By Carsten Dernedde. Michelle Griffiths-Reeve and Joe Kearney
Mike Rivers, Chair, welcomed us to the first in-person CPD and Networking Event in Ely since 2019 in the Ely Beet Club, a venue of many past such adventures.
With Carsten Dernedde lined up for the end of the morning and Joe Kearney ready for the afternoon, both looking into EMDR and the Body, Jo-without-an-E Gresham-Ord kicked off the day with her talk of EMDR and walking which has been a big part of her EMDR journey. A few in the audience had dabbled with it but blocking beliefs come easily to mind.
A chance encounter with an Australian psychologist was the first time Jo encountered an enthusiast for walking EMDR, and with Covid forcing us all to make choices about social distancing, Jo gave herself a push and chose walking – experimentally at first, and not yet in the best physical location. Her feeling was that it would particularly suit highly complex patients.
Jo uses the standard EMDR protocol with tweaks. She took us through the eight-phase protocol and the adaptations she has found most useful, with history-taking including a risk assessment and consent form and resourcing/phase two preparation beginning indoors and carrying on outside..
Fed up with only meeting virtually? Wondering what we all still look like below Zoom’s Face-and-Shoulders view? Longing to give each other that long-awaited bilateral hug? Curious about innovations in EMDR that might include the most ancient forms of bilateral stimulation before Shapiro invented ships-in-the-night eye movements?
The EMDR UK Association’s Regional Group in East Anglia was delighted on Saturday April 27 to host our first in-person meeting (break out the champagne…) since the pandemic, at our well-known and well-loved Ely (Sugar) Beet Social Club in the heart of Fenland.
Jo Gresham-Ord, sharing her thoughts on Walking and EMDR, all in good time.
Blowing Covid cobwebs to oblivion, Jo Gresham-Ord took us through EMDR with Walking, and while Joe Kearney and Carsten Dernedde enthused us about EMDR and the Body, somatic experiencing in EMDR, and, especially also, all that very topical polyvagal stuff.
As long-standing members of our Regional Steering Group and organisers of many a past networking day, Joe and Carsten needed perhaps less introduction, though we added a few further down.
Fuller report of the day coming shortly, so at this point, just saying thanks to the team and all our guests for making this day such fun and so professionally rewarding.
Regional Chair Michael Rivers saying thanks to Carsten for his wonderful presentation
And for Jo without an E, she’s an EMDR Europe-Accredited Consultant with over 20 years of experience working in the NHS, University of East Anglia and in private practice. Since the Covid crisis her practice has broadened out to include the use of Walking and EMDR as a modality for treatment, and she’s an Ely local.
Joe Kearney Inspiring…
Jo (the one without an -e) writes:
Have you ever wondered why Francine Shapiro, who discovered EMDR when she was walking in the park, focused so much on the eye movements and not the walking part? I have.
Maybe it was due to the cultural norms of doing therapy in the room at that time or simply that the eye movements were a more noticeable part of what she experienced.
Therapists have been working outdoors for a long time. This is not new. However, with the advent of the Covid virus meaning that meeting in rooms was more challenging, one thing is for sure, more people seem to be taking the therapy outside.
Consequentially, I have increased my use of EMDR using Mindful Walking as BLS and will be sharing how to adapt the standard protocol by giving some examples of how and when it has worked most effectively. I’d like to encourage any therapists who feel apprehensive about doing this to embrace the opportunity to use nature as part of their therapeutic tool kit.
For the rest of the day, once Jo has taken us all for at least a metaphorical walk, Carsten and Joe outline their ideas thus:
Why is EMDR Bodywork? Before lunch, and taking in the neurobiology of trauma and social engagement, we’ll explore why thinking is feeling, why the past is present, how resonance sends adaptive information processing in the right direction, and the deer metaphor explanation of why EMDR works.
Plus as a bonus feature why the earth is flat after all. Not really joking but rather an invitation to consider EMDR from the body’s point of view.
After the lunch break, we will do some practical exercises to illustrate some of these points.
Joe Kearney will present on Somatic Experiencing and EMDR, and we will explore how EMDR can be enriched by giving the body room in the Eight Phase protocol. There will be opportunity for small group experimentation and reflection.
