracy Verified: Yes

11. Knipe, J. (2008, June). EMDR toolbox. Presentation at the annual meeting of the EMDR Europe Association, London, England .

Language: English

Format: Conference

Abstract:
It is clear from over 17 published studies that the EMDR method is highly effective in assisting clients in resolving PTSD (Maxfield and Hyer, 2002). However, most clients who enter therapy do not have a simple problem of a single disturbing memory, but a complex history. Typically, clients come to therapy with a mixed presentation, of not only emotional disturbance, but also mental structures and actions which function to soothe, contain, avoid or dissociate from emotional disturbance. Thus, the initial presentation of most clients is complex and often ambivalent. In this workshop, examples will illustrate Adaptive Information Processing methods of targeting and resolving psychological defenses, such as avoidance, ambivalence, and idealization. Also, the BHS/CIPOS (Back-of-the-Head Scale/Constant Installation of Present Orientation and Safety) method will be described. This method is a set of procedures that can be used during the EMDR Desensitization Phase to therapeutically reverse dissociative processes while preserving emotional safety. Video segments from therapy sessions will be shown to illustrate each of these methods.

Keywords: Back-of-the-Head Scale BHS CIPOS Contant Installation of Present Orientation and Safety Psycholgical Defenses Targeting

Accuracy Verified: Yes

12. Knipe, J. (2012, June). EMDR toolbox [La Caja de herramientas en EMDR]. Presentation at the annual meeting of EMDR Europe Association, Madrid, Spain.

Language: English

Format: Conference

Abstract:
EMDR has had a profound positive impact on the lives of many clients and has been shown in more than seventeen published trials to be effective in the treatment of PTSD (Maxfield & Hyer, 2002). However, the DSM IV definition of PTSD is focused on the single traumatic incident, and many clients seeking relief in therapy have a damaging traumatic history that extended over repeated events or over long periods of time. The term, Complex PTSD (Herman, 1992, van der Kolk, 2005) has been proposed to describe a pattern of negative effects of prolonged and extreme stress, particularly during childhood. The focus of this workshop is to describe a theoretical framework, and specific therapy “tools” which may be useful in providing effective therapy, within the EMDR Adaptive Information Processing Model, to individuals suffering with Complex PTSD. Important concepts and particular interventions will be illustrated through video examples and transcripts from therapy sessions. Dr. Knipe will present methods for identifying and treating specific dissociative symptoms with accompanying evidence from available research or case studies. He will offer EMDR “tools” that can be used to make the healing power of EMDR more available to clients who are avoidant, and/or highly vulnerable to dissociative abreaction, chronic shame, and unrealistic idealization of self or of others. He will discuss the primary characteristics of clients with Complex PTSD, including problems with disrupted attachment and inappropriate psychological defenses. He will illustrate how to identify various Ego-‐States and work with these within the Adaptive Information Processing Therapy Approach. Time will be available for participants to discuss difficult EMDR cases.

EMDR ha tenido un profundo efecto sobre la vida de muchos clientes y ha demostrado en más de diecisiete ensayos publicados, ser eficaz para el tratamiento del TEPT (Maxfield & Hyer, 2002). Sin embargo, la definición del DSM IV del TEPT está centrada en el incidente traumático único, mientras que en muchos de los clientes que buscan el alivio a través de la terapia su historial traumático incluye episodios traumáticos repetidos o que se extienden a lo largo de períodos prolongados de tiempo. Se ha propuesto el término TEPT complejo (Herman, 1992, van der Kolk, 2005) para describir un patrón de efectos negativos derivados una situación de estrés prolongado e intenso que ha aparecido principalmente en la infancia. Este taller estará centrado en describir el marco teórico y las “herramientas” terapéuticas específicas que pueden ser necesarias para proporcionar , dentro del modelo de procesamiento adaptativo de la información de EMDR, una terapia eficaz a los individuos que sufran de un cuadro de TEPT complejo. Los conceptos importantes y las intervenciones concretas que se realizan serán ejemplificadas mediante ejemplos en vídeo y mediante transcripciones de sesiones de terapia. El Dr. Knipe presentará diversos métodos que permitan identificar y tratar los síntomas disociativos específicos, los cuales irán acompañado de la evidencia de que se dispone procedente de la investigación existente o de los estudios de casos. Ofrecerá, además, aquellas “herramientas”de EMDR que pueden ser empleadas para que el poder sanador del EMDR esté más disponible para aquellos clientes con comportamientos evitativos y/o que son extremadamente sensibles a experimentar abreacciones disociativas, vergüenza crónica o conceptos idealizados de sí mismos o de los demás no realistas. Comentará también cuales son las características principales de los pacientes que padecen de TEPT complejo, entre los que se incluyen los vínculos afectivos perturbados y los mecanismos de defensa psicológica inadecuados. Ilustrará, igualmente, cómo poder identificar los diversos estados del ego que se producen y cómo trabajar con ellos en el marco del procesamiento adaptativo de la información. Se dispondrá de un tiempo adicional para comentar con los participantes los casos difíciles que se presenten con EMDR.

Keywords: EMDR Toolbox

Accuracy Verified: Yes

13. Knipe, J. (2012, October). EMDR toolbox: Methods of extending EMDR to traumatized clients with significant vulnerability to dissociative abreaction and/or psychological defenses. Presentation at the 29th annual meeting of the International Society for the Study of Trauma and Dissociation, Long Beach, CA.

Language: English

Format: Conference

Abstract:
Abstract:The focus of this workshop will be to describe a theoretical framework, and specific EMDR-related therapy tools which may be useful during Janets Phase 2, the Phase of trauma processing, for multiply-traumatized clients with Complex PTSD. Points of similarity and difference will be described between the EMDR Adaptive Information Processing Model, and two other models of dissociation treatment: the Theory of Structural Dissociation of the Personality and the Internal Family Systems model. EMDR variations will be described which increase emotional safety, and thereby extend the use of EMDR to clients who might otherwise be vulnerable to the intrusion of overwhelming post-traumatic memory material. Through transcript and video examples, the Loving Eyes method (for safely accessing a traumatized Part), the Back-of-the-Head Scale (for measuring the degree of dissociative experience, moment-to-moment, in a therapy session), and the method of Constant Installation of Present Orientation and Safety (for maintaining emotional safety during the processing of a traumatic memory) will be presented. In addition, the structure and treatment of psychological defenses will be conceptualized within the Adaptive Information Processing Model.

Learning Objectives: 1. Describe the Loving Eyes method of developing a co-consciousness between an adult Part and a traumatized child Part. 2. Describe the clinical situations in which the use of the Back-of-the-Head Scale and the method of Constant Installation of Present Orientation and Safety would be likely to be helpful to a traumatized client. 3. Describe how psychological defense may be conceptualized within the Adaptive Information Processing model, and how defenses may be safely released, so that underlying post-traumatic material may be processed.

Keywords: Dissociative Abreaction Psychological Defenses Toolbox

Accuracy Verified: Yes

14. Knipe, J. (2010, July). EMDR toolbox: Specific methods of treating adult clients with complex PTSD, psychological defenses and dissociative personality structure. Preconference presentation at the 1st EMDR Asia Conference, Bali, Indonesia.

Language: English

Format: Conference

Abstract:
EMDR has had a profound positive impact on the lives of many clients and has been shown in more than twenty randomized, peer-reviewed trials to be effective in the treatment of PTSD. However, the DSM IV definition of PTSD is focused on the single traumatic incident, and many clients seeking relief in therapy have a damaging traumatic history that extended over repeated events or over many years. The term, Complex PTSD (Herman, 1992, van der Kolk, 2005) has been proposed to describe a pattern of negative effects of prolonged and extreme stress, particularly during childhood. The focus of this workshop is to describe a theoretical framework, and specific therapy “tools” which may be useful in providing effective therapy, within the EMDR Adaptive Information Processing Model, to individuals suffering with Complex PTSD. Methods will be described that can make the healing power of EMDR more available to clients who are avoidant, defensive, and/or highly vulnerable to dissociative abreaction, chronic shame, and unrealistic idealization of self or of others. Important concepts and particular interventions will be illustrated through video examples and transcripts from therapy sessions.

Keywords: Complex Posttraumatic Stress Disorder Complex PTSD, C-PSTD Dissociative Personality Structure Psychological Defenses Toolbox

Accuracy Verified: Yes

15. Knipe, J. (2006, June). EMDR toolbox: Video examples of methods of targeting avoidance, procrastination, affect dysregulation, the pain of being "dumped" by a lover, and a shame-based ego state in a client with a identity disorder. Presentation at the annual meeting of the EMDR Europe Association, Istanbul, Turkey.

Language: English

Format: Conference

Keywords: Back-of-the-Head Scale BHS CIPOS Contant Installation of Present Orientation and Safety Psycholgical Defenses Targeting

Accuracy Verified: Yes

16. Korn, D. L. (2008, May). EMDR treatment with survivors of chronic abuse and neglect: Repairing developmental deficits and shattered selves - [Utilisation d’EMDR dans le traitement des survivants d’abus ou négligence chroniques: Réparer les déficits développementaux et les sois éclatés]. Presentation at an annual meeting of EMDR Canada, Montréal, Quebec Canada.

