By Carsten Dernedde
Up to sixty delegates were present in the Zoom conference room and more than 140 in total had signed up to the mini conference and regional networking day.
Claire van den Bosch, EMDR Practioner and IFS Level 3 trained therapist, started the day with her presentation and personal manifesto “EMDR for all our Parts”. She presented her passion with her colleague Bethany Parris, EMDR Europe accredited practitioner and certified IFS therapist
Before getting into the IFS framework she uses to guide her work with complex clients, Claire took the delegates through an IFS-informed unblending meditation.
Accompanied by her own beautifully sketched graphics, Claire talked us through different stages of identifying our in-the-moment available parts and unblending them from the core self.
Creating first a ‘glow’ around the physical body and then breathing into an enlarging space around the body, there was eventually enough space for the parts to remain connected to the core self but move out from the felt body, so that calm regard and focus on the task at hand were possible.
The meditation is useful in the preparation phase or as a clarifying moment in any session.
Claire then gave her introduction to Dick Schwartz’s Internal Family Systems.
By way of creating dialogue, she invited everyone to a pop quiz to explain terms of the IFS language that they know.
Parts – there are no bad parts, all parts have good intentions
Protectors and Exiles – exiles hold the trauma, protectors keep us from feeling their distress
Managers and Firefighters – These protective parts can be hard to distinguish.
Managers ‘function’ (and are usually who we think we are) is to protect, could include addictions (incl phone), policing, control or avoidance. These parts are usually around all of the time.
Firefighters are involved when the exiles become activated and try to calm them down through thoughts, feelings and behaviours that are defensive. Firefighters awaken when there is danger present.
Self and Self Energy – the core of a person, the frontal vagal self, it can be calm but it can also be highly energised, compassionate, and courageous. Its characteristics are the “9Cs” (see below.)
Unblending – fully unblended, we can separate from a part’s experience and observe it
Unburdening – desensisation and reprocessing of a part’s SUD in the EMDR sense
Claire explained the interplay between the parts as the ‘Managers/protectors -Firefighters/distracters – Exiles triangle’:
Managers are commonly identifiable parts, because they are mainly cognitive in their functioning and are the face of ‘normality’. Firefighters are more emotional (thus more connected to the pain of the exiles), and the Exiles are the carriers of too painful emotional memory.
Whereas traditionally EMDR is very focused on the Exiles’ experience, what IFS brings to the party is that Managers and Firefighters control access to the exiles and deserve our attention. ‘If we leave our Managers and our Firefighters to duke it out between them, it doesn’t work.’
From her experience, Claire felt that there is something about IFS that is so deeply spacious that there can be a perceived clash with the agenda-driven characteristics of EMDR.
What she discovered for herself is that the most powerful aspect of IFS-informed EMDR is the silent work of the therapist with their own parts.
What Claire terms the ‘silent interweave’ is when the therapist notices that part of the therapist badly wants to get a part of the client out of the way. When the therapist pauses to calm the impatient part in themselves, it is often felt by the client as non-judgmental and respectful to their experience.
Blocked processing tends to resolve. Judiciously this can be made explicit: ‘I notice that I am feeling stuck and frozen, have you noticed that?’
After a tea break, Claire and Bethany took us through the eight phases of EMDR from an IFS point of view.
Complex clients come into therapy with all aspects of their lives ‘on fire’. In the preparation and history-taking phases, you can begin by re-framing the presenting issue in terms of parts; in contrast perhaps to ‘standard’ EMDR, the main relationship in the room is the relationship between the client’s self and their parts.
By gathering already identifiable parts, you begin mapping. You also identify accessible elements of the client’s Self and Self-Energy – they are the IFS equivalents of resources (8 C’s). Guided meditations and unblending allow access to self energy.
Bethany explained how during mapping, and at any point in the therapy process, you need moments of of what she terms ‘micro-unblending’ of the parts that arise.
A powerful way to strengthen the ‘just noticing’ observer attitude you need the client to be able to take for EMDR processing is to invite the parts to notice the client, rather than the other way round.
In this phase you orient protectors to the present and to the self and the client learns to unblend from them. It is important that protectors feel seen and heard by the therapist. That way they can later give consent to access the Exiles.
It is worth remembering also that protector parts themselves can be burdened. Obtaining and re-confirming consent from parts for any processing/unburdening is in Claire’s experience essential.
Claire and Beth then role-played a condensed IFS-informed EMDR session with more of Claire’s wonderful illustration and with teaching moments interwoven. Beth role-played a client who, after being shouted at by her partner, was flooded with the memory of her mother calling her stupid when she was a child.
