Coping with Unexpected and Intense Trauma Reactions during Treatment
Research 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:
- The intensity of the reprocessing has been too much for them, and they need a break.
- The reaction is what it was like for them at the time of the incident they are processing; it’s part of the memory.
- The client has an underlying, unidentified psychotic disorder.
- The client has an underlying, unidentified dissociative disorder.
- The client has few skills in affect management/tolerance.
- 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.