with Mary Clare de Echevarria
Saturday, 3rd February 2024
Summary of the day by Carsten Dernedde
Our day with Mary Clare gave a clear outline of how to integrate every way of working with ego states and dissociative parts into the practice of EMDR, and included some essential steps that are often missed out.
Mary Clare de Echevarria is a UKCP registered Psychotherapist, Recognised Supervisor and Recognised Training Supervisor, and EMDR Europe Accredited Consultant.
She is also a qualified teacher, with over 30 years’ experience of teaching and training, and with a style that’s been described as clear, accessible and engaging.
A very rewarding 200 participants had signed up for EMDR East Anglia’s latest training day, 145 of whom were in the Zoom room on the day.
Trained by Deborah Korn, Dolores Mosquera and Laurel Parnell among others, Mary Clare has been training trauma and parts work for many years, and had prepared a formidable handout for the day. In the event, and reflecting how she works, a day unfolded of sparkle, interaction, discussion and innovation – no death by Powerpoint on this occasion…
The introduction – an exercise in body awareness
Mary Clare started with an exercise, inviting us to feel into the body, welcome any difficult sensation or emotion, and to continue to take note of those inward experiences throughout the day. She asked us to say ‘hello and welcome’ to them, just as we ask our clients to do. Our feelings, noted Mary Clare, wish us no harm: they have something to tell us.
The Basics of Dissociation
To understand the origin and purpose of dissociative parts, updated polyvagal theory helps with the understanding of trauma responses. The Still Face experiment, of which Mary Clare showed a video clip, helps with understanding the biological mechanisms in early-life attachment of rupture and absent repair.
Dissociation is after all an adaptive survival response. An infant needs an attuned adult to learn to handle arousal and widen the window of tolerance. If there is no effective soothing available, shutdown occurs and the (dissociated) arousal goes ‘into the cupboard’ rather than being metabolised.
In the language of Structural Dissociation, what gets put in the cupboard are the traumatised parts of the personality, becoming sequestered away from what might be termed the Apparently Normal Part (ANP) of the personality.
Trauma Flashbacks in PTSD are a lot more identifiable than the flashbacks of unfulfilled need in dissociation. It’s safe to assume that flashbacks happen all the time, and we can introduce clients to the idea of child parts wanting their needs fulfilled. Pay attention to the discontinuities, said Mary Clare – we can use words like ‘I think this is a different you… this is normal… it is something you felt a long time ago, and it’s coming out of the cupboard…’
In Phases 1 and 2 of the EMDR standard protocol, it’s important to understand that people who experience dissociation don’t often know that’s what’s happening. A therapist needs therefore to look out for discontinuities, suddenness of feelings, a sensation of observing oneself, strangeness of feeling states, an inability to self-soothe.
Mary Clare suggested routinely asking yourself ‘Where is this person on the spectrum of dissociation?’, and ‘can they stay in their adult self while connecting with dissociative parts?’
For some people it is helpful to map their parts (adult vs dissociated). If a person has dissociative parts, the standard EMDR protocol may be too much – they may become flooded. But we can start at the periphery, such as the person’s fear of their parts, and do short fast sets to ease that emotion, focusing on the feeling in the body. This, we were reminded, is what Shapiro termed desensitisation without reprocessing (EMD without the R).
How Does One Work With Dissociation
In part two of her presentation, Mary Clare went into more detail about how to work with dissociative parts.
Parts, she said, are flashbacks – to something from the past that is unresolved; the ‘thinking brain’ looks for an explanation in the present but the feeling itself is old.
’This isn’t me, this is her/him’, referring to a younger part of the self, is a helpful insight – of course the younger part is you, but it’s a different part of you, and telling yourself ’this isn’t me, this is her/him’ automatically activates your noticing brain, allowing you to stay in your adult self and give that part of you what she or he needs.
Working with parts is easiest when the person is in their adult self and can see the other ego states or dissociative parts. But a person’s adult self can be overshadowed (Mary-Clare’s term) by the feelings of the part. Or they can be in another part and still ‘see’ the adult self. Or they can be completely ‘switched’ but still believe they are in the adult self. At the extreme end of dissociation, they can have no memory of the switched state when returning into the adult state.
Whether to add BLS depends on whether the person can remain connected to the adult self. If they are phobic of the part, Mary Clare suggested the use of what Gonzalez and Mosquera call microprocessing.
For clients who can tolerate this and stay present, you can record sessions and let clients watch them to see their parts in action.
Mary Clare showed a video clip, recorded as part of John Bowlby’s investigation of early childhood attachment, of a two-year-old in hospital, alone and unconsolable, to illustrate the origin of strong feelings that can pour out in a session from an adult.
She then talked the group through Jim Knipe’s loving eyes protocol with her own additions, including micro-processing the reluctance that may occur towards the younger part. Keep it very somatic, you can do it with or without BLS.
A Case Example
Mary Clare told (with permission) a client’s story.
The client believed an early accident to be the key trauma. From the beginning Mary Clare felt notably maternal toward her, and this turned out to be what the client had always missed.
A ‘shawl of light’ between sessions can encompass those memories and emotions that are present and those yet to come forward. A despairing 19-year-old part showed up in the processing, with no knowledge of comfort to which to connect.
Don’t underestimate, Mary Clare observed as she told the story, the degree to which historic parts are stuck in the past – they need to be oriented to the present and to the adult self. They must not be left in the past but brought into the present; nonetheless, coming into the present can be allowed to be a gradual process.
