In the broadest view, EMDR facilitates the linkage and assimilation of “stuck” information into existing adaptive information. Part of my initial assessment also explores for the presence of healthy and adaptive information. I’m not very picky about the types of adaptive information that the client has. If it has helped the client function or develop some sense of self outside of the trauma, we’ll find a way to leverage it, strengthen it, and position it to better receive the information that it needs to absorb. Some clients have broad deficits in adaptive “stuff.” Others may lack the specific information needed for a specific maladaptively stored memory to merge into. In those cases, we have to work to create adaptive information and we often have to do this inside of a reprocessing session. If reprocessing becomes blocked, particularly during the second half of a reprocessing session, I start to consider the possibility of a deficit in adaptive information. Conducting a detailed assessment helps me intuit what some of those deficits might be and have some tentative plan to address them before reprocessing brings us there.
As we zoom in, EMDR facilitates this movement through three simultaneously occurring components. 1) The client accesses/activates a maladaptively “stuck” memory/information. 2) The client notices what comes up in response to that activation. 3) The client receives a bilateral stimulation that helps facilitate the movement of the stuck information into the existing adaptive information.
If a client encounters some type of block or difficulty in reprocessing, it may be helpful to think of these occurring primarily in one of four places: with the maladaptive-adaptive linkup, with how the client is accessing the memory, with how the client is noticing what is coming up, or with the bilateral stimulation itself. Part of our job is to quickly figure out how to intervene to guide the client though or around obstacles. Intuition and experience play important roles. There may be small clues that can help assist your intuition or exploration. Some problems or blocks are more likely to occur in the first quarter of a reprocessing session, some in the middle, and some in the second half. However, almost any block might occur at any time in reprocessing.
Problems with the Adaptive Information Networks
- Deficits in adaptive information can derail reprocessing. Because the linkup doesn’t start to happen in full force until after the client has activated the memory and done some noticing, problems of this type often manifest in the second half of a reprocessing the session. You have to help the client create the adaptive information that is missing.
- Guilt, shame, non-adaptive interpretations, or self-blame are blocking the assimilation into the adaptive stuff (or reflect a deficit in adaptive stuff). While most of these are emotional processes on the emotion channel, my experience is that they usually aren’t discovered by asking the client if anything is coming on the emotion channel. They are more likely to be detected when you ask the client about the thought channel: “I feel like all of this is my fault.”
- Secondary gains may be stored as a kind of false asset or placeholder that displaces or blocks access to adaptive stuff.
- The client may try to enlist adaptive information too soon in a session. It will likely be a block to reprocessing if the client is active on the thought channel to purposefully calm himself early in reprocessing. The client may dismiss the severity or legitimacy of his trauma as a way to avoid the distress of reprocessing and the drudgery of noticing in session. It is helpful to be skeptical of adaptive information when the client is trying force a connection. Provide education about this. Redirect the client to target and encourage the client to simply notice what comes up without pushing or pulling anything.
Problems Accessing the Memory
- These difficulties tend to occur much more often in the first quarter of a reprocessing session (although they can occur any time).
- The client struggles to find the right entryway to the memory. Or, a new client is distracted by the salience of the bilateral stimulation itself. This is resolved in most instances by simply redirecting to target giving the client more time.
- The client may be in the right neighborhood but at the wrong house. Sometimes we have the right category of target, but we’re not targeting the best memory. It may not be clear to the client new to EMDR that he can switch to the memory that wants to come instead. Good education related to noticing whatever comes up on any channel goes a long way. It’s helpful to ask if anything is coming on any channel, including the memory channel. “When deep healing comes to you in EMDR, it comes to you. And it comes through noticing.”
- A surprising number of issues can emerge from difficulty that clients may have with noticing. Most issues related to problems noticing are likely to occur in the first half of a reprocessing session and are more likely to happen when clients are new to EMDR reprocessing (but they can occur any time).
- The client is not embodied enough to notice what is occurring. Large parts of the body from chin to stomach may simply be offline. I’m careful to check with clients in the first session or two where their anxiety, sadness, and anger sit in their bodies. It’s a good sign if they know. We spend a lot of time engaging in grounding techniques, breathing coupled with before and after body scans, and trying to notice small shifts in body sensations in session and between sessions. Helping clients to be embodied enough to notice takes time. Some capacity to notice (especially what is happening in the body) is one of my prerequisites for reprocessing.