Language: English

Format: Conference

Abstract:
Cet atelier d’une journée met l’accent sur l’intégration de l’EMDR à l’intérieur d’un plan thérapeutique. Nous aborderons l’utilisation d’EMDR pour traiter le Stress post-traumatique complexe, de même que d’autres syndromes cliniques d’origine traumatique, tels que le Trouble de personnalité limite et les Troubles dissociatifs. Des modifications et/ou additions au protocole EMDR seront proposées afin de tenir compte des capacités limitées à tolérer les affects, des défenses rigides, de la sur-utilisation des stratégies d’évitement, des conflits entre les états du moi, des tendances à la dissociation ou des dérégulations émotionnelles importantes.

Nous aborderons l’évaluation des aspects développementaux et des besoins d’attachement du client, l’établissement d’une bonne compréhension de la situation clinique et le développement d’un plan de traitement intégré avec des objectifs atteignables et réalisables. On portera plus particulièrement notre attention sur l’intégration de l’EMDR comme moyen de renforcer l’Ego et le développement des ressources au cours des différentes étapes du traitement. This full-day workshop will focus on integrating EMDR into an overall recovery plan. The use of EMDR in treating complex PTSD as well as other trauma-related syndromes such as borderline personality disorder and dissociative disorders will be addressed. In recognition of clients’ limited affect tolerance, rigid defenses, overdeveloped avoidance patterns, ego state conflicts, dissociative tendencies, and extreme emotional dysregulation, strategies for modifying and supplementing standard EMDR protocols will be explored. Assessing the developmental and attachment needs of the client, establishing a useful case conceptualization, and developing an integrated treatment plan with achievable goals will be discussed. Considerable attention will be devoted to integrating EMDR ego strengthening and resource development protocols into all phases of treatment.

Keywords: Complex PTSD Dissociative Disorders

Accuracy Verified: Yes

17. Siano, J. (2008, April). Emergency intervention in art therapy with EMDR and somatic experiencing. Workshop presentation at the 1st Bi-annual International European Society for Trauma and Dissociation Conference, Amsterdam, The Netherlands .

Language: English

Format: Conference

Abstract:
The following presentation shows a model, which was built and applied with many different populations, children, aged people and adults, during the Lebanon War 2006 and after it. The purpose was prevention of PTSD and overcoming the difficult and painful period. Originally it was aimed at art therapists, psychologists, and other mental health staff – Jews and Arabs. They work with already traumatized children and youth in the shelled north of Israel, have to contain much pain and to be strong for others. They were close to break down, or already broke down. The same model served the presenter later in many cases of crisis, with groups and individuals. Especially it was adapted with some much dissociated clients, giving voice (visual representation) to the different sub – personalities. The model aims for (1) bridging between state of freezing or collapsing and functioning; (2) providing tools for self regulation and helping others to self regulate; and (3) strengthening the felt sense of well-being connected to resources within the person and preventing PTSD. The methods used are: (1) evaluation of body-sensation, feeling and thoughts with SUDS (Subjective Units of Disturbance Scale); (2) drawing a picture of resource; installation of resource; (3) drawing a deficiency picture, a picture which represents the disturbing part in one’s present life; (4) EM (eye movements) between both pictures, through working in couples - bilateral stimulation; (5) re-evaluation of body – sensation, feeling and thought with SUDS. Learning objectives: 1. To demonstrate the impact of art in developing inner boundaries towards integration of ego states. 2. To legitimize extreme emotions and to understand that they are normal defenses to trauma. 3. To acquire tools for coping with trauma in the present.

Keywords: Art Therapy Emergency Intervention Somatic Experiencing

Accuracy Verified: Yes

18. Grand, D. (1998). Emerging from the coffin: Treatment of a masochistic personality disorder. In P. Manfield (Ed.), Extending EMDR: A casebook of innovative applications (1st ed.) (pp. 65-90). New York: W. W. Norton.

Language: English

Format: Book Section

Abstract:
"Dan" was a 48-year old married man who, despite ten years of psychoanalytic treatment, awakened every morning with the image of lying dead in a coffin. This dovetailed with his experience of daily life as devoid of meaning and pleasure. Despite his apparent relentless suffering and preoccupation with death, Dan reported never having been actively suicidal. In fact, his life appeared to be oddly homeostatic. He sought out therapy at the urging of his wife, who was exasperated by his pervasive negativity. This case illustrates the successful use of longer-term EMDR charactered by the multiple sessions and many months to fully reprocess individual protocols. Treatment was completed, with Dan free of coffin fantasies and capable of experiencing hope, joy and purpose for the first time in his life. His positive response, over time, indicates that individuals with characterological defenses can process, albeit incrementally, difficult material and ultimately reach a level of full resolution. Since my success with Dan, I have replicated this startling outcome with numerous clients in periods ranging from 9 to 18 months. This was inconceivable for me in my pre-EMDR days when many years of treatment yielded far more limited results. [Text, pp. 66-67]

Keywords: Adults Americans Case Report Life Experiences Males Personality Disorders Psychotherapeutic Processes Survivors Treatment Effectiveness

Accuracy Verified: Yes

19. Wolff, R. P. (2004). Evaluation of effectiveness of individual therapy sessions over 60 minutes. California Institute of Integral Studies, San Francisco, CA. AAT 3158599.

Language: English

Format: Dissertation/Thesis

Abstract:
Research has produced few studies that support the 50-minute therapy session as the most effective session length for achieving optimal therapeutic results. This descriptive study attempted to determine differences in therapists' perceptions of how session length might impact therapeutic process, therapeutic outcome, treatment of specific psychological disorders, and if session length preference was based on theoretical orientation or procedures/techniques. A total of 65 practicing therapists drawn from the International Society for the Study of Dissociation, EMDR International Association, Trauma Incident Reduction Practitioners, San Francisco Society of Lacanian Study, and California Psychological Network completed questionnaires regarding their perceptions about psychotherapy for individuals employing longer session lengths versus the standard 50-minute session.Overall frequencies of questionnaire responses and between groups comparisons were analyzed using Chi-Square. The sample endorsed the use of longer sessions at statistically significant frequencies on the following questionnaire items: three therapeutic outcome items: Increases client's satisfaction, Shortens overall duration of therapy, and Facilitates corrective emotional experience; and nine therapeutic process items: Access to client's emotional material, Integration of experience before leaving session, Deepens development of transference, Working through defenses, Access to traumatic experiences, Integrate traumatic experience within session, Working through traumatic experience, and Improving likelihood of breakthrough experiences. The sample also agreed on the use of longer sessions as potentially contributing to positive outcome for treatment of the following disorders: Substance Abuse, Panic Disorder, Agoraphobia, Specific Phobia, Social Phobia, PTSD, GAD, and Eating Disorders. The findings of this study suggest that longer session lengths may have a positive impact on therapeutic process, therapeutic outcome, and certain disorders. Specific implications for the field of psychology and suggestions for research are discussed. [Author Abstract]

Dissertation Abstracts International: Section B: The Sciences and Engineering. 65(12-B), 2005, pp. 6680.

Keywords: Empirical Study Health Personnel Attitudes Individual Psychotherapy Posttraumatic Stress Disorder Psychotherapeutic Processes PTSD Quantitative Study Treatment Duration Treatment Effectiveness

Accuracy Verified: Yes

20. Schottenbauer, M. A. (2006). Expert therapists and practicing clinicians: Reported prototypical treatments of trauma. The Catholic University of America. AAT 3239353.

Language: English

Format: Dissertation/Thesis

Abstract:
PTSD is a frequent psychiatric response to a variety of extreme psychological stressors. While several effective treatments for PTSD such as cognitive-behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) have been included on lists of empirically supported treatments, nonresponse rates to these treatments can be high. According to patient report, psychodynamic interventions are more common than CBT for PTSD in the community, yet only one randomized controlled trial has included a psychodynamic treatment for PTSD. This dissertation reviews the treatment dropout and non-response rates in studies of empirically supported treatments for PTSD. Next, a case for the value of psychodynamic treatment of PTSD is made, utilizing empirical research on links between the psychopathology of PTSD and psychodynamic concepts such as defenses and relationship patterns. Then, an empirical study was conducted to find out how psychodynamic and CBT therapists treat patients with PTSD, to discover commonalities and defining characteristics of treatment within each group of respondents, and to delineate the unique contributions of psychodynamic psychotherapy to the treatment of such patients.Therapists who identified themselves primarily with psychodynamic/psychoanalytic or cognitive-behavioral theoretical orientations were recruited online through professional organization listservs. They were randomly presented one of four case studies, describing variations on trauma. Participants then completed a Psychotherapy Process Q-Sort to describe quantitatively their ideal treatment of the given patient. Results indicated many similarities among clinicians of widely different perspectives. Among clinicians who indicated that their primary theoretical orientation was psychodynamic, three prototypical treatments were discovered, and among clinicians who indicated that their primary theoretical orientation was cognitive-behavioral, four prototypical treatments were found. Overall, the prototypes in the current study were correlated with, but not identical to, prototypes of PD, CBT, or interpersonal therapy (IPT) developed in previous studies based on experts' ratings. While the literature has suggested that clinicians who treat patients who have PTSD may make alterations in their techniques to address issues that are specific to PTSD, the current study provides some evidence that therapists are not aware of how their treatment for trauma is different from the theoretical approaches they endorse. [Author Abstract] Dissertation Abstracts International: Section B: The Sciences and Engineering. 67(10-B), 2007, pp. 6077.