Further flashbacks of despair, anguish and apathy (the 19-year-old part) kept occurring, but all parts of the client became able and eager to learn to be loved. Bridging from other intense feelings in the present led to a three-year-old child, before the accident even occurred, who had never been loved. Integration occurred when the client felt love for the little child, the five-year-old and her 19-year-old self. ‘I’m loving that little girl in my heart and soul… I want to do nothing else for the rest of my life…’
Parts may need to live in an ‘inner house or home’ being taken care of for a while before they are ready to be integrated.
Part Two Of The Case Example – It Gets Rocky
Mary Clare started the afternoon with a ‘teaching interweave’ about adaptive and maladaptive affects.
Adaptive are those affects that are adaptive and can be processed just with EMDR’s “Go With That’. Maladaptive affects on the other hand are those that are associated with low energy states, eg. shame, self-hatred, despair, profound and utter aloneness. We need to work with these using plenty of active interweaves, proactively supplying adaptive information where it is missing – ‘You think you hate yourself because you are bad, but that’s not true. You hate yourself because you were mistreated, and that’s what people who are mistreated feel about themselves.’
Mary Clare then returned to her example case.
The 19-year-old part was the repository of all the pain from birth until then. Remember suicidal parts hold the ultimate hope of relief – they hold the ‘escape card’.
In the inner world, the adult client said, the 19-year-old, like the younger ones, was eager to be loved. ‘She’s taking in love because it’s at her pace… She’s calm – I used to think I would die of joy if anyone loved me… She’s smart, she appreciates what you are doing for her very deeply’. And yet the 19-year-old’s feelings of ‘I can’t take it any more’ kept intruding. Mary Clare had to be her resource figure and be quite direct to get her attention, and a good deal of psychoeducation and interweaves were needed to allow the adult self to stay present while connecting with the 19-year-old. Eventually there was a 35-minute stretch of just BLS with waves of relief and relaxation.
The beginning of integration was a ‘true’ hug between the 19-year-old part and the adult self. She then was able to take actions in her life to reflect this. And one of these, Mary Clare related, was a time of getting angry with, and distancing herself, in a healthy way, from her therapist.
‘You see how rocky it can get’. As the 19-year-old integrated, the client experienced the intensity of her pain and despair, and yet she reprocessed fast, because she felt loved. This client needed the full intensity of maternal love – and that included Mary Clare herself experiencing the ‘letting go’ part of motherhood.
Protector/ Blocking Parts
Any kind of stuck processing may be to do with a protecting/blocking part.
As with any part, you need to get their attention and interest – the protector parts are after all doing this intending to keep the client safe. Protectors, inner critics or perpetrator introjects can be the only aspects of the client’s personality that experience having power. As therapists, we have to welcome them – the client needs their protection. And we need to talk with the client to explain their protective function.
When a blocking part agrees to let you work with an exiled/child part, you have to come back to check in with the blocking part afterwards. You need to facilitate connection and understanding between the blocking or protector part and the adult self. Remember the adult client is always older than the protective part – the intrusion of the protective part is a flashback.
Demonstration Session
An experienced colleague volunteered for an EMDR session to work on her personal ‘gremlin’ of ‘not being good enough’, ‘not knowing enough’ which she’d never been able to resolve during her training and career as a therapist.
The recording will be shared for attendees to watch. It would not be appropriate to give details of personal material in a blog.
To give a flavour, Mary Clare used language like:
Go inside and picture the younger you who feels that… what do you see?… What do you feel towards her, as you look at her now?… what does she need?… does she feel you?…
Find the words to show her that you get it… Does she know who you are? … Find your own words, just quietly in your mind, to explain to her, ‘You are part of me; you just got left behind in 19 whatever it was’… ‘that time has gone; it’s the future now’… Tell her, ‘I’m you, all grown up, and I’ve come to get you, because you were never meant to be alone’… I’ve been looking for you’…
Tell me when she understands… give her time to take it in, this is a lot… Ask her if she is ready to come and be with you now… ask your imagination to show you a way to bring her here… where is she now; inside? on your knee?… Notice how it feels to have her here in your arms… feel that little body relaxing… I think you’ve been missing her …
Tell me when she’s ready to join up with you, and when you are ready… she may have some questions or concerns…
If it feels right, say to [the part who kept the person on her toes], thank you… could you keep the excitement without being hard on her?… Get a little closer, look at her face, her eyes… is this really your aunt?… Is she inside you now, with the little one?
Q&A Session
In the discussion, there was much gratitude from participants to Mary Clare and to the volunteer.
Mary Clare explained how she uses microprocessing to ease transitions. BLS is not always needed, as long as processing occurs – trust AIP.
If in a session you don’t have time to integrate a part, that’s what the ‘inner house’ is for.
Asking the person to look closely at the face of the part is about facilitating connection; later it can be about looking at a part who has taken on the guise of another person, eg mother, adding micro-processing, to get to who they really are.
If you bring a part into the present but don’t integrate them, they can slip into the past again. But if you integrate a part that is still carrying a lot of pain and distress, the adult self will get all that and it can be hard to handle. In that case, take the part to the inner home, so that they can be looked after and given what they need to heal, then they can be integrated.
The standard protocol is the gold standard, the royal road, use it when you can, but people with dissociative parts can’t always make use of it.
A spontaneous but typically encouraging closing statement from Mary Clare was ‘go forth and process’