CHAPTER 4.....GET READY, GET SET,
GO.....
Dr Scott Borrelli
2002
In my last chapter, I emphasised the importance of client preparation, and introduced
a number of suggestions, or "BP's" ("Borrelli Pointers") which
I have found most helpful in my practice. Honoured to be a regular contributor
to now an even fancier electronic journal, I go forward to continue to provide
my experiences in the clinician seat. Some focus remains on the uniqueness of
client's responses.
As you may know by now, EMDR is quite seductive for the clinician as well as the
client. Massive positive changes promised in, as it were, a "blink of the
eye"? Although Francine Shapiro, the creator of EMDR, warns that EMDR is
not a panacea, we also suspect that she is underestimating the potency of the
methodology for good reason. Indeed, something important has been stumbled upon,
and continues to be built on. The structured, multi-modal protocol offers an invitation
to the client to reach into nearly every corner to identify where change is most
needed and likely to begin. Images, cognitions, emotions, and sensations are the
halls through which I and my clients can wander, sometimes aimlessly, but more
often with a sense of purpose and concluding with results that matter.
Get ready:
During a carefully prepared introduction to EMDR see Chapter 3, my clients often
display a mix of curious enthusiasm and healthy scepticism. The head tilts slightly
to the side, lips are pursed, and the body posture resembles the apprehensive
sprinter at the "get ready" position. There is a mix of innocence and
ambivalence I often see reflected in clients who have been betrayed by those they
have most needed to trust. I, and my client, are in touch with a healthy and optimistic
"child within", who is forever on the verge (often prematurely) to "forgive
and forget". After all, kids rarely hold grudges, and (sometimes unfortunately)
their loyalty to family knows no limits.
I am reminded that my responsibilities are great, as I offer the promise to join
my client fully in the treatment, processing successes and impasses, making sense
of the unexpected, and applauding the almost inevitable movement forward. The
initial "sprint" and those that follow will be interspersed with a series
of baby steps which also deserve accounting. It takes a keen eye.
Get set:
To illustrate some of these points, I will discuss a first session with a mid-adolescent
young woman we will call "Jill". Several months ago, she was the victim
of a sexual assault by a neighbourhood "gang" with whom she had spent
time, though always "on the fringes". The incident took place in a clearing
in the forest where she used to visit to enjoy peaceful moments on her own. These
enjoyable moments were replaced by anxiety, avoidance and images of her personal
nightmare. These generalised into a refusal to leave the house alone, for fear
that she would be ridiculed or physically attacked, and requiring that her mother
transport her to school. Her inner and outer lives had shrunken considerably by
a fateful moment.
The manifest injuries from trauma experiences are as unique as the individuals
who experience them, providing all the more reason to utilise a multi-modal approach.
Jill's injuries included the belief that she was betrayed by her "friends",
and the loss of innocence and control. She believed she was branded the neighbourhood
"whore". Her own developing identity was contaminated by what she believed
they believed.
Jill's negative cognitions further reflected this internalisation of "badness":
"I'm a really bad person. I'm completely worthless". Feelings of rejection
and abandonment were accompanied by a "twisted stomach" and "shaky
legs". She said she felt the incident "down to the bone", rating
it a 9 on the SUDS scale. She opted for the tactile bilateral stimulation offered
by the Theratapper, a simple and user-friendly device which offers alternating
vibrations through each handheld component, and which she found soothing. Mother's
beating heart, perhaps?
Go:
Throughout a lengthy first EMDR session, Jill moved in and out of many old places,
and began to construct new ones. She wished things "were as they were".
She wanted to escape "and live in America". After several sets, the
familiar vacillation between rage and hurt eventually mellowed into feelings of
"annoyance". Eventually, her positive cognition, "I am appreciated
and loved", reached a 6 on the VoC (up from 1), reflecting fuller appreciation
of her personal value - in spite of the trauma. Using cognitive interweave, I
asked what it would be like and what it would take to reduce her SUDS score further,
below the 2 at which she stubbornly remained. Jill quickly replied: "Then
what would I cry about? It's my security blanket!". This surprise response
offered me the opportunity to accept her logic by applauding her assertive positioning.
I remembered some lessons (these could be BP's!):
- all suffering has a purpose,
- do not assume what people need or want, and
- do not be too eager to take anything away from someone which they might
still need.
Indeed, Jill had created a positive use for a remaining bit of the trauma memory
- it gave her permission to cry. She had made sense of the "unexpected".
In future sessions, I would be eager to further understand her choices. Perhaps
all experiences truly are "unforgettable" and for a reason. We do know
they change us forever.
During subsequent sessions, a number of accomplishments were made. Jill did not
have to believe that her friends betrayed her. Instead, she realised that they
were not "good" friends after all. In fact, she was able to admit to
herself that they never "felt" like good friends. Two points for intuition!
She was now freer to trust and protect herself, and to correctly identify true
friendship. Additionally, we had installed "strong legs" on which she
could confidently transport herself through the neighbourhood, and beyond. She
remembered that love and appreciation existed for her (for example, her family
who cared so much that they brought her to therapy). She knew again that life
provided unending opportunities for creating new experiences of bonding and attachment.....
Postscript:
Did I mention Jill's original choice for "safe place" imagery? It was
the forest meadow where the incident occurred and where she had originally cherished
feelings of safety and peace. Suggesting that there might be a better choice,
I asked, "Jill, are you sure that's the best place for you?" She replied,
"absolutely". After three sessions, she was able to return to the forest
in vivo, fortified by new and "trusty" legs, and a remarkable
determination to face the demon invaders and reclaim her innocence.
Good Practice!
Scott E. Borrelli
©2002 The EMDR Practitioner - All
Rights Reserved Worldwide