Keywords: Cognitive Therapy Empirical Study Health Personnel Attitudes Mental Health Personnel Posttraumatic Stress Disorder Psychoanalytic Psychotherapy Psychotherapeutic Processes PTSD Quantitative Study

Accuracy Verified: Yes

21. Manfield, P. (1998). Extending EMDR: A casebook of innovative applications. New York: W. W. Norton.

Language: English

Format: Book

Abstract:
"Extending EMDR" is divided into two parts: those cases in which it was possible to target a relatively small number of distinct traumatic experiences, and those in which the client's symptoms have resulted from ongoing childhood trauma or neglect for which they are initially unable to identify representative discrete traumatic events. The cases in which clear targets were available required the therapists to identify those targets and work with a variety of resistances in order to achieve adaptive resolution. These clients could generally address their maladaptive defenses directly. Typically, their therapists relied on extensive cognitive interweave, structuring, support, and sometimes direct nurturing to make it possible for these clients to tolerate and utilize EMDR to process their targeted traumas.Where there were no distinct memories to target, the therapists needed to create innovative interventions. Their clients tended to be unable to address their maladaptive defenses directly without fragmenting or closing off. These cases required far more treatment time than those for which there were a limited number of discreet traumatic memories to target and process. Each therapist working with these clients needed to find a way to strengthen their ability to maintain internal cohesion and increase their sense of safety so that they could relinquish defenses without the threat of becoming overwhelmed and fragmented. Several of the therapists attempted to address directly the deficits that prevented their clients from recalling their past experiences, organizing them, and gaining access to specific memories and affect. [Text, pp. 9-10] [Pilots]

Keywords: Adults Americans Child Abuse Complex PTSD Defense Mechanisms Depressive Disorders Females Life Experiences Males Neglect Personality Disorders Posttraumatic Stress Disorder Psychotherapeutic Processes PTSD Survivors Treatment Effectiveness

Accuracy Verified: Yes

22. Browning, C. (1999). Flotar hacia atrás y flotar hacia delante: Técnicas para ligar el pasado, Presente y futuro [Floatback and Float Forward: Techniques for the Tie Past, Present and Future]. Presentation at EMDRIA Latinoamericana.

Language: Spanish

Format: Conference

Abstract:
El protocolo estándar de EMDR requiere enfocar los orígenes de la perturbación, los gatillos del presente y crear un patrón de conductas adecuadas para el futuro (Shapiro). Algunos pacientes, sin embargo pueden tener dificultades para conectar su problema actual con acontecimientos del pasado. Así también, otros pacientes pueden tener dificultades para crear patrones positivos para el futuro, especialmente si ensayar conductas nuevas los pone ansiosos. Para estos problemas las técnicas de "Flotar hacia atrás" y "Flotar hacia delante" desarrolladas por William Zangwill Ph. D., entrenador del Instituto EMDR, son métodos efectivos para ligar el pasado, presente y futuro en un ámbito terapéutico y proveen al terapeuta de instrumentos para abordar eficientemente ambos temas. LA TÉCNICA DE FLOTAR HACIA ATRÁS Abordar recuerdos tempranos asociados con el material perturbador es fundamental para EMDR. Shapiro dice que ayudar al paciente a encontrar un recuerdo temprano "debe ser una de las primeras opciones que debe considerar al terapeuta..." (Shapiro, 1995). La Técnica de Flotar hacia atrás es un camino eficiente y poderoso para llegar a esta meta, permitiendo al terapeuta asistir al paciente a llevar a cabo sus propias asociaciones con acontecimientos del pasado. Su uso es muy apropiado cuando el terapeuta sospecha que una perturbación que el paciente experimenta en el presente, tiene sus raíces en experiencias del pasado; especialmente cuando preguntas como "Cuál es su recuerdo más temprano en relación a lo que se siente ahora? no ha tenido éxito en ayudar al paciente a conectar con eventos del pasado. También cuando un paciente presenta un tema o experiencia recurrente, la Técnica de Flotar hacia Atrás es ideal para ayudar al paciente a identificar un target para el reprocesamiento. Muchos pacientes se ponen en contacto con los problemas actuales con relativa facilidad. Por ejemplo, una paciente que se queja que se siente abandonada cuando su marido se va de viaje de negocios, probablemente pueda recordar sus problemas actuales con facilidad. Entonces el terapeuta puede aplicar la Técnica de Flotar hacia Atrás para ayudarle a la paciente a recordar un acontecimiento del pasado con rapidez y eficiencia. Para usar la Técnica de Flotar hacia Atrás, arme el protocolo con el problema actual, utilizando los pasos que figuran en el Manual de Entrenamiento del Nivel I y del Nivel II (Shapiro, 1994) incluyendo la imagen, la cognición negativa (CN), la cognición positiva (CP), la validación de la cognición (VoC), emociones, Unidad Subjetiva de Perturbación (SUD) y sensación corporal. Sin embargo, no incide todavía el procesamiento (es decir, movimientos oculares u otra estimulación). En vez de eso, diga a su paciente: "Fíjese en la imagen de... y esas palabras (repita la imagen perturbadora del paciente y su cognición negativa), fíjese que emociones le vienen y donde las siente en el cuerpo. Ahora cierre los ojos y deje que su mente flote hacia atrás a un período anterior en su vida, no busque, simplemente deje que su mente flote a una época donde usted pensaba cosas similares... (repita las emociones que dijo el paciente) en ...(repita los lugares del cuerpo donde el paciente sintió las sensaciones). Cuando esté listo abra los ojos y dígame lo primero que le viene a la mente". Utilice esta experiencia más temprana como target, completando todos los items del protocolo: imagen, CN, CP, VoC, emociones, SUD y ubicación de las sensaciones corporales y comience a procesar con movimientos oculares u otro estímulo bilateral. Una vez que se ha procesado este material, vuelva al target original del material actual. Muy a menudo se generaliza el trabajo realizado sobre el material más temprano y ya no hace falta procesar el material actual. Es importante usar términos generales cuando se le dan al paciente las instrucciones de la Técnica de Flotar hacia Atrás, es decir, pedir un recuerdo temprano y no el más temprano. Hay varias razones que avalan esto. Primero, muchas veces es el peor recuerdo y no el primero que funciona como el mejor target para el reprocesamiento,. Además, usar términos generales es una ayuda para los pacientes más compulsivos y perfeccionistas que de otra manera estarían demasiado preocupados en no equivocarse y encontrar exactamente la primera asociación. Finalmente, la flexibilidad que permite la utilización de términos generales más que términos específicos aumenta la posibilidad de éxito del paciente de conectarse con el pasado que es la meta de esta técnica. El rasgo esencial de la Técnica de Flotar hacia Atrás es usar las preguntas del protocolo para conectar los problemas del presente con eventos del pasado. Pasar las preguntas como fueron desarrolladas por Shapiro es un potente método para ayudar a los pacientes a sintonizar con todos los aspectos de su experiencia del problema. El material perturbador se vuelve más vívido y actual para el paciente y posibilita recordar experiencias similares. Se supone, como hipótesis, que al haber desarrollado el protocolo con todas las preguntas sobre el problema actual, estimula la red neuronal de asociaciones y posibilita casi sin esfuerzo el "flotar hacia atrás" a asociaciones tempranas. Además, el vínculo paciente-terapeuta es realzado porque el terapeuta valida la experiencia del paciente (la perturbación actual) al empezar el trabajo desde el punto en el que se encuentra el paciente. Las asociaciones son del paciente, eliminando el tema de la resistencia a cualquier idea o interpretación introducida por el terapeuta. El paciente se da cuenta vivencialmente de la conexión del presente con el pasado usando la Técnica de Flotar hacia Atrás, pudiendo esquivar la evitación y otras defensas. LA TÉCNICA DE FLOTAR HACIA DELANTE Mientras que la Técnica de Flotar hacia Atrás posibilita muy a menudo que los pacientes vean y sientan la conexión entre el problema actual y los eventos pasados, la Técnica de Flotar hacia delante permite que el paciente identifique y reprocese la ansiedad anticipatoria y desarrolle patrones positivos para el futuro. Es un método que puede ser utilizado en cualquier momento del proceso terapéutico para solucionar bloqueos, renuencias y en algunos casos, resistencias o temas de beneficios secundarios o pérdidas. Es especialmente útil para trabajar con el miedo del paciente a hacer EMDR. Para ponerlo en práctica, primero pida al paciente que imagine lo peor que le puede pasar si hace "X" (por ej. probar una nueva conducta, testear una nueva habilidad, empezar una experiencia nueva). ¿Qué es lo peor que le puede pasar si hace EMDR? Que es lo peor que le puede pasar si soluciona este problema? ¿Qué es lo peor que le puede pasar si le pone límites a su jefe respecto a la cantidad de trabajo que espera que usted haga? El paciente puede necesitar ayuda para identificar la peor escena. Algunas sugerencias incluyen el miedo a perder el control de sus emociones, el miedo a perder el control de sus funciones corporales como el control de esfínteres, miedo a tener un ataque de pánico, y no poder manejar su vida emocional entre las sesiones. Una vez que el paciente ha identificado el incidente, pregunte por la peor parte de esa escena y utilícelo como el target de EMDR, armando el protocolo con las preguntas estándar, pero con una leve modificación: pregunte por la imagen que representa la peor parte del peor incidente, por ej. "Cuando usted ve una imagen de si mismo/a haciendo......, que es lo peor que puede pasar?" Después siga con el resto de las preguntas estándar, es decir, CN, CP, VoC, emociones, SUD, y ubicación de la sensación corporal. Estimule el procesamiento del paciente con movimientos oculares u otro estímulo bilateral. Si el desarrollo de la peor escena del paciente le provoca un miedo racional, puede que se tengan que tomar medidas prácticas para solucionar estas preocupaciones. Por ejemplo, usando la técnica de flotar hacia delante con un chico de 13 años que estaba en un hogar adoptivo transitorio, la peor escena evocada por él fue: "Me van a devolver al Hogar si esta adopción no resulta". Durante el procesamiento, el SUD se redujo de 8 a 3 con bastante rapidez pero de ahí no bajaba. El paciente comentó que no bajaba porque esta "peor escena" podría sucederle realmente y le había sucedido en el pasado. Paramos los movimientos oculares, charlamos un rato y elaboramos un plan para: a) una sesión con sus padres adoptivos para hablar sobre la permanencia de la adopción y b) una llamada en conferencia a su asesor legal para clarificar sus derechos y opciones. Volviendo al target después de esto, le fue posible reducir el SUD a 1 con unos pocos sets de movimientos oculares. Al utilizar la Técnica de Flotar hacia delante para reprocesar la peor escena, el paciente tiene una oportunidad para resolver la ansiedad anticipatoria. Durante la instalación de la cognición positiva, el paciente está creando patrones positivos para acciones en el futuro. Una mujer cuyo hermano fue verbalmente abusivo con ella en la infancia y en la actualidad la intimidaba, armó una "peor escena" con: "Va a ser igualmente abusivo cuando lo vea la próxima vez". La paciente había hecho mucho EMDR, reprocesando incidentes de la infancia relacionados con el abuso verbal del hermano. Sin embargo, sin un referente positivo vivencial, seguía ansiosa cada vez que interactuaba con él. Pidiéndole que "flote hacia delante" y usando EMDR sobre una de las peores escenas, alivió su ansiedad respecto a una fiesta familiar que tenía pendiente. Instalando una CP de "Ahora estoy más fuerte" le permitió crear una imagen de si misma manejando a su hermano con humor y sintiéndose segura. A aplicar las Técnicas de Flotar hacia Atrás y hacia Delante y ocuparse así del pasado, presente y futuro, el terapeuta de EMDR puede sanar mejor a su paciente. Es más, las Técnicas de Flotar hacia Atrás y hacia Delante están basadas en EMDR. Las dos incorporan las preguntas del protocolo standard y le dan al terapeuta y al paciente la oportunidad de manejarse más fluidamente con dicho protocolo.

