|
Wrestling with the past
May 2004 Editor’s Note: Mr Koppel presents an illuminating
and touching account of a successful EMDR session. We are reminded of the importance
of attending to the client on all levels, and the efficient impact that a skilled
EMDR therapist can have on a client. Thanks to Mr Koppel for this enlightening
contribution! SEB
The warm glow of the subdued lighting and the chintzy comfort of the armchairs
contrast oddly with the rugged bulk of the man sitting opposite me, and the almost
tangible anxiety radiating from him.Mike looks bulky because of the padded jacket he is wearing, but the muscles that lie beneath are the products of a successful career as an amateur wrestler and his job in the car industry in the West Midlands town that he comes from. One might imagine that a physically strong man like Mike would be confident, and that such internal strength would be reflected in his face, battered and knobbed like a root vegetable. Instead, he looks hunted, haunted and defeated. This is why he is here, in the cosy room of a community counselling service. He is a desperate man, at the end of his tether. He told me his tale two weeks ago, and now he is back, to see if EMDR will address the images that terrorise him, “twenty-four seven”. He had explained that he had been suffering for three years. Only his counselling with Mary had kept him from “going under” i.e., committing suicide. However, that he was hanging on was not good enough; he wanted to be better. Somehow he had heard of EMDR, and felt that it was his only, or his last, chance to recover. I had explained that I would give him an EMDR session, but I offered no guarantees, and made no predictions about the outcome. Talking in short sentences, in an ashamed mumble made less comprehensible by his strong accent, Mike indicated that he understood, and that he had nothing to lose. His story was that, twenty-two years ago, he and his friend Kevin had stolen a car, and were racing around the estate on which they lived. Taking a corner too fast, Kev had lost control; the car had hit a lamppost and burst into flames. Mike had been thrown clear and, his wrestling instincts and body armour of muscles saving him from anything worse than a bruising, had lain on the kerb watching helplessly as Kevin, trapped behind the wheel, had turned into a human torch. Surprisingly, Mike had not experienced any after-effects of the accident for the next couple of decades. He had continued as a successful wrestler, he gave up joy riding, he had a wife and they had two sons. A teenage tragedy recovered from, and no particular consequences. That is, until three years ago. Then Mike, now in his early thirties, was driving home from work one evening when he heard a bang, and had woken up in hospital. What had happened was that the driver of a car-transporter lorry, ironically from Mike’s own company, had fallen asleep at the wheel, and the lorry had rammed Mike’s car from behind. After this accident, Mike had a collection of physical damage. He had been unconscious for several hours, and had received many neck and head injuries. He started to experience intense headaches daily. Far, far worse was the way this accident had reawoken memories of his teenage experience. He was now plagued by nightmares in which he was forced to watch, helplessly and repeatedly, as Kevin burned alive. The nightmares did not fade on awakening. The image stayed in front of his head, an image that superimposed itself upon whatever he was really seeing. The crackle of the flames was louder even than the hammering of the presses in the factory in which he worked. Mike took pills for the headaches, pills for the insomnia, pills for what the doctors called the depression. Nothing helped. He started drinking and, (this was hugely embarrassing for him to tell me) began smoking. He started becoming angry, and then violent. Then he became reclusive, afraid of doing anything that might end with him using his enormous strength to hurt someone. His wife left, taking their children, petrified by the person that Mike was becoming. Mike had now reached the limit of his endurance. At our first meeting he told me that he always was a fighter, but he could not go on fighting forever. Now he is sitting opposite me, perched uncomfortably on the edge of the armchair, listening intently as I explain what we are going to do. I ask him about the issue that he wants to deal with. He looks puzzled, wondering, I imagine, if I had forgotten what he had already explained only two weeks ago. So I tell him that I do remember, but I do EMDR by the book, going through exactly the same questions, in the same order, with every person that I see. Reassured, he tells me that he wants to stop thinking about Kev. I ask him what picture he has that represents this issue, and he describes the scene – very economically, but the picture is sharp, intense. I explain that he is going to be looking at this picture, but that he should always remember it is only a picture, not the event. We are not doing time travel, and he is not going to re-experience the accident. He understands this, and tells me that he sees the picture all the time, anyway. I ask him for a negative cognition, one that applies now. Of course, I do not use those words, and I laugh sheepishly as I try to define what I mean. Every time I begin an EMDR session with a new patient I become stuck, trying to explain this to my patient. The easiest way would be to give an example, but when I have tried this, the patient has just used my example as their negative cognition. What I hope Mike will come up with is a negative, probably irrational, thought about himself that the image conjures up right now, as he sits in the cosy counselling room with me. Unusually, he has no problem with this concept, and says, without having to search for something, “I feel guilty”. A positive cognition, “I can forget” comes equally effortlessly. I get him to scale his cognitions and the level of disturbance of the image. This perplexes him – no numbers are big enough for the distress he feels. I use the analogy of a doctor measuring a temperature to monitor the progress of a disease, and Mike’s face clears. He now comes up with some numbers for the scales. We do a few more preparatory tasks, and then start the eye movement work. Our chairs are positioned in what my trainer called “ships-passing-in-the night”. I am leaning forward and holding my hand in front of Mike’s face, ring and middle fingers extended as though I am giving Mike a papal blessing. Despite a thorough scrubbing, the odour of the garlic that I had been chopping earlier this evening lingers. I hope that it will keep the vampires at bay, rather than put Mike off. However, he is unlikely to be thinking about smells as he is concentrating on tracking my moving fingers. He is trying to help his eyes flicking