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Abreaction and Reprocessing: The
Importance of Defining Terms
December 2004 Chief Editor’s Introduction: We are delighted to
publish Kate Cohen-Posey’s thoughts on the impact of the clinician’s
perception of abreaction, especially as this relates to the practice of EMDR.
Thanks to Kate for this thoughtful explanation, and for highlighting some key
historic roots from which our current practices have evolved, and continue to!
We wish her much success with her new book. -SEB
Any seasoned EMDR therapist has been an eyewitness to abreaction. The protocol
itself puts the brain in "safe mode” so that potentially abreactive
material can be processed rapidly without the need of prolonging abreactive experiences
(Silver, 1999). This author recently discovered that she was operating under the
definition of abreaction as originally stated by Breuer and Freud, not as described
in EMDR. This paper will explore these different definitions and the implications
they have for reprocessing. "Abreaction”: Past and Present
In their book written in 1893, “Studies in Hysteria,” Josef
Breuer and Sigmund Freud found that hysterical symptoms immediately and permanently
disappeared when they had succeeded in vividly triggering the memory of the event
which had provoked the symptom while arousing accompanying affect. They found
that recollection without affect produced little result. Breuer believed that
affects that are stronger, such as anger, must discharge through motor activities
alongside verbal expression while Freud preferred verbal expression (van der Hart,
1992). The American Psychiatric Association (1980) now defines abreaction as,
“An emotional release or discharge after recalling a painful
experience that has been (disassociated) because it was consciously intolerable.
A therapeutic effect sometimes occurs through partial discharge or desensitization
of the painful emotions and increased insight.” Francine Shapiro (2001, p.92) defines abreaction as “the reexperiencing of the stimulated memory at a high level of disturbance….the client is coached to have a dual focus by maintaining an awareness of the disturbing past event while staying in the safety of the present.” There is no mention of discharge or release. Interestingly, the APA definition notes that therapeutic effect occurs through discharge or desensitization of the painful emotions. In EMDR we notice that SUD levels often dissipate without apparent release, allowing seemingly spontaneously engagement of positive cognitions (vs. insights). However, sometimes focus on images, negative cognitions, and sensations accompanied by dual attention stimuli do, indeed, produce release. If a client begins crying, we are appropriately instructed to switch from eye movements to tapping so processing can continue without interference. Yet, an explanation of this “discharge” is not included in our theoretical framework. Reprocessing Reexamined
In order to decide if discharge is incidental or intrinsic to abreaction, reprocessing
must first be understood. Reprocessing is not abreaction nor is it sets of alternating
sensory stimuli. Throughout a normal experience, images are evaluated for meaning,
placed in a narrative, and stripped of irrelevant information (Mansfield, 1998,
p. 4): “During a severe psychological trauma it appears that an imbalance
may occur in the nervous system involving neurotransmitters, adrenaline, and so
fourth…. The original material is held in this distressing, excitatory state-specific
form” and continues to be triggered…. (Shapiro, 2001, p.
31). The theoretical explanations by which the EMDR protocol and, more specifically, dual attention stimuli (DAS) facilitates reprocessing of information are beyond the scope of this paper, but the outcome of reprocessing is clear—new words and meaning are wrapped around the original experience—“I have self worth,” “I’m safe,” “I have choices.” Shapiro (2001, p. 32) offers the metaphor of the processing mechanism as “’digesting’” or “’metabolizing’” the information so that it can be used in a healthy, life-enhancing manner.” Perhaps, during reprocessing, information held in distressed, excitatory state-specific form is getting “giggled.” We know that such information includes images, words (negative cognitions) and body sensations. Related muscular tensions might also echo an earlier time when a person was externally restrained, or internally restrained herself? During reprocessing, new words (positive cognitions) and new motor responses begin to emerge. Shapiro (2001, p.182-184) discusses this phenomenon: “Certain kinds of body tensions can indicate the need to voice unspoken words…the cries or statements the client held back during the trauma….” Often it is preferable if the client can verbalize so the clinician can assess whether these words are being said firmly and without fear. “Clinicians can assist clients…by asking them first to mouth, then whisper, and then vocalize statements in progressively louder voice with each successive set (p. 183).” Release of body tensions indicating suppression of movement during the original experience should be encouraged, such as by punching out. “This manifestation of physical sensation is similar to the unspoken words phenomena...both allow the stored (verbal/muscular) information to be adequately processed… (by stimulating) suppressed emotions, statements and physical actions. Allowing these to be vented during (or between) sets appears to increase the rate of processing….(p. 184). If clients verbalize (or act) between sets, their statements (and movements) should be mentally rehearsed during the next set (p. 183).” Verbalizing/acting between sets to or with the therapist aids dual focus by bringing past suppressed words and movements into a safe present. Rehearsing with dual attention stimuli during sets may expedite reengagement of new adaptive information. The Importance of an Inclusive Definition of Abreaction
Considering the above, verbalizing (unspoken) words, and making (unmade) movements
along with crying, shaking and laughing (which also release muscular tensions
and even chemicals held in status) certainly seem intrinsic to abreaction. They
are not interruptions in reprocessing, but an essential part of reprocessing.
