EMDR Therapy and Parts Work: Working with the Inner System Across the Lifespan in Complex Trauma, with Ana Gomez

Ushma Patel reports.

The EMDR Association’s East Anglia Regional Group were delighted on Saturday 24th April 2021 to welcome internationally renowned and legendary EMDR Consultant and Trainer Ana Gomez to take us on a journey on parts and inner systems to explore complex trauma.

Ana is a psychotherapist, author of several books, chapters and articles, and a lecturer internationally known for her innovative work with children and adolescents.

She is an EMDRIA approved consultant, an EMDRIA advanced training provider, an EMDR Institute and EMDR-IBA trainer and a trainer of trainers. Ana has worked with children, adolescents, adults and families affected by trauma and adversity for over 25 years, presenting in more than 40 cities in the USA as well as 30 cities in four continents.

Over 600 delegates signed up to Ana’s workshop, with many attending on the day online and others chossing to watch the recording at a later date. Every delegate received the handouts, recording and certificate for six EMDR UK Association CPD points.

Ana presented to us from across the pond in Phoenix, Arizona, meaning a very early start for her and an afternoon 2pm start for us.

The plan for the day was to explore her theoretical framework along with specific, practical and creative tools and strategies to work with entrenched maladaptive forms of self-protection using parts work.

We had an opportunity to understand clients with complex and developmental trauma and their layers of adversity, attachment injuries and unmet needs, and how parts work alongside the EMDR’s eight-phase protocol can support the healing of the complex internal self-system.

The day started off with Ana enabling us to understand who we are and how we are.

As therapists, it’s so important to recognise that ‘’In order to fully understand the enigma of another’s psyche, we have to be aware of our own’’ i.e. it’s not about just learning a technique but understanding our own mind before we can open up to the client’s psyche.

We are not the expert with our client, Ana reminded us, simply another human working together with them.

We understood that trauma prevents integration, and that as a result traumatic memories remain segregated from other memory networks, inhibiting the capacity to synthesise our conscious awareness, and preventing acts of triumph to take place; failure of this completion, noted Ana, results in exhaustion.

Poet Rune Lazuli wrote ‘I am not looking to escape my darkness, I am learning to love myself there.’

Anna elaborated that it’s a journey not just of the trauma but also one’s self as a person, through light and darkness with the power to embrace ourselves and to love the parts of us that are ‘broken’ that can enhance our understanding of the world.

EMDR can be the guiding light to help us as therapists, with our clients, to delve into both inner and outer world, and explore and heal.

Ana walked us through an exercise to gain insight in what it’s like to work with images, exploring what needs to be seen, felt and known; physicalising as Ana puts it the image to bring it from the inner world to the outer, validating its existence.

Trauma survivors can often wonder ‘is this real?’ Anna explained that an image has a somatic response and affective signification. It is the only event in the psyche that is fundamentally psychosomatic and unites mind and body in a single, undifferentiated whole (Ahsen 1972). It’s the union of the mind and the body with effective meaning and is psychosomatic.

We were fortunate to be introduced to a brilliant exercise helping us to explore our ‘therapeutic house’ i.e. where do we live as therapist – with different floors (EMDR phases), spaces (structure) and furniture (approaches).

Perhaps the basement of the house is a space for attachment theory or polyvagal theory. Or the floors display furniture from various approaches like internal family systems or play therapy.

As we navigate the eight phases of EMDR we are practising the art of EMDR.

The intention, curiosity, the playfulness and reflective communication also inform how we attune, and synchronise and dance with what emerges in the here and now, where interpersonal creativity creates a nest in our human mind and a bed for the techniques and procedures that come from EMDR therapy.

We examined Dan Siegel’s notion of ‘name it to tame it’, based on identifying the emotion and experience which in turn helps the prefrontal cortex calm the amygdala.  If the client can’t do this with language, a representative image/object enables that connection.

We also went on with Ana to discuss parts and how some can be more complex than others.

The parts tell us stories, from attachment and trauma to unmet needs and defence mechanisms.

Using a weighing scale can help us to work out which parts have more or less of something, and where weights can be helpfully added or removed. The client is able to modulate what they need in order to find a balance, for example if a part has too much fear and anxiety but not enough of connection or patience.

After the first break, the focus was on using practical and creative tools to explore and work with defensive, wounded and/or broken self-states in order to prepare for EMDR.

Ana talked us through the use of sandtray and the applicability to the client’s narrative as a container for their world. The different parts can be represented by objects and figures, with fluidity and an ability to build boundaries high and low, and freedom to measure what you hide or see. The sand itself lends to a kinaesthetic experience for the client, aiding self-regulation.

Ana offered some useful tips on using objects when working with a client online. We were fortunate to see a demonstration of an application www.onlinesandtray.com which is free and allows access to several figures/objects that can be used with a client online.

Snap Camera’ can also be used to identify feelings and physicalise them, again using Ana’s language, through the camera, also representing a part of the self. It’s a great tool for children and adults alike, helping with expression and also defences where the client using a sandtray can use Snap Camera to take on different parts.