EMDR standard protocol requires a focus of the origins of the disturbance, the triggers of this and create a pattern of behaviors appropriate to the future (Shapiro). Some patients, however, may have difficulty connecting the current problem with past events. Also, other patients may have difficulty creating positive patterns for the future, especially if you try new behaviors makes them anxious. For these problems the techniques of "float back" and "Float forward" developed by William Zangwill Ph.D., EMDR Institute trainer, are effective methods to link the past, present and future in a therapeutic area and provide the therapist tools to effectively address both issues. THE ART OF FLOATING BACK Addressing early memories associated with foreign material is essential to EMDR. Shapiro said that helping the patient to find early memory "must be one of the first options to consider when therapist ..." (Shapiro, 1995). Floating Technique back is a powerful and efficient way to reach this goal, allowing the therapist to assist the patient to carry out their own associations with past events. Its use is most appropriate when the clinician suspects that a disturbance that the patient is experiencing at present, is rooted in past experiences, especially when questions like "What is your earliest memory in relation to what you feel now? Not been successful in helping patients to connect with past events. Also when a patient has a recurrent theme or experience, the Backward Floating Technique is ideal for helping the patient to identify a target for reprocessing. Many patients come into contact with the current problems with relative ease. For example, a patient who complains that she feels abandoned when her husband goes on a business trip, you can probably recall their current problems with ease. Then the therapist can apply the technique Float Backwards to help the patient to remember a past event quickly and efficiently. To use the technique to back float, arm the protocol to the current problem, using the steps listed in the Training Manual Level I and Level II (Shapiro, 1994) including the image, negative cognition (NC) positive cognition (PC), validation of cognition (VoC), emotions, Subjective Unit of Disturbance (SUD) and bodily sensation. However, it still affects the processing (ie, eye movements or other stimulation). Instead, tell your patient: "Look at the picture ... and those words (repetition of the disturbing image of the patient and negative cognition), note that emotions come from and where you sit on the body. Now close eyes and let your mind float back to an earlier period in your life, look no further, just let your mind float to a time when you thought things like ... (repeat the emotions that said the patient) .. . (repeat parts of the body where the patient felt the sensation). When you are ready open your eyes and tell me the first thing that comes to mind. " Use this early experience as a target, completing all protocol items: image, CN, CP, VoC, emotions, SUD and location of bodily sensations and begin processing with eye movements or other bilateral stimulation. Once this material has been processed, return to the original target of the current material. Very often we generalize the work done on the earlier material and no longer have to render the current material. It is important to use general terms when the patient is given instructions Technique Float Backwards, ie a memory request early and not earlier. There are several reasons that support this. First, it is often the worst memory and not the first that works as the best target for reprocessing. In addition, using general terms is an aid for compulsive and perfectionistic patients who otherwise would be too concerned with avoiding failure and find exactly the first association. Finally, the flexibility that allows the use of general rather than specific terms increases the likelihood of success of the patient to connect with the past that is the goal of this technique. The essential feature of the technique is to use Float Backwards questions of protocol to connect the problems of the present with past events. Skip the questions and were developed by Shapiro is a powerful method to help patients to tune into all aspects of their experience of the problem. The foreign material becomes more vivid and present to the patient and possible recall similar experiences. It is assumed, arguendo, that having developed the protocol with all the questions about the current problem, the neural network encourages and facilitates partnerships almost effortlessly "float back" early associations. In addition, the patient-therapist relationship is enhanced because the therapist validates the patient's experience (current disruption) to start work from the point where the patient is. Partnerships are the patient, eliminating the issue of resistance to any idea or interpretation introduced by the therapist. The patient realizes experientially connecting the present with the past by using the technique Float Backwards, can avoid the avoidance and other defenses. THE ART OF FLOATING FORWARD While technology enables Float Backwards often patients to see and feel the connection between the current problem and past events, the forward float technique allows the patient to identify and reprocess anticipatory anxiety and develop positive patterns the future. It is a method that can be used at any time of the therapeutic process to troubleshoot crashes, reluctance and in some cases, resistance or topics of ancillary benefits or losses. It is especially useful for working with the patient's fear to do EMDR. To put this into practice, first ask the patient to imagine the worst that can happen if you "X" (eg. Try a new behavior, test a new skill, start a new experience.) What's the worst that can happen if you EMDR? That's the worst that can happen if you solve this problem? What's the worst that can happen if you put your head limits on the amount of work expected to do? The patient may need help to identify the worst scene. Some suggestions include fear of losing control of his emotions, fear of losing control of their bodily functions such as bowel and bladder control, fear of having a panic attack and can not manage their emotional life between sessions. Once the patient has identified the incident, ask for the worst part of that scene and use it as the target of EMDR, setting up the protocol with the standard questions, but with a slight modification: ask for the image that represents the worst of worst incident, eg. "When you see a picture of him / herself by ......, it's the worst that can happen?" Then follow with the rest of the standard questions, ie, CN, CP, VoC, emotions, SUD, and location of bodily sensation. Stimulate the processing of patients with eye movements or other bilateral stimulation. If the development of the patient's worst scene provokes a rational fear, you may have to take practical steps to address these concerns. For example, using the technique of floating forward with a boy of 13 who was in a temporary foster home, the worst scene evoked for him was: "I will return home if this adoption is not." During processing, the LDS was reduced from 8 to 3 fairly quickly but it does not down. The patient said he did not go down because the "worst scene" could really happen and had happened in the past. Eye movements stopped, we chatted a while and developed a plan for: a) a meeting with her adoptive parents to discuss the permanence of the adoption and b) a conference call to his legal adviser to clarify your rights and options. Returning to the target after that, it was possible to reduce the LDS-1 with a few sets of eye movements. Using Floating Technique forward to reprocess the worst scenario, the patient has an opportunity to resolve the anticipatory anxiety. During the installation of the positive cognition, the patient is creating positive patterns for future action. A woman whose brother was verbally abusive to her children and now intimidated, put together a "worst stage" with: "It will be equally unfair when I see him next time." The patient had done much EMDR reprocessing childhood incidents related to verbal abuse of his brother. However, without a positive reference experiential, still anxious every time I interacted with him. Asking him to "float forward" and using EMDR on one of the worst scenes, relieved her anxiety about a family party that was pending. Installing a CP of "I'm stronger now allowed him to create an image of herself driving her brother with humor and feeling safe. To apply the techniques to float back and forth and deal well past, present and future, the EMDR therapist can heal your patient better. Moreover, techniques to float back and forth are based on EMDR. Both incorporate the standard protocol questions and give the therapist and the patient the opportunity to be managed more smoothly with this protocol.

Keywords: Floatback Technique Float Foward Technique

Accuracy Verified: Yes

23. Wizansky, B. ([2003]). Footsteps through the maze - A model for using EMDR with oppositional children. Presentation at the EMDR Israel Association, Nazereth Ilit, Israel.