Welcome back Breuer and Freud! But, is this inclusive definition of abreaction
important? The intent of words points the way for healing to occur. The psychodynamic definition assumes the dual focus of awareness. Abreaction as defined by EMDR may presume emotional release along with intensely reexperiencing an emotional state. However, when discharge is not explicitly stated as a part of abreaction, clinicians may not support and encourage it, and processing can shut down. “Clients should feel safe enough within the therapeutic alliance to express anything that emerges, because trying to suppress the material can cause retraumatization (with agreements not to injure themselves or the therapist during processing….) This strategy has proved successful, even with the most explosive veterans in the VA Medical Centers” (Shapiro, 2001. p. 184). We are trained to notice reexperiencing of intense emotion by changes of coloration and tension in a client’s face. But, it is also important to discern clues that indicate a need to discharge—hands curling into fists suggest the urge to punch out (Shapiro, 2001, p. 184); tears welling up show the need to release sadness; tremors (or laughter) can indicate a discharge of fear; and so on. Because many clients have strong negative cognitions not to cry and are terrified of their own anger, therapists must be vigilant when clients are attempting to control such abreactions and their release. “When clients appear to be experiencing emotions of anger…the clinician should ask them to say whatever they want out loud or to themselves (Shapiro, p.182).” Just as it is important to insure dual focus of awareness with words like, “That was then, this is now,” it is equally important to foster discharge with encouragement, supportive contact, and subtle interweaves: Client’s tears begin to surface, but he is
holding back.
Many current therapeutic orientations avoid abreaction of any definition. EMDR
is a remarkable synthesis of the old and new approaches to emotional healing,
and reflects a more inclusive definition of abreaction. The EMDR therapist must
be increasingly sensitive and skilled to promote thorough release of anger, fear,
and deep pain. The evolution of EMDR may be best guided by integrating the wisdom
of the old masters with the technology of dual attention stimuli and findings
from neuropsychology. Therapist: Breathe…. It’s OK to make noise, let the sounds out. Client (re-experiencing victimization): I don’t know what to do. Therapist: What did you want to do? (Follow with an EM set.) *Client (talking about, angry tone): Why did he have to drive drunk and hit that tree? Therapist: Use my eyes and say it to him, “Why did you have to….” Go with that… *Client (somewhat dissociated grabs the therapist’s wrist during an eye movement set): Don’t touch me! Therapist (resists slightly): Push my wrist again. Say, “Don’t touch me!” again! (Repeat as necessary and follow with mental rehearsal during a DAS set.) *Written permission was obtained from the client to publish an article anonymously using her material in which on two different occasions the death of her 23 year old son and molestation by her father when she was 12 were processed. Background
Kate Cohen-Posey is a Licensed Mental Health Counselor and Marriage and Family
Therapist practicing in central Florida since 1973. She attended her first EMDR
workshop in 1995 and maintains her EMDRIA certification. She presented two workshops
at the EMDR International Association Conference in Toronto, Canada in October,
2000—“Using EMDR with Panic Disorder and OCD” and “Using
the Draw-A-Person Test to Introduce EMDR. She presented again in Tampa, Florida
in April 2003. Ms. Posey is the author of two books, How to Handle Bullies, Teasers,
and other Meanies (Rainbow books, 1995), and Brief Therapy Client Handouts (John
Wiley & Sons, 2000). She is now working on a third book, Befriending the
Bullies Within, which adapts the EMDR protocol to reify negative cognitions into
“subpersonalities”, and uses dual attention stimuli to engage and
strengthen the inner “adaptive self.” Ms. Posey can be reached
at PO box 535 Lake Alfred, Fl 33850, or laposeys@tampabay.rr.com
References
American Psychiatric Association (1980). A Psychiatric
Glossary (5th ed). Washington, DC.: American Psychiatric Association.
Manfield, Philip (1998). Extending EMDR. New York: W. W. Norton & Company, Inc. Shapiro, Francine (2001). Eye Movement Desensitization and Reprocessing. New York:The Gilford Press. Silver, Steven (1999). Abreaction/Retraumatization—a reason for not doing therapy? EMDR Portal Van der Hart, O. & Brown, P, (1992). Abreaction Re-evaluated. Dissociation. 5(3), 127-140.
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