Some Notes on Abreaction in EMDR

Some clients will experience intense emotions during reprocessing (other clients will reprocess without a lot of intensity). EMDR therapists should be comfortable with a wide range of emotional expression or emotional lack of expression.  The purpose of implementing strategies to help clients navigate intense emotions during reprocessing should never be to ease therapist distress triggered by strong client emotions.  Rather, some of these strategies might assist the client in reprocessing by providing the him options related to how the target is experienced or how he notices.  As navigational assistants, we go on journeys with our clients in EMDR.  Sometimes it’s okay for some of this journey to occur by bike.  Sometimes we might need to walk.  Sometimes we will crawl.  Sometimes we need to sit down and rest.  Having options related to managing periods of intense distress in different parts of journey may make the journey “less distressful” for many clients.  Ideally, some of these options should be presented to the client before reprocessing begins so that they can be utilized by clients as needed.

Shapiro provides 14 guidelines (pp. 174-180) to help clinicians facilitate abreactions.  The first several of these guidelines normalize that intense emotions are simply a part of EMDR reprocessing for many clients and provides suggestions to therapists about how to reflect that normalization.  Several guidelines address the importance of frequently reminding the client that they are safe in the present and that the memory represents “old stuff.”  Shapiro stresses that clients need not reinhabit the memory, they can simply observe it passing by.  She presents options that allow clients to “play” memories much like they might with a DVD (fast forward, pause, stop, etc).  She also presents options that help the client manipulate the visual or sensory of the memory components themselves.  Additionally, she stresses the role that check-ins between sets can play in helping moderate and monitor distress and plateaus that the client is experiencing.

Having conversations about target order can be helpful.  Listening to client fears about specific targets can be helpful.  It is difficult for therapists to anticipate with any certainty which targets of any individual client are likely to be most intense.  We might have some general suspicions, but I have been surprised by the intensity of some targets that I guessed would be relatively innocuous.  More frequently, I have been shocked by the lack of distress of some targets that I anticipated would be intensely distressing for clients to reprocess.  In general, clients will often be in a better position than I am to judge their ability to navigate and tolerate a specific target on a specific day, so my general strategy is to trust their intuition related to target selection and order.

In preparing to do EMDR reprocessing, I use (or make sure that clients are aware of) these resources or options:

• I make clear that clients are allowed to experience whatever they need to experience emotionally and that I’m making no judgements about anything that they feel or don’t feel. There is no required, suggested, or ideal way to feel. We’ll notice whatever comes up.
• I stress that we can pause at any time the client needs and use one of the skills he has practiced to decrease tension. Taking a break is a completely valid part of the process.  Often excellent reprocessing happens after the client selects to take a short break.
• I offer the use of the VCR/DVD metaphor (depending on age) for nearly all of my clients. I let them know when approaching a memory that they can initially skip certain parts.  They can slow down certain parts.  They can fast forward.  They can stop.  We don’t consider the memory fully reprocessed until the client can play the whole memory without distress, but it works well to allow the client flexibility in how he accesses the memory.
• When intense and distressing sensations do not shift because of a block in reprocessing, my job is to help clients navigate around that block as quickly and efficiently as possible. I often educate clients about common blocks to reprocessing, stressing those types of blocks that I suspect that the client may encounter.  I also work to provide education to address any deficits of information that will be needed for reprocessing.
• I request that clients do their reprocessing in the present. I say something like, “This tends to work best if you stay in this room with me and don’t time travel.  I’ll be right here with you in this room.  You have already survived these experiences.  Keeping your eyes open may help keep you grounded.”  Reminders about staying present helps clients perform the noticing component of EMDR, which is a key and active ingredient in reprocessing.
• I’m careful to remind clients not to “push or pull anything” with their noticing, as this can slow reprocessing.
• I’m careful to encourage clients to simply notice deeply what is coming up. If the client is noticing an intense body sensation and that sensation seems “stuck,” I may ask him to notice the edges of it or the shape of it.  This lets me check to see if the block in reprocessing is because the client isn’t adequately noticing what is occurring.
• As best I can (and my capacity varies), I try to be a slow, calm, stable, warm, completely accepting, fully present, and deeply genuine presence in the room. I am certain that for many clients that alone can provide some comfort through emotionally intense reprocessing.