Trauma Therapies: EMDR and More
Seeking care for a history of trauma?
What is the “right” kind of help for you, and how do you find it?
What makes some people more vulnerable to becoming traumatized after a specific event, while others are able to move on? This article from the National Institute of Mental Health does a really good job at discussing PTSD and talking about what are called “risk factors” (things that make a person vulnerable to becoming affected by trauma) and “resilience factors” (protective factors—things that provide a level of protection against being affected by trauma).
Understanding all aspects of a person’s story, and the type of trauma they have experienced, is an important factor for any clinician who is assessing for care. Consider this: some people grow up in stable loving households, and then sometime in adulthood, they experience something truly upsetting and even life threatening. Given the recent events with climate change, there are many examples to pull from, such as suddenly having to leave one’s home and losing everything to fire. If a person who survives a horrible event like this comes in, they would be addressing an “acute” traumatic stress response—and if that person had a relatively stable past, it would likely be fairly easy to resolve even severe symptoms, particularly if they have plenty of protective factors in place.
Generally, when people come in for care, however, they don’t have just one traumatic experience that they remember. They have many traumatic experiences, over the course of their lives. This often leads to more complex traumatic stress, and requires more sophisticated interventions. Luckily, the field of trauma care has opened up dramatically over the past 20 years, and whereas in the past treatment may have been limited, now, there are many evidence based models of care available to individuals seeking to recover.
Looking for EMDR?
EMDR stands for Eye Movement Desensitization Reprocessing. I am an EMDR certified therapist and many people come to me having learned about this therapeutic approach and hoping for relief from the pain of intense anxiety, traumatic stress, and other symptoms that may respond to what truly is a revolutionary approach to working with people.
People often are curious about what EMDR is, how it works, how fast it works, and so forth. There are two websites that do a great job of explaining EMDR—the website for EMDRIA and the website for the EMDR Institute. Please check them out to see if they answer your questions.
When people call and want EMDR therapy, I try to be both hopeful and honest. EMDR is a powerful therapy if and when it is right for you, and has helped many of my clients enormously. However, many people aren’t ready to start EMDR right away.
EMDR is an intensive form of treatment that can lead to a radical shift in how one lives in the world, because when it works, it will change a person’s relationship to the past. People very quickly go from “reliving the past” to “remembering the past”, and burdening and painful beliefs attached to old experiences resolve quickly.
While this may sound wonderful, for those with complex trauma histories, there is a lot of preparation work to be done before EMDR is going to be helpful or effective. Sometimes, the internal parts of traumatized individuals aren’t ready to let go of negative self-beliefs. These beliefs may have been formed when the person was a young child, and their parents or caregivers told them repeatedly that they didn’t matter or that they were stupid, lazy, or selfish. Children believe what their parents say is true, even if it makes them feel bad. They have no reason to believe that their parents are wrong. Also, to go against a parent means risking survival, because children need their parents for food, shelter, and protection.
Just because the child grows and becomes an adult, such beliefs don’t necessarily change over time. Often people still have a child inside of them that feels just as strongly as ever that everything their parents said about them was true. To release negative beliefs about oneself can feel terrifying, and like an act of betrayal, or self-annihilation. As hard as this may be to understand, it can be even harder for people when they are trying to get better and something inside of them is struggling to let that happen. Our minds are powerful, and because of this, I tend to be careful and take my time in the preparatory phases with EMDR. It is in everyone’s best interest to support the success of the intervention.
That being said, EMDR is an excellent way to work with individuals with trauma, and my training as an EMDR therapist informs almost everything I do. If you are looking for an EMDR therapist and I don't have any openings, or you have any concerns about what I have written above, please click here to see if you can find anyone else in your zip code or region.
Ego state work
Ego State Work likely has many definitions, but I think of it as any sort of psychotherapy work that is focused on development of a relationship between the Adult Self and the internal parts of oneself that drive one’s behavior. What does that mean?
This is definitely an abstract concept, but once people hear a little bit more, they have no trouble grasping what it means. The way I think of it is that there are parts inside of us that we know are there, and that can sometimes get in the way of us living the lives we want.