- Clients may not know how to notice multiple things happening at once, yet it is very common for clients to experience multiple things at once. Inside reprocessing, new clients are already nearly saturated (between the memory activation, bilateral, and their own performance anxiety related to starting EMDR). Noticing multiple things on multiple channels is very difficult for most clients to do. It’s helpful to assist them in slow things down. If the client has multiple (usually conflicting) thoughts, it makes sense to ask the client to notice one thought on one hand and the other thought on the other hand (and toggle between them). When it comes to body sensations or emotions, that type of toggling is difficult for many clients to do (and toggling from one to the other doesn’t seem to facilitate reprocessing as quickly as noticing one fully first). Clients will often report (when asked) that they are experiencing two emotions in separate parts of their bodies. I usually ask clients to notice the most distressing one first. When it moves, shifts, or changes and it no longer becomes the dominant emotion/sensation, we switch to notice the other one (if it is still present).
- Many clients struggle to notice immediately after changes in emotions during reprocessing. It’s a change that is reflected in changes of activity across many channels. Shapiro is clear in her advice when the client reports a sudden change in emotion. Ask the client “where is that [emotion] sitting in your body right now? … Good, notice that.” This is consistently helpful suggestion. It helps quickly reorient the client.
- The client may be somewhat aware of sensations, but not noticing deeply. Reprocessing works best when clients are able to notice deeply. This can be very difficult for people whose primary coping strategies have revolved around not noticing. It is frequently helpful to instruct clients concretely how to notice. When you suspect that a client may simply be vaguely aware but not noticing, a good interweave is to ask the client to notice the edges of a sensation. This seems to promote noticing at the level necessary for shifts and movement. Shifts and movement are good. I have found that some of my clients fidget with hands or feet when they are aren’t noticing deeply.
- Clients may report difficulty tolerating what is coming up. Clients may be too cognitively or emotionally overwhelmed to notice at the level needed for movement. It’s helpful to know if the client is overwhelmed on only a single channel, or if information is overwhelming because intense distress is coming in on multiple channels at once (client may be have a rush of memories, a rush of negative thoughts, and have intense body sensations all at the same time). If the client is active on multiple channels, it may make sense to see if the client is okay with temporarily reducing the channels to notice. My experience is that if you ask a client to temporarily turn off a channel, they are usually able to do so. You can ask the client to bring the other channels back online as the capacity to notice them as discrete occurrences is restored.
- Recent marijuana or benzo use prior to session is very likely to calm the body sensation channel below the client’s capacity to notice. Often this problem shows up in the first quarter of a reprocessing session. Clients may notice sensations, then they instantly disappear. Or, clients who were able to do EMDR successfully in the past sessions may report no body sensations below the chin. I provide repeated psychoeducation on the inadvisability of marijuana or benzo use within eight to twelve hours of a reprocessing session.
- Clients well into the second half of reprocessing report that they are noticing nothing on any channel and cannot identify where any distress is sitting (this is usually after the client has “come up” from deep layers of distress). The client may be struggling to notice because what is present is much less intense than the sensations experienced several minutes ago (and the current sensations are below the client’s current “sonar settings”). I ask the client to go back to target and I ask for a current SUDS rating. If the SUDS is between two and five, I ask them a question like “Where is that four sitting in your body right now?” Ninety-nine times out of 100, they are able to tell me and this immediately gives them something to notice. More often than not, the SUDS will be zero or one within 10 minutes or so.
Problems with the Bilateral Stimulation
- My clients rarely have problems related to the bilateral stimulation. Once we find the best method in preparation, it tends to work well for that client throughout treatment. I will sometimes switch from tappers to eye movements (if eye movements are fine for the client) when a client is working on a target and reprocessing is going very slowly (and I am unable to find a block in any of the other areas). About half the time this adjustment is helpful.
- My Tac/AudioScan’s fastest setting seems to be an ideal processing speed for most of my clients who use the tappers. I get the sense that some clients might benefit from a faster pace, but a faster setting isn’t available with my current equipment.
- I am a male therapist and I tend to see severely traumatized clients. I am careful to stay out of the body space of my clients. I have only tapped on the knees of a few of my male teenage clients. Even eye movements put me too close to some of my clients.
- I have had several teen clients with ADHD. Their reprocessing seems to work best with very short sets (7-9 seconds) using both tappers and headphones. We have also experimented with self-tapping or squeezing a stress ball in each hand. Regardless of method, twenty-five second sets were excruciatingly slow for them and was causing distress and disengagement.