Language: English

Format: Other

Abstract:
This paper presents a therapeutic model developed to facilitate communication with children who have difficulty cooperating with the therapeutic process. The model utilizes the concept of a Maze metaphorically, in combination with the directed focusing, dual attention, and bilateral stimulation of EMDR in order to meet and process disturbing emotion. Underlying this model is the concept of an internal psychic space, connected to memory and association, wherein reside the child's potential range of emotions. “The Maze”, becomes the metaphor for that space, while a step by step process leads gradually to playful, non threatening communication with the child about his problem. (the entrance). The Footsteps (self drumming on alternate knees) provide the bilateral stimulation and dual attention required by EMDR. These lead the child on his own path to better ways of coping (the exit). Before presenting the model, the paper discusses several points: First, the necessity of touching on this inner space in order to bring about balance and change; second, the difficulties which traumatized, rigidly defended children have in approaching their emotions; and third, the role of cumulative trauma in preserving the child’s defenses and oppositional stance.

Keywords: Children Footsteps Through the Maze Opposition Disorder

Accuracy Verified: Yes

24. Leeds, A. (2007, June). Improving self-regulation and social functioning for survivors of early emotional neglect and abuse with positive affect tolerance and integration protocol: A case series. Poster presented at the annual meeting of the EMDR Europe Association, Paris, France.

Language: English

Format: Conference

Abstract:
Survivors of early emotional neglect experience pervasive difficulties including vulnerability to adult psychiatric disorders and inability to regulate emotional states (Schore, 1996, 1997, 2000, 2001a, 2001b; Teicher, 2000, 2002; Teicher et al, 1993; Teicher et al., 1997). Their inability to regulate emotional states is not solely linked to effects of adverse events, but is significantly linked to insufficient exposure to normal, developmental attachment sequences that foster capacities for self-regulation.
A subset of adult survivors of early, pervasive, emotional neglect who meet full or partial criteria for posttraumatic stress disorder also present with comorbid Cluster C Axis II symptoms (Avoidant, Dependent, Obsessive-Compulsive) and meet criteria for dismissing (or fearful) insecure attachment (Cassidy & Shaver, 1999; Main, 1996).
Clinical assessment reveals these patients have low tolerance for positive interpersonal emotions and engage in defensive strategies to dismiss, minimize, deny or subtly avoid experiencing and assimilating this positive emotional states into their internal model of self. These strategies include overt and covert behavioral avoidance as well as dissociate defenses. Paradoxically, these patients may show superficial characteristics or competence, interpersonal skills, or emotional stability which on closer examination prove to be fragile or which collapse in the face of social stressors.
The general theoretical base for the Positive Affect Tolerance and Integration (PAT) protocol is related to McCullough’s (1996, 2003) model of affect phobia and recognizes McCullough’s emphasis on an anxiety regulating, titrated approach to developing tolerance for adaptive affect and associated coping behaviors. Putnam’s (1997) discrete behavioral states model provides an important conceptual framework for understanding these patients’ needs to gradually develop new discrete behavioral (psychophysiological and affective) states and new pathways (schemes and scripts) fostering access to these shared positive states often as a crucial early phase of treatment to help resolve their impairments in emotional self-regulation.
This presentation describes the use of standard EMDR procedural steps in a treatment plan that postpones the standard three pronged (past, present, future) PTSD protocol, but which is consistent with the consensus model for Complex PTSD (Brown, Scheflin & Hammond, 1998; Chu, 1998; Courtois, 1999; Hart, Nijenhuis, Steele, 2006) and other EMDR approaches focused initially on improving response to current stimuli (Hoffman, 2004; Leeds & Korn, 1998; Leeds & Shapiro, 2000) before attempting to target childhood traumatic memories. Targets for PAT are recent experiences in which the patient was exposed to positive, shared, interpersonal emotional states. The purposes for applying PAT to these targets are: to decrease defensive avoidance; dissociation and anxiety about shared positive emotional states; to increase capacity to tolerate and enjoy these shared positive emotional states; and to integrate these shared positive emotional states into positive schemas and self-concepts. Observed clinical gains following PAT included: improved mood and resilience, and decreased depersonalization during subsequent use of EMDR to reprocess traumatic memories.
The goal in presenting this “Positive Affect Tolerance and Integration Protocol” case series is to encourage research to evaluate the clinical effectiveness of this application of the standard EMDR procedures for a clinical subpopulation generally considered challenging to treat.

Keywords: Affect Tolerance Poster Self-Regulation Social Functioning

Accuracy Verified: Yes

25. Colelli, G. (2009, August). Integrating EMDR into a long term psychodynamic treatment. Presentation at the annual meeting of the EMDR International Association, Atlanta, GA.

Language: English

Format: Conference

Abstract:
This workshop will cover specific strategies in implementing EMDR into a long-term psychodynamic treatment. Participants will learn how to create a treatment plan integrating EMDR into long-term treatment. The workshop will cover target selection, pacing of treatment, using EMDR with transferences and defenses and processing characterological symptoms to a state of resolution. Participants should be well versed in a psychodynamic method and the use of EMDR. The workshop will be specific to how to integrate the methods for successful, goal-oriented treatment.

Keywords: Psychodyamic Treatment

Accuracy Verified: Yes

26. Colelli, G. (2010, April/May). Integrating EMDR into a long term psychodynamic treatment. Presentation at the annual meeting of EMDR Canada, Toronto, Ontario.

Language: English

Format: Conference

Abstract:
This workshop will cover specific strategies in implementing EMDR in the creation of a psychodynamic treatment plan. The workshop will cover target selection, pacing of treatment, using EMDR with transferences and defenses, and processing characterological symptoms to a state of resolution. Participants should be well versed in a psychodynamic method and the use of EMDR. The workshop will be specific to how to integrate the methods for successful goal oriented treatment.

Keywords: Psychodynamic Treatment Plan

Accuracy Verified: Yes

27. Knipe, J. (1998). It was a golden time...: Treating narcissistic vulnerability. In P. Manfield (Ed.), Extending EMDR: A casebook of innovative applications, (1st ed.) (pp. 232-255), New York: Norton.

Language: English

Format: Book Section

Abstract:
This chapter focuses on EMDR-enhanced therapeutic protocols to treat individuals whose painful life experience is separated from consciousness by complex defensive structures, particularly those associated with narcissistic and avoidance defenses.In many of the clients I have worked with, the healing power of EMDR is prevented or impaired by unresolved positive feelings that block the client's full awareness of the negative experience associated with trauma. This can occur when the overall complex of posttraumatic images, self-defeating cognitions, unpleasant feelings and sensations (what Francine Shapiro calls the unprocessed "memory network") contains embedded strong positive affect that is highly valued by the client. In the case of a person with narcissistic defenses, the positive material may block awareness of negative memories, especially if the positive experience occurred in the larger context of trauma and neglect. In such instances the positive part of the experience is idealized through selective memory and strengthened in intensity, because it serves as a defense against the core PTSD. The negative part of the memory is partially or wholly dissociated and is thus less accessible to processing. [Adapted from Text, pp. 232, 233-234]

Keywords: Adults Americans Case Report Defense Mechanisms Life Experiences Males Posttraumatic Stress Disorder PTSD Self Concept Survivors Treatment Effectiveness

Accuracy Verified: Yes

28. Manfield, P. (1995, June). Narcissistic disorders: Using EMDR with these difficult clients. Presentation at the EMDR Network Conference Santa Monica, CA.