As an example, let’s say you have been told from childhood that you were always argumentative. There can be lots of reasons someone can have that trait—being argumentative—and certainly these reasons are not always bad. But if a person grew up in a family with lots of siblings, where they had to fight for everything they had, or where they had to take care of their family and perhaps life in the community wasn’t very safe, or where their parents were tough and expected the same of them, or where they felt that something important was taken from them when they were young, that trait might represent basic self protection.
We might call that part (also known in some models as an ego state) of the person a “protector” within them—meaning that in childhood, it developed to keep them safe from whatever was going on in their environment. Typical parts include the peacemaker, the workaholic, the neat freak, the caregiver, the control monster, the jokester, the addict, the saboteur, and so on. Sometimes in therapy these are also called defenses, but I like to think of them as parts, in that they often seem to have a distinct memory or set of memories attached to their development, and relate to childhood.
Sometimes, we have parts of us that create all sorts of trouble in our present day lives. Sometimes, we have parts that work against one another—”a part of me wants to stop, and another part of me doesn’t care at all!”. Sometimes, we have parts that totally confuse us—”I don’t understand why I would do such a thing!”
Working internally—that is, from our adult self, looking inward, to our own internal system, is a way to understand who we are, and to map out why we do what we do. These parts of us that cause us confusion or trouble may represent a moment or moments in time when as a child things went wrong, and we had to develop certain habits or traits to survive.
Becoming more connected to what is happening internally, and developing a compassionate relationship with ourselves, is a remarkably effective way to heal. It is often hard work for people who have been living in a way that keeps them disconnected from themselves. That being said, the relief that can be achieved through working in this way is transformative.
Internal Family Systems Therapy
Some of the ideas above have come from a model called Internal Family Systems Therapy. “The Internal Family Systems (IFS) model of psychotherapy offers a clear, non-pathologizing, and empowering method of understanding human problems, as well as an innovative and enriching philosophy of practice that invites both therapist and client to enter into a transformational relationship in which healing can occur.” This quote comes directly from the website of the Center for Self Leadership, which coordinates all trainings and research related to this model. The CSL website is very comprehensive and accessible for individuals interested in learning more about this model. To hear more about IFS from its founder, listen to the following podcasts. As a reminder, I am not an IFS therapist, but have some training and exposure to the model.
Somatic Oriented Therapies
There are several schools that teach body oriented trauma care. Some of the best known include Peter Levine’s Somatic Experiencing Trauma Institute , Pat Ogden’s Sensorimotor Psychotherapy Institute, and the Hakomi Institute.
A fascinating and fast moving area of research development in the treatment of trauma and other psychiatric illnesses is around the use of psychedelics to assist psychotherapy. There are numerous talks on this topic that have exposed me to the potential this treatment offers for the future of care for PTSD. In sharing these podcasts, my hope is to encourage people seeking relief to remain hopeful themselves, and to consider exploring signing up for treatment trials, if appropriate. That being said, I do not offer underground psychedelic assisted psychotherapy. I also am not posting this as a way of encouraging people to attempt to heal their PTSD through use of psychedelics on their own. It is clear, after listening to these various talks, that such efforts are at best, ineffective, and at worst, can result in worsened symptoms.
This is the talk that sparked my interest:
From the Good Life Project: Michael Pollan: Psychedelics, Science, Fear and Hope. Pollan is an investigative reporter whose most recent book is called “How to Change your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence”
Pollan referenced Rick Doblin in his interview, as well as MAPS. Learn more about Doblin and MAPS, and their current research, here: It's All Happening Podcast: MAPS Founder Rick Doblin
Here are a couple additional articles that offer nice overviews.
And one final talk that I found really interesting: “Part of the reason why humans suffer is that we don’t honor the expression of these so-called weak emotions—meaning sadness, fear, and shame,” says psychiatrist Will Siu. [In this talk] “Siu shares paths toward healing and connection, including what he’s learned from psychedelic-assisted psychotherapy, or as he puts it, psychedelic-assisted humanity.” (https://goop.com/the-goop-podcast/processing-the-trauma-of-loneliness/)