And as we conclude here, potential future presenters at regional networking days please take note: it can be very enjoyable and stimulating preparing a presentation in a group, even if you don’t take the stage.
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.
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.
[The East Anglia EMDR Association AGM will be held at 12:30, during the lunchbreak]
Morning
EMDR for All Our Parts with Claire van den Bosch
Claire van den Bosch, EMDR Practioner and IFS Level 3 trained therapist, will present on experiencing our clients and ourselves through the intensely and explicitly relational systems theory lense of Dick Schwarz’s Internal Family Systems. Claire will share reflections on her experience of the power and beauty of incorporating IFS into every Phase of EMDR psychotherapy with complex clients and of the “most important” interweave available – working with our own parts – as therapist – in real time in sessions.
Please email any questions you have for Claire in advance of the day: clairepvdb@gmail.com
Afternoon
GTEP Presentations with John Mulhall & John Davies –
GTEP in ICU during COVID >EP with staff in an Inpatient setting
John Mulhall, Cognitive Analytic Psychotherapist, Supervisor & Trainer, & EMDR Consultant. Presenting on the GTEP (Group Traumatic Episode Protocol) project, a single session group based intervention, outlined in the attached paper (view document) was conceived, co-facilitated by John, and his colleagues, at the St Aubyn Centre in Colchester. The Centre is an NHS adolescent inpatient psychiatric setting. John will be presenting and discussing aspects of the project, and its findings.
A further study will be presented by Dr John Davies, Psychologist & EMDR Practitioner, on using GTEP with patients and staff in ICU during COVID-19. John has a particular interest in using this approach with critical care inpatients who have been identified as being at increased risk of developing ICU-related psychological morbidity, including PTSD. He has similarly used RTEP and elements from GTEP to support staff during the height of the COVID-19 Pandemic.
EMDR Bosnia Herzegovina talk with Mevludin Hasanovic, Shemsa Hasan and Selvira Draganovic.
Mevludin Hasanovic, President of EMDR Bosnia Herzegovina, will talk of his work in developing EMDR in Bosnia Herzegovina as a Consultant Psychiatrist & later EMDR Consultant post war (1992-1995). Supported by Trauma Aid UK.
Followed by Shemsa Hasan, EMDR Consultant, talking of her experiences in the Child War Museum in Sarajevo and the Memorial Centre, Portocari.
Finally, Selvira Draganovic, EMDR Consultant in Bosnia Herzegovina, will then talk on ‘The Elephant in the room’; Incorporating spirituality & religion in psychotherapy.
EMDR East Anglia Regional Group online event – 29th April 2023
This was a dynamic deep dive into EMDR With Every Client with Gus Murray EMDR Europe Trainer and Consultant, President of EMDR All-Ireland Association, Integrative Psychotherapist and Trainer.
Answering questions such as: Can we make EMDR Therapy work with every client? and How do we make it work?
Gus offers us wisdom and insight into three distinguishable levels of EMDR Practice – helping the clinician to better understand some of the complexity around the uses of EMDR in different frameworks, e.g.:
Level 1: Using EMDR techniques – when a clinician uses EMDR techniques as a standalone intervention or as an adjunct to their existing approach.
Level 2: Using the EMDR Standard Protocol to treat dysfunctionally stored episodic memories, arising primarily from shock (Big T) trauma.
Level 3: EMDR Therapy with complex clinical presentations, e.g.: EMDR as a comprehensive model of psychotherapy.
Throughout, Gus used recorded case examples and demonstrations from his clinical caseload.
Paying attention to which level the clinician offers to their client, better enables the therapist to understand the difference between offering EMDR Techniques and EMDR Therapy.
“EMDR is not talk therapy with bilateral stimulation.” (Gus Murray 2020, 2023)
Gus expanded on Level 3 EMDR Therapy, particularly paying attention to what he describes as the competencies needed to work with the complexity of level 3 clients. “Expanded competencies are needed for clinicians to successfully work with complex clinical presentations.” (Gus Murray 2023)
Level 3 competency in this presentation focused on revisiting the EMDR Therapy AIP Model – paying attention to the key function of EMDR therapy as resolving dysfunctionally stored memories through the vehicle of the neurobiology of EMDR therapy, understanding survival adaptations and facilitating somatic processes.