Language: English

Format: Conference

Abstract:
Definition of client population: Disorder of the self. The narcissistic character is often identified by his or her grandiose facade concealing an underlying sense of emptiness and worthlessness. To experience the underlying emptiness is so painful for them that these people cut off their inner experience and rely instead on external admiration and praise to support their grandiose or superior view of themselves; their condition is often referred to as a "disorder of the self." Because of their dependence on others for their sense of themselves, they are exquisitely sensitive to criticism or disapproval, often warding off deflation by becoming increasingly grandiose, superior, disdainful or demeaning. Many conceal their grandiosity, maintaining a secret sense of superiority which may be based upon their perfectionism or their quiet devaluing of others. View of others: there is a range of severity of the narcissistic character from personality disorders to a narcissistic character style. People with personality disorders, are unable to form a trusting bond with another person; they view people primarily as interchangeable, performing a function which could equally be performed by many others. Less impaired narcissistic characters, however, are able to form varying degrees of attachments to other people, although their ability to trust and care about other people is limited. Most commonly they relate to people they can idealize or be admired by. People tend to be seen in extremes as either superior and powerful or inferior and worthless; supportive and admiring or critical and attacking. Difficulties in using EMDR: Clinically these clients represent a difficult and often frustrating population to treat; they are brittle and easily injured if they to not feel perfectly understood by their therapists, and they will distance at the slightest hint that they are being judged or used. They resist focusing inward and defining their problems as arising within themselves, and find it difficult to sustain any genuine affect, other than perhaps rage. If they feel understood and accepted, however, they will eventually talk about their sense of emptiness and worthlessness and their confusion about who they are and what is truly meaningful and valuable to them. Beck, Young and others have described factors that make it difficult to treat any personality disorder using a cognitive behavioral approach. There have in fact been very few reported "successes" in the literature. Most of the difficulties are related to the self and object splitting characteristic of these clients. These clients have limited access to feelings, limited access to spontaneous thoughts, body sensations, memories, etc., and vague unfocussed presenting problems making targeting difficult. They usually have difficulty with emotional and often intellectual continuity from session to session; they will rarely keep a log or follow through with homework; transference issues often come into central focus and must be addressed before other targets; and their selfdefeating beliefs and behavior patterns are extremely deeply held, pervasive and resistant to change. In addition to varying degrees of these difficulties, narcissistic clients present all of the problems in EMDR that they do in more traditional therapies; including their tendencies to act out, deny, and avoid. These and other defenses interfere with completion of segments of therapeutic work and make it difficult for the clinician to keep work focused within one neural network. Self and object splitting leads to continuity problems within or between sessions and a difficulty maintaining clarity about the reason for being in treatment. The client may feel suicidal one week and declare himself or herself to be fully recovered the next. Perhaps the most confirming aspect of the treatment of these clients, however, is their emotionally impoverished pasts; they have very limited experience of nurturing, loving and caring to draw !?om in order to interweave new meanings and perspectives into traumatic or painful past experiences. Length of treatment: I have found that I have been able to achieve good results with higher level narcissistic clients with whom I have had an established relationship at the time I introduced EMDR into the treatment. My results with clients who have come to therapy asking specifically for EMDR and with whom I have begun using EMDR soon after the beginning of treatment have been generally poorer, varying with the severity of the client's disorder, the less severe doing best. The client needs to be able to establish a meaningful trusting relationship with the therapist; the more severe the client's difficulties with attachment, the more time this process requires. Narcissistic clients do not tend to see their difficulty with vulnerability, trust and intimacy as a problem within themselves. If they are able to recognize personal problems, they are usually in the area of self esteem and obstacles to achievement. When they are able to resolve some of these latter problems fairly rapidly through treatment they tend to terminate, no longer seeing a sufficient purpose for treatment. In a sense, they can become better narcissists; their grandiose view of themselves is enhanced and they are reinforced in their use of self-sufficiency as a defense against interpersonal vulnerability. I view the relative efficiency of EMDR as a problem for deeper treatment of narcissistic clients because there is less time for the therapeutic relationship to develop and consequently a limited opportunity to impact the client's object splitting. I believe that this is why I have found EMDR with narcissistic clients to be most effective when it is introduced after a therapeutic relationship has had time to develop. Negative cognitions: The early maladaptive schemas of narcissistic clients are pervasive in their lives and point to a plethora of negative cognitions. Typical early schemas are: I must control myself (or my feelings, my behavior, my body) at all times; no one cares; my needs will never be met; I can't trust anyone; I am deeply flawed and unlovable; I am dikeable, unattractive to others; I will always fail; my flaws are totally unacceptable to others; I must be perfect or I am worthless; I deserve to be treated more specially than others; I must please others to avoid attack; I'm alone; nobody understands me; I am OK if I am better than others; I am OK only if others admire me. It is often helpful to narrow these cognitions down to make them manageable with EMDR Treatment: In addition to the recommended protocol of establishing a safe space to which the client can retreat if necessary, before doing an EMDR session with one of these clients, the therapist should identify as many of the client's emotional resources possible, in particular expriences if any of having felt loved and accepted ad examples of loving people or relationships the client has observed Among other things, these facilitate more effective copitive interweaves. The initial task in doing an EMDR session with this client population is to establish an appropriate and richly defined target. Since it is more difficult for these clients to access meanm&l memories in an emotionally alive way, the therapist must be more active in helping the client stimulate the associated neural netork as I l l y as possible. In addition to the client's reaction to the plight of children he may be related to or observe (Level I1 training), a rich source of emotional responsiveness and resources is the client's own response to situations he has witnessed in news media, TV, movies or theater. A major challenge in addressing a narcissistic character type using EMDR is tracking the course of the session with these clients and identifying when they drip out of the targeted neural network. This process can be subtle because it requires an ability to differentiate true avoidance hm spontaneous associations which may appear at hat to be irrelevant; it requires a familiarity with and sensitivity to the protective or defensive mechanisms they use to insulate themselves fiom painful memories and affect. As the patterns ofmovement in and out of the targeted network are identified it is important to use interventions that are experienced by the client as supportive but nevertheless make hun or her aware of having wandered. Although the narcissistic client may initiate treatment with the stated goal of improving his performance in specified areas, he will agree upon reflection that the real problem is that he feels an overriding need to perform in order to feel worthwhile. Since he has never known any other way of dealing with his self-worth, he will be skeptical about whether it is possible to feel a sense of worth that is not based upon performance, and it is easy for the therapist to lose perspective and join him in that beliet especially while doing EMDR with its potential for reprocessing with extraordinary precision specific obstacles to performance. The therapist must, however, retain her healthy perspective if the client is to learn to accept himself. For more clinical information about treating disorders of the self: 1.)Beck, Aaron T., et al, Cognitive Therapy Of Personality Disorder Guilford Press, New York, N. Y., 1990 2.)Manfield, Philip, Split Self/Split Object: Understanding And Treating Borderline, Narcissistic And Schizoid Disorders, Jason Aronson Publishers, Northvale, N.J., 1992. 3.)Young, Jeffrey, E, Cognitive Therapy For Personality Disorders: A Schema-Focused Approach, Professional Resource Exchange, Inc., Sarasota, Florida, 1990.

Keywords: Narcissistic Personality Disorder

Accuracy Verified: Yes

29. Bergmann, U. (2004, June). Personality disorders as a variant of dissociative phenomena. Treatment with an integration of EMDR and ego-state work in the healing of self. Presentation at the annual meeting of the EMDR Europe Association, Stockholm, Sweden .

Language: English

Format: Conference

Abstract:
The integration of EMDR with Ego State Therapy will be presented as a comprehensive approach to treatment of the wide spectrum of personality disorders. These diagnostic categories include individuals manifesting character pathology, borderline personalities, antisocial and sociopathic tendencies as well as addictive behaviors. These clients have often been seen as poor candidates for EMDR or even nonresponders. They are often mandated for treatment or come at the behest of others. Their histories often include early repeated experiences of abuse, deprivation, abandonment, and parental coldness. The hallmarks of personality disorders are rigid, intractable defenses, difficulty relating and empathizing with others, as well as acting out behavior. Historically, the treatment of personality disorders has been described as the symptoms of personality disorders be viewed as aspects of dissociation and will examine the applications of ego state concepts and techniques to all phases of the EMDR protocol in order to facilitate the treatment of these clients. Central to this approach is the conceptualization of self and object rcpresentations, self-objects or schemas as ego-states. Discussion will include how to use a developmental approach to assessment and will review the identification, mapping, and accessing of ego-states as well as how to promote ego-state-specific EMDR targets, facilitating the enhancement of EMDR processing.

Keywords: Complex Trauma Dissociation Ego State Therapy Personality Disorders

Accuracy Verified: Yes

30. Easterling, M. (2002, June). A protocol for building emotional resilience within a troubled world. Presentation at the annual meeting of the EMDR International Association, San Diego, CA.

Language: English

Format: Conference

Abstract:
The participant will be able to 1) develop the imaginational context of and employ this stabilizing protocol, useful in clients with insecure attachments, strategically ordered to elicit and allow desensitization of the inhibitory and adaptive affects within the basic EMDR protocol to allow completion typically within a fifty minute session; 2) teach to clients necessary integrated aspects of short term anxiety regulating psychotherapy and Heartmath methods, including how innate affects can act to guide adaptive behavior within a functional and dysfunctional system and how commonly used defenses and inhibitory affects impede adaptive behavior. Case examples and videos demonstrate the protocol.

Keywords: Emotional Resilience Protocol Heartmath

Accuracy Verified: Yes

31. Gomes, A. L., Fonseca, A. M., & Alabe, E. (2011, August). Psychology for humanity. Poster presented at the annual conference of the EMDR International Association, Orange County, CA.

Language: English

Format: Conference

Abstract:
Poster outlines the work accomplished by the Brazilian Association of Psycholgical Humanitarian Aid Program

Keywords: Brazil Disasters Humanitarian Assistance Poster

Accuracy Verified: Yes

32. Giovannozzi, G. (2012, June). Regulated eye contact activation and installation protocol [Regulación de la activación del contacto ocular y protocolo de instalación]. Presentation at the annual meeting of the EMDR Europe Association, Madrid, Spain.

