Dr Derek Farrell on EMDR When There Are No Words | Chelsmford Saturday Nov 30 2019

EMDR EAST ANGLIA REGIONAL NETWORKING DAY

CHELMSFORD CRICKET GROUND

NOVEMBER 29th 2019

DEREK FARRELL ON THE BLIND to THERAPIST PROTOCOL

By Shirley Young

On an amazingly sunny day in November a large number of local and not-so-local EMDR therapists met for our last networking event of 2019.

After an introduction to the day by our current chair James Thomas, and an impassioned speech from Ulf Jarisch about the work of trauma aid endorsing membership to support their vital work, Derek Farrell took over the microphone.

After warming up the audience Derek seamlessly introduced the two threads for our focus for the day.

Starting from his experiences with writing up EMDR’s bid for inclusion in the Nice Guidelines and the actual outcome for EMDR, he highlighted the need for the EMDR Community to be learn to be politically savy about research.

Secondly, using a personal story about shame and humiliation as well as later case histories and evidence from intensive training with therapists in Iraq, he highlighted that history taking and assessment are not a technical exercise but rather an ongoing process.

Derek showed us how important it was to realise that some clients will disclose readily whilst others will be highly guarded.

Importantly, where shame-based experiences are involved and/or where disclosure involves a perceived risk to self or others and may include a risk of affirming a sense of shame in the client, the client is unlikely to disclose.

Indeed, if they are unprepared to disclose this may even lead to a client being discharged before treatment has occurred!

Derek asked us to consider how shame might present itself in the therapy room (both for the client and for the therapist).

This involved considering internalised and externalised judgement, being silenced and keeping the secret thus fuelling shame and, therefore avoiding an experience of feelings being validated.

Instead, silence maintains the expectation of retribution and shaming exposure. Thus, Shame can be a hidden but maintaining force in psychopathology. It can be multifaceted, whether a primary or auxiliary issue, covering beliefs, cognitions, relational/relationally avoidant behaviour, actions and stigma of being part of a particular cultural (e.g Germany or British Empire or currently Brexit).

Derek then went on to consider the meta principles for effective treatment.

The client needs an explanation to account for symptoms and experience in a client focused manner.

Treatment needs to consider what can actually be done – can things be changed and if not changed then the focus is on how to accept reality

Therapy involves an emotionally charged relationship with the therapist bearing witness from a place of detached compassion to avoid burn out.

Ultimately the client is the key to a successful outcome. They need to be willing to tolerate momentary discomfort and buy into the therapy plan.

Considering the targeting of traumatic memories Derek suggested that the AIP model, acknowledging the possibility of change via brain neuroplasticity, coupled with a compassion focused approach that can mediate the fact that the brain’s adaptability may need additional information, are both important in trauma processing.

It is also helpful to consider that reconfiguring memory is a trans-diagnostic model targeting neural networks and viewing diagnostic symptoms as a secondary consequence rather than a primary problem (a view supported by the BPS in their development of The Power, Threat, Meaning framework)

Derek then revised both general and EMDR specific core knowledge for working with traumatised clients and linked this with the issues that have arisen in relation to the NICE guidelines and its limitations and lack of acknowledgment and research evidence regarding working with trauma complexity.

Indeed, Derek asserted that shame-based trauma does not respond to normal treatment. It needs longer sessions because it takes time to go into and come out of. He reminded us of the empowerment for clients when they discover there are things they can do to calm themselves, explicitly going with what works to help slow down heart rate.

Derek then went on to consider using the blind to therapist protocol which, in the case of shame-based material with the perceived associated risks is useful as it allows the client to work with the material without having to talk about it.

Indeed, for many experiences finding a narrative is highly difficult.

The client is asked to give a target word for the memory to be processed (the therapist needs to ensure that the memory is active) this can be gauged by naming the current emotion linked with the memory, the subjective units of distress and the location of the body sensation. A cognition/voc is not sought.

The client is told to only disclose what they feel happy to disclose.

If the memory is processing – what are you noticing (i.e. is it changing) – “go with that.” It is important to return to the target memory, not any new memory that might arise. (This can also be talked about prior to starting processing so boundaries are made clear and the client prepared).

When the installation phase is reached either install a positive cognition that has naturally arisen during processing or use a more generalised statement such as I processed this (target word) memory today.

A body scan is still carried out to check whether there is still residual disturbance.

On re-evaluation if the client has disclosed then the normal protocol can be used but if non-disclosure is still the case then continue with the blind to therapist protocol.

In the afternoon Derek briefly introduced some data for us to consider about the future of EMDR, building on his introduction regarding the NICE guidelines.

We split into small groups and considered Politics/Training/Research and the question What are the challenges for EMDR Therapy and its future.

Following the feedback from groups which Derek will take back to the board for consideration a large group question and answer session with consultants rounded up the day before we moved on to the AGM.