Utilizing EMDR consultation in a concurrent treatment model
Concurrent psychotherapy has proven to be valuable for providing timely interventions to patients with specialized needs. When clinicians perceive that a patient requires additional help, they frequently refer them for psychiatric consultations, group work and/or to clinicians who specialize in problem areas such as panic disorder and substance abuse. Current research indicates that many adults will experience significant trauma in their lifetime. Such traumas as child sexual abuse, family violence and disasters result in a large population suffering from Post Traumatic Stress Disorders and other Dissociative Disorders. Additionally, other patients have long-standing depressions, panic disorders, and phobias which do not resolve in traditional psychotherapy. Given such high rates of patients suffering with trauma and other treatment difficulties and relatively low numbers of clinicians trained in working with these problems, EMDR trained therapists with experience in these specific areas are uniquely positioned to provide adjunctive treatment. This presentation will propose an innovative model to address issues that create difficulties and impasses in psychotherapeutic treatment. When these issues persist over time, patients and therapists alike experience high levels of frustration, loss of motivation and belief in the efficacy of therapy. The benefit of EMDR as an adjunctive treatment will be amplified by an understanding of the types of patients who are appropriate for concurrent referrals. These include patients who experience major trauma while in therapy; survivors of child abuse who are revictimized in adulthood; those who destabilize after a disaster; patients with psychosomatic problems, unresolved depression, anxiety and phobic disorders. EMDR may enable these patients to reduce or eliminate symptoms. Other important issues presented will include knowledge of the type of therapist with whom to develop a successful collaboration, as well as the benefits for therapists who can provide additional resources while maintaining the patient in the primary therapy relationship. The concepts of contracting with both primary therapists and patients will be explored. Pitfalls and potential problems such as guilt stemming from perceived failure for the primary therapist, "sibling rivalry", split transference and patient ownership will be discussed and elaborated upon in order to help EMDR therapists anticipate and avoid problems. Case material from the perspective of both EMDR and non-EMDR trained clinicians will be presented to enable the attendees to understand how to utilize this consultation approach in their practices. Psychotherapy treatment with sexual abuse survivors is often lengthy and complex. For therapists and patients alike, intrusive and dissociative aspects of Post Traumatic Stress symptoms in combination with self injurious behavior, mood disorders and current problems produce a variety of treatment difficulties. These range from dealing with destabilization, dissociative episodes and crisis intervention to more typical treatment impasses and resistances. These difficulties and resistances to theraputic work may involve a range of fears of exposure, violating early taboos against "telling", sequelae to revelations, and overwhelming shame and concern about rejection by the therapist. Other patient concerns are of being flooded by feelings and memories; or of dissociating in such a way as to remain "lost" to themselves. Stuck, immobilized and frozen in this state. the patient may have a sense of "pseudosafety" in the familiarity of these feelings. At the same time, as the symptoms persist with small or no reduction in levels of distress, patients may experience high levels of frustration. increased feelings of defeat, depression and anxiety. Loss of motivation and belief in the efficacy of therapy often follows. At such times, the therapist may wish to consider EMDR as an adjunctive course of treatment to resolve problems such as the above.
Original Work Citation
Forgash, C. A. (1997, July). Utilizing EMDR consultation in a concurrent treatment model. Presentation at the 2nd EMDR International Association Conference, San Francisco, CA
“Utilizing EMDR consultation in a concurrent treatment model,” Francine Shapiro Library, accessed September 30, 2020, https://emdria.omeka.net/items/show/16505.