Integrated EMDR For Child Abuse – Part 2
Integrated EMDR For Child Abuse – Part 2
By Jeff Dwarshuis LMSW ACSW
As explained in Part One of this series, a person who has a history of child abuse will often develop two relational and cognitive problems called “Ambivalent Attachment” and “The Locus of Control Shift”. These are both unconscious and expected reactions to the feelings of loss and overwhelm experienced with child abuse. EMDR has been found to be a highly effective treatment for traumatic memory and the EMDR technique called “The Cognitive Interweave” is especially suitable for the problems of Ambivalent Attachment and The Locus of Control Shift.
The Beginning of Therapy
As stated in previous articles, EMDR quickly eliminates the negative impacts of traumatic memory leading to PTSD. However, EMDR also works on bad memories that negatively impact a person’s life but do not cause PTSD. Generally people with a history of negative memory from child abuse come to therapy with problems such as Generalized Anxiety, Depression or Panic Attacks. In some cases people will have PTSD or a related Dissociative Disorder. Relational discord is also common and problems in relationships such as conflicts, breakups and divorce can lead to Adjustment Disorders. EMDR treatment will successfully work with all of these presenting concerns.
EMDR treatment consists of first completing a client centered assessment and diagnosis followed by the listing of negative contributing memories. Often times a Cognitive Ranking is helpful (See blog article “EMDR for Depression – Bridging The Gap) to measure self esteem and to list any negative contributing memories to self concept.
When listing EMDR target memories it is important to include the memories that are the earliest and that cause the greatest negative reaction. Clients do not have to list all memories of abuse if they follow these steps. Memories are thematic and often times successfully completing one early and most intense memory will also reprocess other related, later memories. In order to do this, however, the earliest and worst memories need to be addressed. If only later or less traumatic memories are done then the earlier and more severe memories will not be reprocessed simultaneously.
Also, during the set up for the memory the client does not need to discuss the details of what happened in the memory and the therapist does not need to know what happened in the memory in order to do the treatment. The client simply needs to imagine the traumatic picture. Communication with the therapist about the memory can be done by using key words that the client knows represent the memory and then allows therapist and client to discuss, set up and reintroduce the memory when it is time to apply the protocol.
The Cognitive Interweave
The Cognitive Interweave was developed as an added technique to the EMDR Standard Protocol in an effort increase the speed of reprocessing as well as helping a client who seemed to not be moving through the EMDR reprocessing. The Cognitive Interweave is based on a researched clinical description of steps needed to complete in order to psychologically overcome a traumatic event. The technique has three parts – Responsibility, Safety and Choices. The Cognitive Interweave is generally suggested as a method to use sparingly since the idea of EMDR is to allow the client to move uninterrupted through reprocessing. However, this technique is perfectly suited for individuals who have been abused since its three steps line up with the particular complications found in both Ambivalent Attachment and The Locus of Control Shift. For that reason it can be used with each memory of child abuse.
The three parts of the Cognitive Interweave are introduced to the client by the therapist during the EMDR Standard Protocol. At determined times during EMDR processing, the therapist asks questions to elicit the client’s thoughts and imagery of responsibility, safety and choices as they apply to the particular memory. These questions and client responses during EMDR reprocessing both assure and facilitate the process of completing what is needed to do to eliminate the negative impacts of memory and address some of the specific difficulties people face who live with these traumatic experiences particularly self blame, fear and helplessness.
Stay tuned for Part Three of this blog on child abuse which will explain the steps of the Cognitive Interweave and its useful application to the dynamics of child abuse.
Jeff Dwarshuis LMSW, ACSW is a licensed psychotherapist in private practice specializing in EMDR therapy. For contact call (616) 443-1425 or send an email to email@example.com.
Also see Dwarshuis’ webpage at http://www.jeffdwarshuis.com/ for free clinical information and blog entries on EMDR, performance strategies, upcoming presentations and family health.
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