A protector part prevents access to the child’s feelings. Permission to speak to the protector part directly is sought (tapping on the benign intent of the protector). It feels like the child’s pain is shut away in a protective cocoon. Only when (with BLS) the cocoon becomes permeable does it becomes possible directly to access the wounded child part inside.
The interweave ‘how do you feel towards this part’, reveals whether it is the compassionate self, or another protective part that is doing the healing work.
Claire and Beth demonstrated how giving time and tapping-in for a long time allows the part-to-self connection to deepen. Dual awareness is established through the client’s calm adult perspective and the child’s perspective.
Unburdening and letting go can take a long time; an interweave can offer the opportunity to repair – ‘now that the dark stuff has flowed out, what does the child part need to fill up with’?
Sometimes different types of BLS (tapping, eye movements, butterfly hug) may be needed for different parts, depending on whether they are, for example, stand-offish or in need of a hug. The installation phase, in Claire’s and Beth’s practice, consists in inviting in rather than formulating new insights.
An important phase is working with the client on committing to let the previously exiled part stay connected to the self.
In the Closure phase, Claire invites the protector part that initially prevented access to witness the part we have worked with as it is now.
In the next session, the therapist can check whether connections have been maintained, whether desensitisation has held, and whether any other parts that had been involved need support.
Beth and Claire then took us through eight different IFS-characteristic interweaves.
Parts can be highly polarised, and drawing attention to black-and-white thinking parts can be very relieving (orienting protectors to self). Also useful is a somatic parts interweave: you can invite the protective parts to do what they needed to do in the moment and couldn’t.
To conclude, Claire came up with a number of answers to a question she has long asked herself, ‘what does EMDR add to IFS?’
In her experience, EMDR provides structure and stops ‘popcorn parts’ popping up everywhere; neurodiverse clients benefit from structure and from BLS; clients with a strong protective structure may not get there with IFS alone without EMDR; and finally there is something about EMDR that ‘just gets into the body’.
In the lunch break, EMDREA’s AGM was held. Some conference delegates attended the AGM, which any of EMDREA’s delegates are always welcome to do.
An afternoon of fiercely packed conference presentations awaited.
John Mulhall, EMDR consultant and CAT therapist and trainer, presented his G-TEP project in an Acute Adolescent Inpatient Setting where he worked for ten and a half years.
Healthcare Professionals in an inpatient setting are at higher risk of developing PTSD and burnout. At any one time, a third of the staff working on the unit may be agency or bank staff. The young people in the unit have high and rising acuity and severity and a high prevalence of aggression, violence and self-harm.
The G-TEP protocol includes all 8 EMDR phases in a highly structured procedure. Clients’ Distress is ring-fenced within a time frame from the incident to the present day.
All staff including agency staff working at the unit were eligible to take part in G-TEP. Thirty-three staff members took up the offer of G-TEP.
This took the form of 2 hour sessions on a monthly basis, with up to 6 participants per session. The outcome scale was the impact of event scale (IES-R).
John took us through the G-TEP worksheet, where disturbing memories and their processing are sandwiched between resources and between ‘Here/Now’ and ‘There/Then’.
The quantitative data showed a large reduction in impact of the distressing events.
SUDs were also analysed and showed large reductions. Overall the reduction was from clinically significant to sub-threshold scores, and four out of five participants reported lasting benefits reaching into their professional and private lives
Qualitative analysis showed a sense of professional development, better coping skills, and a positive effect on staff’s personal lives.
Dr John Davies, Clinical Liaison Psychologist and EMDR practitioner, then presented his work on adapting G-TEP to use in critical care unit at the Norfolk and Norwich University Hospital during the Covid-19 Pandemic
Critical illness and admission to ITU can be a highly distressing experience. Delirium, causing delusions and hallucinations, is very common – two out of three patients have these experiences.
Depression, Anxiety and PTSD are common post- discharge.
At the hospital where John was one of two liaison psychologists at the time, critical care beds were expanded 400% during COVID, without an increase in staff. John had to think on his feet and in discussion with his EMDR supervisor, he developed his concept of administering the most parsed, cost- and time-effective intervention possible to the largest number of distressed patients.
Early detection and treatment of acute stress in ICU patients is vitally important.
People admitted knew what was coming and witnessed deaths. They were alert, albeit ventilated, all staff were in protective gear, the hiss of oxygen was everywhere and those who were ventilated couldn’t speak.
Rehabilitation assistants helped the patients (with the help of their families) to create a rehabilitation board, which included the G-TEP worksheet, next to their beds, so that the patients could see these boards. John showed a mock-up of such a rehabilitation board.