We gained a greater understanding of the concept when Ana took us on a journey of ‘inner roads and highways’ within our self-system, with the aim of looking together with the client at the inner landscape, the different parts, the varying speed limits or active roadblocks and a traffic light system of what is an open road and one where the road (part) is blocked. 

It’s a great approach with both children and adults, particularly when working on dissociation, looking at multiplicity while honouring a client’s fragmented parts with the ‘me’ still there underneath it all.

(Ana used the metaphor of one hand with five fingers, one rainbow with many colours, one flower with many petals.)

In essence the message to the client is one of a life story as a book. Each part has its own pages, and each part is a storyteller. There is only one book, but many chapters, which creates the space for small steps accessing the client’s mind, with the option to work with the whole system or just individual parts.

Next, we explored with Ana interventions that can support stabilisation for client preparation in EMDR’s phase 2, moving from fragmentation towards neuroplasticity.

At this stage it’s useful to have regular ‘check-ins’ with the entire system to increase both interoceptive as well as exteroceptive awareness.

Ana talked us through a case example where sandtray was used to incorporate different parts, including the story holder and the wiser figure, enabling the client to hold the latter two in their field of consciousness.

Holding both the wounded story and the wiser one can enhance awareness and realisation, ‘the moment of knowing’ which allows other parts to be included and with that a client’s mentalisation of their issues.

Another brilliant tip Ana talked us through when resourcing clients is to add the positive, wise, protective etc. figures or objects literally in physical form on to the top of the light bar, so that as BLS takes place, the ‘wise’ or ‘protective’ or ‘positive representations’ are with the client all the time.

We gained insight into the portals of the minds of both children and adults. For children, it’s good to discuss what Ana termed directive portals, enabling them to verbalise and self-regulate, or non-directive, non-verbal portals into the system with the use of play.

For adults, a directive approach facilitates the acknowledgement of different parts, and the non-directive identifies safely both defences and shame which the system otherwise finds hard to embrace.

We understood how the different parts tell a story and the importance of being open to listening, whether it’s through relational patterns via play, or what is felt by the therapist’s own subjective experience.

It’s important to take stock of what we feel when we are in front of our client, allowing us to hear parts that are communicating with us. Ana also explained how important it is to normalise the parts, so the client can understand how all relate to the ‘one’ you.

After supper (Ana’s early Arizonan lunch), we moved on to discuss the discrepancies that persist in the mind of a client who has had to accommodate trauma.

We need to help the client ‘know what they know and feel what they feel’.

This is where internal conflicts can compromise inner safety, in that the greater the conflict, the greater the lack of internal relation and emotional safety.

Ana explained how orientation to the present is important, as clients with trauma often live in trauma time. This can be done by using a rock, with elements that ground the client to the present moment rather as is done with the four elements exercise, allowing the client to feel safe ‘right now, right here’.

Ana then guided us through an experiential learning of our younger self juxtaposed with our current self, using objects to increase our understanding of using parts in anchoring.

Ana walked us through the ‘battlefield’ of the sacred inner system, where permission to enter is required and respect is commanded. To address trauma-related phobias, preparation to enter may require different objects or figures to support different parts. Acclimatisation to the ‘battlefield’ is next, exploring how parts behave, with observation and awareness – ‘just noticing’ these different parts and their physicality.

We can connect our clients with these parts within the body through texture, smell or movement in our awareness, communicating with the parts and noticing when you have had ‘enough’. This enables both of us in the therapy space to get to know the client’s system.

Once on the ‘battlefield’, it can be useful to  map out what happens internally by moving the objects to different areas to stabilise the client and encourage mentalisation, acting out the parts’ story and identifying what they are protecting the client from?

The idea here is, again, to physicalise the inner dialogues that lead to dysfunctional decision-making, and identify inner resources using short sets of BLS during moments of awareness.

Ana highlighted the need to manage conflicts, with the therapist as mediator on the ‘battlefield’ helping to find common ground, physicalising the different parts and the conflict with short sets of BLS to allow the parts in conflict to communicate.

There was a demonstration of psychoeducation with all the parts to encourage them to work together, using a palette of different instruments, including a thermostat to self-regulate, a cupboard to organise, a shield to offer protection, a bigger and wiser self to encourage self-care and playfulness, the metaphor of sun and clouds where compassion and kindness can be hidden, and a magnifying glass to encourage the curious self.

After all, said Ana, it’s part of healing and transformation to get the things we didn’t get!

She explained how to use interweaves during both preparation and processing phases to give the parts what they were missing, with objects or figures that can be added to meet the need, and BLS to move through the grief to the acceptance.

Ana shared with us, in sum, a fantastic day full of theory, experiential learning and case examples, but most of all the creative and innovative ways to incorporate objects and figures to represent different parts, from spiders and dinosaurs to kittens and lion cubs.

If my own response is anything to go by, many of us attending promptly headed out to the toy shop or online to Amazon to explore the objects that might help us work in a Gomez-informed way – prepare for a global shortage of toy weighing scales

As the East Anglia regional group and for myself too, we’re enormously grateful to Ana for an informative, memorable and joyful day.

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