Gus explained key factors in enabling the work of EMDR Therapy. “creating a balance of activation between the present and the past. Dual attention is a primary mediator with emphases placed on the importance of case conceptualisation and treatment planning and the application of an expanded use of the 8 phase protocol.” April 2023.
Other key concepts that Gus suggest that clinicians pay attention to in being able to offer EMDR therapy for all are:
Resourcing e.g.: the positive desired future in addition to resourcing figures and other typical resourcing.
Offer container Exercises – as a way of managing difficult /overwhelming material until readiness to tolerate and a way of making positive resources available to the client accessible when dealing such material.
Identifying readiness to process – crucial in the early stages of the assessment phase.
Identifying targets from core beliefs, including early maladaptive schemas.
Identifying targets from anticipated future experience – helps with moving forward.
Future template versus flash forward protocol
Pendulation and Titration – useful to note how much or how little to offer in the process.
EMDR pendulation Interweaves – to help with being in touch with trauma and helping clients move through it.
Gus ended his presentation with his most important observation that the therapeutic relationship in EMDR therapy is key. EMDR is a Relational Psychotherapy which pays attention to: the working alliance, transference/countertransference and the reparative/developmentally needed relationship. All of that is framed within the person to person (I thou) relationship and the wider context of the transpersonal. (Clarkson P. 1990. A Multiplicity of Psychotherapeutic Relationships, British Journal of Psychotherapy, Vol.7 (2).)
On Saturday 14th January 2023 over 100 delegates came together online for our latest EMDR East Anglia regional networking day to learn about the basics of integrative, attachment–informed EMDR.
We jumped straight in with the recognition that AI-EMDR is not going off-piste, and that it is compliant with standard mainstream EMDR and officially endorsed by the EMDR authorities.
Christine Ramsey-Wade
The morning began with Christine Ramsey-Wade, Senior Lecturer in Counselling Psychology at the University of the West of England in Bristol and EMDR therapist, highlighting the need for further research as EMDR, now more than 30 years old, evolves beyond the Standard Protocol especially now to embrace attachment.
With our presenter Mark Brayne’s first paper on AF-EMDR now published, using Laurel Parnell’s original term Attachment-Focused, (Kaptan and Brayne, 2022) Christine focused particularly on a current feasibility trial for EMDR and AI-EMDR funded by our own East Anglia EMDR Regional Group through the national EMDR Association UK.
The plan is to create a team of co-researchers – EMDR therapists and Consultants working with either the Standard or the Attachment-Informed Protocol – with at least 40 client participants presenting with what the project is terming attachment-informed complexity, rather than the full and formal diagnosis of Complex PTSD.
Those clients will then be randomised to receive either 10 sessions of Standard EMDR or 10 sessions of AI-EMDR – an exciting project that is now actively being recruited to.
Mark then walked us through the goals of EMDR and the survival response that underpins any effective use of this powerful therapy, building on the notion that every dysfunctional ego state, every part, every presentation began life with a survival response and is therefore welcome in the work.
More than 230 delegates signed up for the day, on the day including colleagues from East Anglia and much wider Trauma Aid network from as far afield as Iraq, Egypt and Bosnia.
Dr Millia Begum, Consultant Psychiatrist and EMDR Consultant and Training facilitator, started the day with a deep dive into EMDR and medication.
Three key areas we focused on during the morning were:
Psychological influences of medications on therapies, specifically EMDR
PTSD specific medications and a video from Dr Ruth Lanius on Dissociation medications
EMDR with Psychedelics
Millia walked us through the key medications; antidepressants, anxiolytics, antipsychotics and mood stabilisers as used in services, as well as the effects on the client and their trauma symptoms.
Interestingly, NICE guidelines from 2018 say that medication should not be a first line treatment for PTSD, highlighting the importance of therapeutic input. Millia offered examples of the difference between a nocebo, where a patient might anticipate and therefore experience negative side-effects to what they believe is a medication but is actually inert, and the more familiar placebo that also uses an inert substance but has a positive impact on a patient thinking they’re being medicated.