In addition, patients could through their iPads and noise cancelling headphones access recorded resources in the form of safe space and grounding exercises which required no verbal response from the patients and avoided reference to breathing.
Two G-TEP trained staff members then delivered the intervention. John was able to show dramatic reductions in the impact of trauma scores. As it was a service evaluation, not a research project, it is not known whether such a reduction would have occurred anyway upon discharge from the unit but the reduction in distress was very noticeable.
John then relayed his experience that, among staff, moral injury due to the lack of resources and support was experienced as more traumatic than the events in the critical care unit.
Although it came in the language of statistics and evaluation, it was a moving presentation, not long after the collectively traumatic experiences of the pandemic.
Mevludin Hasanović, Psychiatrist, EMDR consultant and president of the Association of EMDR therapists in Bosnia and Herzegovina then presented on the ‘Development of EMDR therapy in Bosnia and Herzegovina’.
After the war of 1992 and 1995 in Bosnia and Herzegovina (BiH), peace was established but without a functional state. To this day, Bosnia and Herzegovina feels unstable and unsafe to its residents, with adverse consequences for their mental and physical health.
During the war, civilians in BiH experienced many traumatic situations similar to those experienced by soldiers, such as extreme threats and an extreme sense of helplessness
Mevludin’s first encounter with EMDR was at the training at Missouri University, Columbia, USA in July 1998.
Following a workshop in 2008, Mevludin made contact with Sian Morgan, the late president of what is today Trauma Aid UK.
This led to EMDR trainings in London and Edinburgh, and then also in Tuzla and Sarajevo.
Mevludin then traced the painstaking process of building on each step and expanding training and support, which eventually led to the establishment of the Association of EMDR therapists in Bosnia and Herzegovina on February 14, 2014 in Sarajevo.
The association is now an accredited organisation with EMDR Europe and can and does train adult, child and adolescent EMDR therapists to consultant level, publishes conference reports and has many international links and collaborations, which Mevludin reported in his presentation.
Mevludin closed with an appeal. In the light of the present wars in Ukraine and in Gaza, and the deepening divisions of the world, he feels that it is more pertinent than ever to work to relieve the trauma that maintains these divisions.
Selvira Draganović, EMDR accredited Therapist and Consultant in training, then gave her talk on ‘The Elephant in the room – Incorporating Religion and Spirituality into EMDR Therapy’.
Selvira offered the definitions that Religion is usually affiliation with an institutionalised religion, while spirituality is a connection to the transcendent which may or may not be connected to organised religion. It is important for therapists to understand how their clients problems relate to their religious /spiritual requirements.
In terms of EMDR, religion and spirituality are significant for the therapeutic alliance, for resourcing, for therapy goals. It can also be the key when processing is stuck – negative or false religious beliefs can prevent resolution.
In Selvira’s experience, clients respond with great openness in regard to their traumatic experience when they are first asked what spiritual or religious meaning they make of what happened. If their frame of reference is unclear or is a different one than the therapist’s, she encourages clients to turn to their own community (family, priest, imam…).
Šemsa Šabanović, European accredited EMDR Practitioner and Consultant, then reported on her work in the ‘Child War Museum in Sarajevo & The Memorial Centre in Portocari’. , and her experiences with applying the EMDR stabilising techniques in order to psychologically aid preparing genocide survivors make testimonies.
Giving testimony, in Šemsa’s experience, is a battle between good and ugly, where only the bravest make it through this process. It even helps perpetrators to free themselves from the shackles of denial by giving them the opportunity to confess their crimes.
It helps those giving testimony to shed the label of victim.
The people giving testimony, for the most part, did not know that psychological help would be given.
The stabilisation and preparation part of the EMDR protocol was used to prepare people for giving testimony. This made the testifying process easier and enabled rapid stabilisation after the testimony giving. After the event, EMDR reprocessing was completed for those memories activated by the testimony process.
Šemsa found that being part of the process helped her own stability and resilience.
She found that the process revealed beauty and dignity and a desire to forgive (often conditional on confessions from the perpetrators), a desire to break the cycle of violence and trauma.
Through the process of giving testimony, the trauma became a life resource for survivors. Often survivors chose other survivors from the same community as life partners.
A lively discussion followed at the end of the mini conference, with wide ranging questions on spirituality, the increasing violence in the world and the sense of light and community that is needed, and specific questions concerning all the presentations of the day.
Mevludin concluded the discussion fittingly by calling all to work for a future empathic civilisation.