Category: Clinical Practice

Coping with Unexpected and Intense Trauma Reactions during Treatment

Research^[1] has demonstrated that there are three challenging areas for a new EMDR therapist which might keep them from using their EMDR training:  1) introducing EMDR therapy to your clients; 2) coping with unexpected and intense trauma reactions during treatment; and, 3) lack of adequate EMDR consultation when stuck.  This second blog post will offer suggestions in how you can respond to these unanticipated reactions during EMDR sessions.

You may not have seen a client dissociate, have a pseudo-seizure, switch dissociative parts, have a psychotic break, or escalate into a sudden panic attack.  The comfort and ease with which you respond to these reactions improves with exposure and experience, but this first time, you may be unnerved.  I often wish I had a photo of my face the first time I had a client react in such a dramatic way – I’m sure I was looking cool on the outside, but inside, my head was spinning and my heart was pounding.  What do I do now?

If this happens when you are using your standard, more familiar form of treatment, you may well feel more certain about what steps to take. It’s important to rely on your clinical judgment, even when you’re new to EMDR therapy.  Do what you would do even if you weren’t using EMDR therapy.  Stop.  Ask the client what’s going on for them right now.  Remind them to take a breath.  You wouldn’t continue to have them go over a homework assignment if they had a sudden and intense reaction; you’d ask them what’s happening now.  Do the same thing when you are using EMDR therapy – use your good clinical judgement and your skills.  You may or may not get back to reprocessing during the current session.  It’s more important to stay with your client and find out what’s happening for them now.

There are multiple reasons why this kind of reaction may occur for a client, whether or not they are doing EMDR reprocessing.  Here’s a few:

1. The intensity of the reprocessing has been too much for them, and they need a break.
2. The reaction is what it was like for them at the time of the incident they are processing; it’s part of the memory.
3. The client has an underlying, unidentified psychotic disorder.
4. The client has an underlying, unidentified dissociative disorder.
5. The client has few skills in affect management/tolerance.
6. The client has an affect phobia or alexithymia.

If you are seeing this reaction for the first time in any of your clients, or the first time with this particular client, it’s a good idea to get consultation – ask a colleague, supervisor, or EMDR Approved Consultant about it.  They likely will have seen this kind of reaction before and can help sort out what happened, and what you might be able to do to address it.

Sometimes the client needs to be contained and walked through grounding and state-change exercises.  Sometimes the client needs to be supported through processing to help them maintain dual awareness.  You’re the clinician in front of the client, and you will need to rely on your best clinical judgment and experience.  If you are doing EMDR reprocessing with this client, you will back out of that and assess what the client needs to get back to processing at some point, but not necessarily during that particular session.

It is important to go with the client, be where they are.  If I am uncomfortable with the intensity of their reaction, I am more likely to try to shut it down, redirect the client, calm the client.  This may not be what the client needs.  It may be what you need, but that wouldn’t be helpful or fair to the client if you stop the process because YOU are uncomfortable.

Seeking on-going consultation from peers, supervisors or consultants will help you identify what steps you can take in your particular situation to help your client.  You might also learn about the areas you need to address personally.  Nothing will bring up your own unresolved trauma faster than using EMDR therapy.  Get some for yourself so you can be present for your clients.

Learn More About This Julie Miller

Research[1] has demonstrated that there are three challenging areas for a new EMDR therapist which might keep them from using their EMDR training:  1) introducing EMDR therapy to your clients; 2) coping with unexpected and intense trauma reactions during treatment; and, 3) lack of adequate EMDR consultation when stuck.  This first blog post will suggest how to introduce EMDR therapy to clients.

1) INTRODUCING EMDR THERAPY TO YOUR CLIENTS

Introducing EMDR therapy to your clients is often a challenge for new EMDR therapists.  What follows is a synopsis of what I usually say to clients who are new to EMDR.  Make it your own!

When we have negative experiences that may be overwhelming to us, not necessarily those “Big T” events that involve death of others or threats of death to us, our brain flips a circuit breaker.  That protects us from being overwhelmed and keeps us from going into shock or collapsing, which might be deadly depending on the situation.

The brain keeps trying to process these experiences, but if it can’t get them digested, the individual develops symptoms like recurring dreams or nightmares, inability to sleep, intrusive thoughts of the event, flashbacks, anxiety, hypervigilance, getting triggered, numbing, or avoidance of reminders of the experiences.  This takes a toll on the individual with stress hormones and unmanageable emotions.  Some people even feel crazy with all the internal chaos.

I’ve learned a form of therapy called EMDR, which stands for “Eye Movement Desensitization and Reprocessing.”  This therapy allows us to finally be able to get that memory processed so we can learn the lessons, throw away the garbage, and move on.  The symptoms related to having the unprocessed memory, like the ones I just mentioned, are reduced and sometimes even disappear.

EMDR therapy uses bilateral stimulation, moving your eyes left right, left right, which seems to turn on all the lights in the brain and help us finally digest that experience that was stuck.  We can also do tapping on your knees or hands, or snapping fingers in your ears.  Sometimes I use equipment to do this, and we can see what might work best for you.

This is an 8-phase therapy process that is very structured, so it will be different from the talk therapy we usually do.  I’ll be looking at the manual and reading some things to you to make sure I give you the correct information.  Most people think it’s kind of weird to start with, but you get used to it, and it really can help so most people put up with the strangeness.  It’s not for everyone, but if you’re interested, we can give it a try.

I think EMDR therapy might be helpful to you.  You can find more information at the EMDR International Association website (emdria.org)  and I’m happy to answer any questions you may have.

What do you think?  Any questions?  Would you like to see if it might be helpful for you?

©2019, Julie Miller, MC, LPC, LISAC, Tucson, AZ

¹ Grimmitt, J. & Galvin, M. (2015). Clinician experiences with EMDR therapy:  factors influencing continued use. Journal of EMDR Practice and Research, 9(1), 3-16.

Learn More About This Julie Miller