Language: English

Format: Conference

Abstract:
Porges’ polyvagal theory provides a plausible explanation for the covariation between psychiatric and behavioral disorders and the atypical regulation of the Autonomic Nervous System (ANS). Porges himself associated this phenomenon with the failed maturation of the ventrovagal circuit, as well as with the child’s failure to learn the ability to modulate the so-‐called “vagal break” which keeps the heart-‐rate low and inhibits the influence of the SNS, allowing the modulation of the facial and head muscles and, therefore, the social engagement function, often impaired in psychiatric pathologies. From a psychotherapy standpoint, Porges’ finding that the maturation of the ventrovagal circuit and of its associated braking function occurs ontogenetically later than that of other ANS branches (last months of pregnancy and first year of life) and that a good relation with the caregiver is essential for its development is of significant importance. In this dyad – with the cortical-‐bulbar pathway, sufficiently myelinated at birth, regulating face and head muscles and allowing signals exchange with the caregiver – children learn to confront their internal states and the environment as well as regulate their emotions, regulating an adaptive neuroception with the consequent possibility of a good social involvement. This focus on the first year of life and the caregiver – child dyad, in terms of time and place for the construction of biologically based behaviors common to all human beings, paves the way, as anticipated by Porges himself, for new possible intervention models in psychotherapy directly acting on the missed or impaired steps in this first phase of the psycho-‐physiological development process, without disregarding its psychobiological quality. Clinical Application Since I believe that the inter-‐brain perspective is the most efficient not only for the etiological explanation but especially for the restoration of relational impairments occurred during brain-‐brain interactions, I chose eye contact (EC), because, according to several scholars, it is a privileged communication channel, in particular between mother and child. Several scholars agree that all forms of psychopathology share a failure in emotional regulation, which can be mostly traced back to the failure in the child-‐ caregiver adaptive tuning and therefore to the impairment of their inter-‐brain communication. An intervention on the EC shifts the therapy focus on this dysregulation to restore its functions. The EMDR AIP approach relies on the brain adaptive processing ability. EMDR has proved, in appropriate conditions (good therapeutic alliance, client stabilization, compliance with the EMDR protocol), our brain can repair traumatic injuries, i.e., reacquire and use information dysfunctionally stored after a trauma. Successful use of EMDR on target not directly traceable to a traumatic event (e.g., defenses, chronic pain, etc.) allows for the possibility to use this processing tool in increasingly broad fields and refines its resources. Thanks to its three-‐pronged approach to dysfunctionally stored information in the brain (EMDR works on the cognitive, emotional and somatic level), the inter-‐brain quality of its scope (the therapeutic alliance is part of the healing process) and for its focus on the present (EMDR works on the present, i.e., on the current and active components of the pathogenetic memory, bypassing all mediations and interpretation), EMDR seemed the most appropriate therapeutic tool to intervene on the EC dysregulation found in several psychiatric pathologies. Conclusion An EMDR protocol for the exploration and modulation of the EC is proposed. This protocol proved particularly useful with depressed or severely dissociative clients. After making clients aware of their difficulty in maintaining the EC, they are retrained to use this contact first on objects, then on animals (excellent mediators of a primitive form of social contact) until they are able to achieve eye contact with the therapist. During this training, clients are encouraged to become aware of their body sensations, emotions and beliefs, and the positive ones are installed with BLS. Memories of relational situations where clients identify an impaired EC are identified and these are targeted with the standard protocol. The focus then shifts to present and future situations. The regulation purpose of this protocol affects the application mode: interventions must never be dysregulating, therapists must proceed slowly. Clients must be rigorously kept within their window of tolerance, must be trained to recognize it and able of staying within its boundaries with respect to the microregulation of the EC.

La teoría polivagal de Porges proporciona una explicación plausible para la covariación entre los trastornos psiquiátricos comportamentales y la regulación atípica del sistema nervioso autónomo (ANS). El propio Porgues asoció este fenómeno con el fallo de maduración del circuito ventrovagal, por tanto el niño falla al aprender una habilidad también llamada “bloqueo vagal”, que mantiene la tasa cardiaca baja e inhibe la influencia del SNS, permitiendo la modulación de los músculos faciales y la cabeza, y por tanto, la función optima del compromiso social, a menudo emparejada con patologías psiquíatricas. Partiendo desde un punto de vista psicoterapéutico, Porges encontró que la maduración del circuito ventrovagal y su asociación con la función de frenado ocurre ontogenéticamente después que otras ramas del sistema nervioso autónomo (Los últimos meses del embarazo y los primeros años de vida) y que una buena relación con el cuidador es esencial para su desarrollo es significativamente importante. En esta línea – con vía córtico-‐bulbar, lo suficientemente mielinizada en el nacimiento, regulando los músculos de la cara y la cabeza y permitiendo señales de intercambio con el cuidador-‐ Los niños aprenden a estar cómodos con sus estados internos y con un ambiente que también regula sus emociones, regular una neurorecepción con la consecuente posibilidad de una buena integración social. Centrándonos en el primer año de vida del niño y el cuidador – La pareja de niños, en términos de tiempo y lugar para la construcción biológica fundamentada y basada en todos los seres humanos, allana el camino, como anticipó Porges, para nuevos modelos de intervención en psicoterapia, actuando directamente con el paso perdido o afectado de esta primera fase del proceso de desarrollo psicofisiológico, sin tener en cuenta su calidad psicobiológica. Aplicación Clínica. Desde que creó que la perspectiva del cerebro interior, continúa siendo la más eficiente no solo para desarrollar explicaciones etiológicas, también para la restauración de los desajustes relacionados ocurridos durante las interacciones cerebro-‐cerebro. Escogí contacto visual (ECE), porque, de acuerdo con numerosos investigadores, es un privilegiado canal de comunicación, particularmente eficaz entre una madre y su hijo. Numerosos profesionales afirman que todas las formas de psicopatología comparten una fallo en la regulación emocional, que solo puede crear un error en el la comunicación interna del cerebro. Esta intervención en el EC modifica la terapia y la centra en la desregulación y la restauración de funciones. El enfoque EMDR SPIA está basado en la habilidad de procesamiento de la información relevante, EMDR ha sido probado en condiciones idóneas (buena alianza terapéutica, estabilización de la queja del cliente disgustado con el EMDR.).

Keywords: Installation Protocol Regulated Eye Contact Activation

Accuracy Verified: Yes

33. Giovannozzi, G. (2013, June). Safety, regulation, self-regulation and eye contact: New challenges for EMDR therapy. Presentation at the annual meeting of the EMDR Europe Association, Geneva, Switzerland.

Language: English

Format: Conference

Abstract:
Porges’ polivagal theory of the hierarchical interpretation of the autonomic nervous system (ANS), in addition to extending the range of human beings’ possible responses to environmental demands, links the first line ventral-vagal response with the regulation of important viscera as well as that of facial and head muscles, mediating social interactions, and associates its activation with the feeling of safety, identifying this latter condition as essential for a person’s well-being.
Without safety no social relations, physiological regulation or healing are possible. Hence the importance for EMDR therapists to lead their clients to this condition: lacking the activation of the ventral-vagal circuit there can be no processing. EMDR therapists will be provided with tools to keep their clients in safe conditions within the setting.
Clients exposed to trauma and/or insecure attachment do not have a good ANS regulation and maintain inadequate defensive attitudes – as demonstrated by Porges’ results, easily comparable with Schore’s on affective development and with those of several multi-disciplinary scholars.
Exploring this dysfunction provides EMDR therapists with useful elements to guide their clients in the difficult task of confronting what they did not/could not process at that time. We propose a three-pronged cross-sectional assessment, regardless of the pathology, aimed at identifying the defensive arousal state of the ANS needed to face the dysregulating impact at that time, focusing on the prevalent activation style of the client, when meeting environmental challenges, and that emerging in the session. Starting from this assessment, EMDR therapists will be provided with tools to help clients recognize and master their defenses to increase their flexibility.
Using the regulation as a healing instrument and goal, and given the two-directional psychophysiological approach, where psychological and physiological processes meet, a new intervention model, stemming from the AIP-EMDR approach, is proposed, acting directly on the missing or impaired developmental stages of the self-regulation ability, consistently with what Porges hoped for.
The intervention focuses on Eye Contact (EC), because, as confirmed by several scholars, this is a privileged communication pathway, in particular in the mother-child dyad, to learn self-regulating skills and is easily impaired in psychiatric clients.
Learning objectives: Raise EMDR therapists’ awareness of the importance of safety for their clients, based on Porges’ Polyvagal Theory; Provide therapists with tools to maintain clients’ safety during the session; Help EMDR therapist to recognize and modulate clients’ Autonomic Nervous System activation; and Present an EMDR Protocol to regulate Eye Contact

Keywords: Eye Contact Protocol Regulation Safety

Accuracy Verified: Yes

34. Knipe, J. (2010, September/October). Shame is my safe place: AIP targeting of shame as a psychological defense. Presentation at the annual meeting of EMDR International Association, Minneapolis, MN.

Language: English

Format: Conference

Abstract:
Within the AIP model, psychological defense can be defined as the part of the trauma-based dysfunctionally stored memory network that blocks access to other parts of the network. For many clients, an essential first step in therapy is to identify and target defense, in order to then access and resolve post-traumatic emotional disturbance. For the AIP therapist, it is useful to categorize defenses as avoidant, idealizing and/or shame-based (i.e. shame as a distortion in identity, left over from a time when it was “better to be a bad kid with good parents than a good kid with bad parents”). This presentation will focus on a method of targeting and processing an identity of shamefulness that is functioning as a defense against full realization of the original trauma.

Keywords: Shame

Accuracy Verified: Yes

35. Manfield, D. C. (1998). Treating a highly defended client: reworking traditional approaches. In P. Manfield (Ed.), Extending EMDR: A casebook of innovative applications, (1st ed.) (pp. 217-231). New York: Norton.