Millia explored the familiar dilemma of clients dependent on Diazepam and fearful that if they don’t take it before their EMDR session they will have a panic attack and not be able to attend. Diazepam can of course interfere with processing, and Millia reminded us how important psychoeducation can be, as well as the EMDR installation of resources to maintain a window of tolerance where emotions are appropriately regulated.
Jim Knipe’s very useful suggestions around targeting what he calls the Levels of Positive Affect (LOPA) where clients are reluctant to let go of the upsides of medication that’s now actually dysfunctional.
We then moved on to PTSD-specific medications and the evidence base for the use of alpha-blockers, a group of blood-pressure-lowering drugs.
Millia explored the case of Don, a military veteran with severe nightmares and how alpha-blockers stopped his nightmares completely after two weeks. Prazosin in particular is found to have a positive effect on hyperarousal, nightmares, concentration and irritability.
Interestingly, the higher the blood pressure before application of Prazosin, said Millia, the better the effect – suggesting that in PTSD, raised blood pressure might be a marker of hyperarousal.
Much appreciated by our group, Millia had secured two recorded interviews to run as part of her presentation, the first of them with Dr Ruth Lanius who discussed targeting dissociation with opioid blockers.
We were introduced to the Defence Cascade Model: from hyper- to hypo-arousal with a delineation between defence reactions and dissociative states, with their reflections in the sympathetic or parasympathetic nervous system response.
It was fascinating to hear how chronic developmental trauma can influence the fight-or-flight, and/or the unresponsive immobility responses, the former being an active defence and the latter a passive defence. This is where Dr Lanius suggested opioid blockers can be helpful in reducing trauma and dissociative symptoms.
After a break, we moved to the thoroughly topical issue of EMDR and psychedelics, with studies of ketamine, MDMA or psilocybin (the ingredient in magic mushrooms) being used to lower defences blocking access to trauma memories in the treatment of PTSD and depression.
Ketamine use, we heard, is licensed in the UK for treatment-resistant depression, with MDMA likely to be licensed next year for Complex PTSD.
Randomised Control Trials on Ketamine on its own have shown promising results in the mainly short term, but with a high relapse rate. However, when paired with EMDR, the temporary enhancement of neural plasticity can be used to address deep-seated trauma very effectively, with much longer-lasting effect.
Attendees were thrilled with Millia’s second special recorded interview, with US-based specialist Sunny Strasburg talking us through how she uses ketamine with EMDR and also an Internal Family Systems model.
Sunny also works with the legendary Bessel van der Kolk in Boston, another enthusiast for psychedelics in trauma treatment, and stressed that building therapeutic alliance is exceptionally important in psychedelic therapy, because the ketamine will disable a client’s protector parts.
Interestingly, in psychedelic-assisted therapy the Negative Cognition has to be tweaked, Sunny said, towards a positive affirmation.
Sunny walked us through how she switches to EMDR’s phases 4-7, actually targeting trauma memories only once the client is coming out of the immediate intensity of the psychedelic experience, only using hand tappers rather than eye movements, since EMs are compromised by the effect of the ketamine on the eyes.
Sunny stressed that specific training in psychedelic-assisted therapy is vital before offering this approach to clients. Also, Sunny was very clear that as a therapist one absolutely must have one’s own first-hand experience of taking ketamine in a therapeutic context, to be able to understand a client’s somatic response when it is administered.
Sunny was so inspiring that there’s a strong chance in the near future of a group field trip of delegates going to one of the retreats she so effortlessly sold to us…
A delegate informed us that there is a documentary on Netflix by Michael Pollan exploring the history and uses of psychedelics, including LSD, psilocybin, MDMA and mescaline, titled,’ How to Change Your Mind’.
Another delegate recommended the docudrama Nine Perfect Strangers starring Nicole Kidman, about psychedelics with veterans and including the use of Ayahuasca.
Millia provided a truly fascinating and thought-provoking morning.
Michael Hase
In the afternoon, we were joined by Dr Michael Hase, Consultant Psychiatrist, Psychotherapist and EMDR trainer from Germany who took us on a tour of EMDR in the wider Europe, current developments in defining the future of the EMDR protocols, EMDR supervision and research.