right-left-right by moving his head as well. I stop and ask him whether I am moving my fingers too fast, or if he would be more comfortable if my hand was nearer or further from his face. I wish that his armchair had a higher back, so that he could immobilise his head by leaning back, but Mike says that he can hold his head still, and we try again. This time it is fine. His eyes track my fingers without difficulty. I explain the sequence of events. I will do a set of finger waving; that is, Mike will do a set of eye movements. During this set, he will begin by holding both the original image, and the negative cognition, together in his mind. At the end of the set I will stop waving my fingers and ask Mike first to take a deep breath, and then to say whatever has come into his mind while doing the set. Mike looks worried. I try to reassure him. “Look, Mike”, I say, “There is no right or wrong in this. There is no ‘supposed-to’. Whatever comes into your mind while you are following my fingers with your eyes, once I have asked you to take a deep breath, you can talk about. It may be nothing, it may be something, it might have nothing to do with the picture that you are looking at, and it may seem silly or daft. Whatever comes up, comes up. Okay?” Mike smiles nervously, but agrees, “Okay”. We do a set. Deep breath. Mike sighs. “So, what came up?” Mike looks disappointed. “Nothing.” “Okay, Mike, hold the same picture, you on the pavement, looking at the burning car, and hold the same thought, ‘I am guilty’” Another set. Another deep breathe. “What came up?” “Nothing.” Another set. This time, Mike’s thoughts have moved to before the accident. He talks in short sentences that are the tips of the icebergs of the images that must be scrolling through his mind. Indistinct and incomplete though his speech is, it is vivid, and he is clearly experiencing something. I do not ask him to elaborate, but just listen. He says something about Kev letting go of the wheel with one hand to punch him, and that was when the accident started to happen. I said, “Mike, stay with that”. And I start another set of eye movements. Over the next few sets, Mike seems to be exploring the part that he had played in causing the accident. If he had not been being arsey, Kev would not have needed to punch him. That way, Kev would not have let go of the wheel, lost control of the car, and crashed the car. Mike expresses the sequence of events that gave him sole responsibility for Kev’s death. Over some more sets we look at the validity of this. Doing what is called a cognitive interweave, Mike begins to talk about Kev’s contribution. He knows that Kev should not have let go of the wheel when they were cornering. Yet he does not convince himself, and when I repeat his comment on Kev’s poor driving, he says, “I suppose so.” In EMDR training, I was shown how to start with an image and follow a strand of thought until nothing further seems to happen, no further change occurs. Then, the patient returns to the original image, and in subsequent sets another strand may develop. To illustrate this concept the trainer held up his left arm, wrist limp. With his right forefinger and thumb he encircled his left wrist, and slid the encircling digits down wrist and thumb. This was the visual metaphor of following the first strand. Then, left wrist encircled again, sliding thumb and forefinger down wrist and left forefinger to follow the second strand. With the pale flesh of the left hand held aloft, the image of a cow’s udder was evoked for me, and following the strands was milking – the image was progressively milked. So, we return to the original image, and this time the strand that is milked is the arrival of the emergency services. Mike recalls the arrival of help. His images shift, his thoughts turn to seeing the fire extinguished, to seeing Kev’s body brought out of the wreck. Another strand to milk; Mike talks about the funeral. Kev’s coffin, in Kev’s parents’ house. During one set, I notice Mike’s face change, subtly. A deep breath. “So, what came up that time?” “I dunno. Don’t understand it. Kev was lying there at peace. He was sleeping, like.” I have no idea whether this is a recovered memory, or whether this is something inside Mike’s mind. I do not ask him if Kev was not so badly burned that he would not have been allowed to be visible in the coffin. I do not check if he remembered an earlier image of Kev asleep, or that maybe the peacefulness that he was talking about was just the funeral director’s art. More eye movement sets. Still Kev is asleep, at rest, at peace. Then Mike laughed. “He said to me, ‘Leave it go, mate.’” Up till now I have never seen Mike look anything but anguished and yet, suddenly, he is looking joyful. I do not usually go on about what EMDR patients say at the end of sets, but I am not sure to whom Mike is referring. “Mike, who said ‘Leave it go, mate’?” Mike shakes his head in disbelief, “Kev. Kev said, ‘Leave it go, mate’” I say, “Hold that.” We do some more sets. I check the disturbance level of the original image. Mike is not at all disturbed by it. He is beaming and looking incredulous. Kev is at peace and has told him to let go of it, and he can, he has. We finish off the session with the installation of the positive cognition. Only two hours ago Mike was saying that the statement “I can forget” was totally untrue; now he is saying that this is a true statement. He can let go. Kev is at peace and he told Mike to let go. Though Mike has no idea how this happened, and he keeps telling me of his incomprehension, he is sure that he can forget. We get up to leave. Mike is smiling, and I tell him that he looks happy. He says that he feels it, and he is looking forward to going home and having a glass of beer, “Not to keep the thoughts away, you know what I am saying? Just to sit down and relax. I can’t believe that I am saying this”. Yet I can. Mike wants another session in three weeks, to consolidate and reinforce what has happened. I agree to arrange this, but I am not sure that in three weeks he will feel that he needs to see me again. At the front door, Mike is laughing and punching my arm with delight. Wincing, I wonder if he is going to start wrestling again. Author’s notes: There is no identifiable reference to the client involved. Written permission has been obtained from the client involved to the effect that permission is granted to publish this article. Background
Hanno Koppel is a UKRC and BACP registered counsellor. Formerly an experimental
neuropathologist and lecturer in Anatomy, he is currently a counsellor of students
at Cardiff University. His contact details are: Hanno Koppel Student Counselling Service Cardiff University 47 Park Place Cardiff CF10 3AT Phone (direct line) 029 2087 6490 Mobile 07904 187 499 Email: koppel@cardiff.ac.uk
©2004 The EMDR Practitioner - All Rights Reserved Worldwide
|