Language: English

Format: Book Section

Abstract:
Several key points emerge for consideration when treating the highly defended client with EMDR, in particular clients whose primary defenses are distancing ones. The first is to carefully gauge the client's level of functioning, the depth of therapeutic alliance, and the client's perceived sense of safety. These factors determine the appropriateness of EMDR, and presuming that, the style and directiveness of the clinician.Secondly, the use of EMDR with highly defended clients may require a directiveness that exceeds the basic protocol designed by Shapiro. Once the therapeutic alliance has been established, the clinician must balance, while being sensitive to, the client's need for control over the therapeutic process, hopefully avoiding unproductive periods of defensive distancing. This balance and sensitivity, inherent in all effective treatments and psychotherapies, is particularly important when the modality is as potent and emotionally evocative as EMDR can be. The case of William illustrates the risks in a directive approach, such as initiating EMDR too early, promoting a withdrawing or angry transference, or choosing the wrong cognitions. Knowing your client well and securing an effective working alliance is crucial to success. [Text, pp. 230-231]

Keywords: Adults Americans Anxiety Disorders Case Report Defense Mechanisms Life Experiences Male Psychotherapeutic Processes Self Concept Survivors Treatment Effectiveness

Accuracy Verified: Yes

36. Bergmann, U. (2004, November). Treating dissociation in the spectrum of personality disorders. Presentation at the annual meeting of the International Society for the Study of Dissociation Fall Conference, New Orleans, LA.

Language: English

Format: Conference

Keywords: Dissociation Personality Disorders

Accuracy Verified: Yes

37. Bergmann, U. (2005, November). Treating dissociation in the spectrum of personality disorders. Presentation at the annual meeting of the International Society for the Study of Dissociation Fall Conference, Toronto, Ontario Canada.

Language: English

Format: Conference

Keywords: Dissociation Personality Disorders

Accuracy Verified: Yes

38. Bergmann, U. (2006, September). Treating dissociation in the spectrum of personality disorders. Presentation at the annual meeting of the EMDR International Association, Philadelphia, PA.

Language: English

Format: Conference

Keywords: Dissociation Personality Disorders

Accuracy Verified: Yes

39. Bergmann, U. (2006, November). Treating dissociation in the spectrum of personality disorders: Integrating EMDR and ego-state treatment. Presentation at the annual meeting of the International Society for the Study of Dissociation Fall Conference, Los Angeles, CA.

Language: English

Format: Conference

Keywords: Dissociation Ego State Therapy Personality Disorders

Accuracy Verified: Yes

40. Snyker, E. (1998, July). Treatment of affect phobias using EMDR. Presentation at the annual meeting of the EMDR International Association, Baltimore, MD.

Language: English

Format: Conference

Abstract:
Participants will be able to 1) describe and use Tomkin's Three System Model of Emotion; 2) differentiate between the regressive/hysterical and obsessive/compulsive character defensive styles and modify treatment plans accordingly; 3) describe and apply the concept of the Two Triangles; 4) distinguish the functions of affect in order to determine if it is being used adaptively or maladaptively; and 5) integrate the knowledge gained with EMDR to help clients move through their defenses and become desensitized to their affect phobia.

Keywords: Afffect Phobia Phobias Tomkin's Three System Model of Emotion Two Triangles

Accuracy Verified: Yes

41. Mosquera, D. (2013, June). Understanding and treating narcissistic personality disorder with EMDR. Presentation at the annual meeting of the EMDR Europe Association, Geneva, Switzerland.

Language: English

Format: Conference

Abstract:
Narcissistic Personality Disorder is associated with selfish behaviors and lack of empathy towards others. Patients with this diagnosis show a self-centered profile and a (sometimes only apparent) lack of concern about the suffering that they can cause in other people but this is only part of the picture.
The DSM-IV description of narcissistic personality disorder focuses on the “overt” qualities of narcissism (grandiosity, exploitation, arrogance, interpersonal problems and rage) while omitting the less obvious and more subtle “covert” characteristics (tendency to be shame sensitive, introverted, vulnerable, inhibited and anxiety-prone). All of these aspects may be present in both abusers and victims, in either overt or subtle presentations. In this presentation we will show how to conceptualize and treat different profiles characterized by self-centeredness, selfish attitudes and a lack of empathy from the EMDR perspective.
To conceptualize EMDR therapy in these cases it is important to understand the developmental pathways from early experiences to present problems. Narcissism features can be final outcomes of a neglecting environment, chronic abuse or other adverse experiences. In some cases it can even be related to excessive appraisal. A variety of attachment disturbances with primary caregivers can lead to lack of empathy and self-centeredness. Being able to identify (and reprocess) the etiological experiences at the roots of the symptoms is crucial for an adequate case conceptualization.
All these aspects and the complexity of therapeutic relationship in narcissistic personalities will be reviewed in this presentation linking theory and case examples. Video cases will be shown to illustrate case conceptualization and treatment methods.
Learning objectives: Narcissism is in many cases a trauma-based disorder. Students will be able to understand Narcissism from a trauma perspective; as a presentation of early complex traumatization. Special interest will be placed on relevant aspects for the history taking and how present symptoms can be linked to traumatic events (triggers). Relational difficulties and defenses are key aspects in the treatment of personality disorders and their management will be one of the objectives of this workshop. Treatment and conceptualization of these complex cases will be explained with the necessary adaptations of the EMDR procedures for narcissism.
Description of how workshop would achieve the learning outcomes: The theory will be illustrated through case examples. Videos of interviews and clinical sessions will be showed, maintaining an interactive dialogue with the audience, where theoretical concepts will be exemplified and discussed with the participants.

Keywords: Narcissistic Personality Disorder

Accuracy Verified: Yes

42. Pessina, C (2007, June). The use and adaptation of EMDR technique with sexually abused children. Presentation at the annual meeting of the EMDR Europe Association, Paris, France.

Language: English

Format: Conference

Abstract:
Thanks to a European Equal project the sexually abused children who came to our Center for therapy have been treated with EMDR. We will illustrate, through the use of clinical examples, the main therapeutic issues, the difficulties and strategies in order to exceed them. In particular, we will address the following topics: the use of "menus,” the use of positive installations, how to identify targets, how to exceed the use of psychological defenses, mainly dissociative, etc. We will then highlight the advantages of using EMDR with those children.

Keywords: Children Sexual Abuse

Accuracy Verified: Yes

43. Wesselmann, D. (2013, April). Using EMDR to treat attachment trauma in adults and children. Preconference presentation at the Congress EMDR Vereniging EMDR Nederland, Nijmegen, the Netherlands.

Language: English

Format: Conference

Abstract:
Trauma experienced within the earliest attachment relationships leave children and adults at great risk for the development of psychiatric disorders. Maltreatment by attachment figures and traumatic losses are both closely associated with attachment disorganization, the attachment category identified in 70% of patients in psychiatric hospitals. Research shows insecure and disorganized attachments to be transmitted transgenerationally at a rate of between 70 and 80%.Adults and children with disturbed attachments frequently experience severe emotional dysregulation along with intense feelings of despair, anxiety, shame, and mistrust of others. Affected children and adults frequently lack helpful or adaptive information or insights and exhibit behaviors that elicit negative responses from those around them. Due to heavy defenses and poor self-regulation and self-awareness, patients suffering from attachment trauma are traditionally difficult to treat. However, with proper adaptations, the EMDR approach becomes a powerful method for healing attachment injuries in adults, children, and parent-child dyads. Participants will learn creative methods of adapting EMDR for the special challenges that accompany attachment injury. Participants will learn to utilize attachment resource development techniques designed to strengthen the capacity for closeness, trust, and self-compassion. They will discover how to coach an attachment figure to provide emotional regulation and help with cognitive interweaves. Participants will be able to write a therapeutic story to help process pre-verbal trauma and develop adaptive information for successful reprocessing. Creative interweaves, contained reprocessing, and methods for weaving together of past, present, and future will help participants experience successful EMDR with their most challenging cases. Case studies, video, and EMDR/attachment research will be presented.

Keywords: Adults Children Trauma Attachment

Accuracy Verified: Yes

44. Manfield, P., Knipe, J., & Snyker, E. (1998, July). Using EMDR with narcissistic personalities. Presentation at the annual meeting of the EMDR International Association, Baltimore, MD.

Language: English

Format: Conference

Abstract:
Participants will: 1) be able to identify narcissistic defenses of splitting, projective identification, avoidance, denial, primitive idealization, devaluation, grandiosity; 2) learn methods of addressing these defenses; and 2) learn how to use EMDR to process transference issues that typically arise.

Keywords: Narcissistic Defenses Transference

Accuracy Verified: Yes

45. Knipe, J. (2006, June). Using EMDR with substance addictions and with behavior problems that have an addictive pattern. Presentation at the annual meeting of the EMDR Europe Association, Istanbul, Turkey.

Language: English

Format: Conference

Keywords: Addictions Substance Abuse

Accuracy Verified: Yes

46. Knipe, J. (2010, September/October). What the adaptive information processing model brings to the assessment and treatment of dissociative disorders. Plenary presented at the annual meeting of EMDR International Association, Minneapolis, MN.

Language: English

Format: Conference

Abstract:
Clients with a dissociative personality structure can be very vulnerable to dissociative abreaction – i.e. “reliving” the trauma with intense disturbance while experiencing a loss of present orientation and safety. In addition, a client who has repeatedly experienced this type of traumatic intrusion is likely to have developed complex psychological defenses. This presentation will include the description of certain AIP “tools” that can be used to help dissociative clients who have strong phobic fears of their own post-traumatic material and who have developed additional mental actions to prevent the emergence of that troubling material. These “tools” will be illustrated with brief session transcripts and video segments.

Keywords: Dissociative Disorders Plenary

Accuracy Verified: Yes