We learned from Michael that EMDR Europe now brings together 36 countries, with a total of 33,645 members in national associations.
Europe is a hotspot for EMDR research, focusing particularly the Netherlands, Italy, Spain, Turkey and the UK, trailblazing with some high-profile publications. Currently, said Michael, there appears to be less research happening in the US.
It was reassuring to hear that after Francine Shapiro died in 2019, the EMDR International Association set up a Future of EMDR Therapy (FOET) project with a Steering Committee and Council of Scholars, and active work groups looking into the future of EMDR, research, clinical practice and training and accreditation.
The goal is to preserve the integrity of Shapiro’s vision of EMDR as a comprehensive psychotherapeutic approach, and stay faithful to the application of the Adaptive Information Processing model. The hope is that this will inform robust and best practice, research as well as training, practice and future innovations.
Michael walked us through core elements identified in this process, including a glossary of terms and an understanding of EMDR under three headings: EMDR-derived Techniques, EMDR protocols and full EMDR Psychotherapy.
Moving to the latest scientific research, Michael talked us through the findings of a computational neural network model which accurately predicts which brain centres respond to Bilateral Stimulation (BLS) when compared to real-life brain scanning data.
This study brings us a step closer to understanding the mechanisms of PTSD and EMDR, particularly of how EMDR achieves trauma remission and how EMDR exerts its therapeutic action.
Michael considered the neurobiology of BLS compared to Prolonged Exposure and the role of the ventromedial prefrontal cortex and the dorsolateral prefrontal cortex.
It is suggested that ventromedial prefrontal cortex activation during exposure and the resulting downregulation of the amygdala are key factors in prolonged exposure therapy.
Interestingly the dorsolateral prefrontal cortex is activated following BLS, a key finding being that EMDR–recruited regions of the brain have a higher capacity to inhibit the amygdala compared to the regions activated during prolonged exposure.
Discussion of the AIP model and resources centred fundamentally on the need for balance between the two; positive memory networks need to be present in order for processing to occur. We also need to understand that the therapeutic relationship is a positive memory network in itself – a dimension to EMDR not often explicitly recognised.
The take-home message from Michael? EMDR is a sensitive therapy strongly dependent on the therapeutic relationship, especially when working with attachment-deficit clients. Resourcing can be as powerful as adhering to protocols.
After Michael’s fascinating presentation, we had a quick break and returned to group discussions in groups of 5-6 delegates to discuss our thoughts on the morning or afternoon’s presentation.
The feedback was that there were many thought-provoking discussions and plenty of reflection and assimilation of the two presentations. It was lovely to be in groups with delegates from all over the world and have stimulating conversations that would not have been possible if the event today were in person.
To end the day, we finished off in our traditional Zoom plenary with questions and appreciation for our two presenters, a perfect way to finish a truly informative day.
On a sunny and chilly Saturday, our April 2022 East Anglia Regional Networking day – continuing a tradition going back now a full eight years – was certainly popular, with over 200 colleagues signing up and 120 attendees joining in online in real time from East Anglia, the UK and as far away as Bosnia and South Africa.
Sonya Farrell
Sonya Farrell, co-founder of our EMDR Association regional group and long-time supervisee of the legendary Jim Knipe of EMDR Toolbox fame, started the morning with a case study of client ‘Christine’, presenting with multiple chemical sensiticity as well as Emetophobia, Trichotillomania and Addictions.
Mapping Christine’s trauma with Jim Knipe’s trademark ovals to demonstrate the various parts, Sonya explained how the overwhelm of the human nervous system’s natural processing system can lead to parts remaining unintegrated into an individual’s sense of self.
We look forward to welcoming the redoutable and hugely experienced Gus Murray to our April 2024 regional networking day online to take us through using EMDR with every client.
President of the still relatively newly-formed All-Ireland EMDR Association, Gus is an EMDR Europe Accredited Trainer and Consultant, and Programme Director at the Cork Institute of Technology for the past 25 years.
As Gus explains it, the full potential of the clinical application of EMDR therapy is still compromised in its application to a full range of clinical conditions, with many clinicians struggling or reluctant to use it with more complex and disordered clients.
