Our previous blog post introduced the concept of EMDR, or Eye Movement Desensitization and Reprocessing, for addressing substance use problems. We gave an overview on how EMDR can target levels of urge and cravings, negative and positive feeling states, and the fear which stems from thinking about relapse and abstinence. Addressing these urges, cravings, feeling states and fears help clients face and resolve challenges.
We also help clients develop internal feelings states, which are positive personal resources. During sessions, we talk about and assess client support systems, and encourage clients to find ways to ask for help when needed. In addition, discussions centering on the importance of setting healthy boundaries are always useful.
Healthy coping skills can be applied in a variety of situations. Clients may feel challenged when dealing with family dynamics, or with stressors in the workplace, demanding friendships, housework loads, childcare pressures, financial problems, health problems, and somatic complaints. When clients can develop and strengthen the qualities they require to manage situations more effectively, change can begin to happen.
Inner Resources
Before work gets started on compulsions and avoidance, clients may begin to find relief as they are led through imaginal exercises involving healthy ways of being in the world. And being healthy in the world presupposes a sense of safety and stability.
To achieve that sense of safety and stability, clients need to become familiar with representations of safety, protection and nurturing. Through envisioning aspects of self, or role models, mythical figures, animals, symbols, objects, scenes, to name a few – and all of which can become meaningful to clients through a process of imagining and feeling – inner resources of protection, nurturing and acceptance can grow stronger.
A client can turn to these inner resources to gain strength and insight.
Once these inner resources are installed, clients will be able to navigate daily life more easily. When safety and stability become more routine and easy to access, we can begin to ask questions about how clients can envision future healthy versions of themselves.
As clients begin to formulate healthy aspects of self, and conceptualize themselves as healed in a future time, they can grow stronger in their daily practice of safety, stability and security.
Exploring Compulsions and Avoidance
When clients have experienced these stabilization and preparation phases of EMDR, they will become ready to take on reprocessing sessions. During reprocessing, disturbing material can be mediated by the client’s strengthened inner resources. The client may have obvious breakthroughs. The client may also not notice much in the moment, except for perhaps that sense of safety which is so crucial to healing.
When clients have experienced episodes of addictive or compulsive behaviors, or continue to experience them, it is useful to explore and review these episodes and discover what kinds of triggers or urges accompany the episodes. It is at this point that clients can rate how intense their urges and triggers feel – whether these urges/triggers happen in the home, in public, at work, with certain people – or because of certain smells, sounds, textures, memories or emotions.
When working with internal or external triggers, clients may find that they engage in compulsive behaviors either because they want to achieve a positive feeling state, or else because they want to avoid something painful. This something painful can be related to emotions, memories, body sensations, tasks, responsibilities that feel overwhelming, or any kind of stress.
Sometimes what needs to be avoided can’t even be formulated. It’s when clients become more aware that trauma may be connected to avoidance that clients can begin to better understand patterns of thoughts, emotions and behaviors.
The EMDR therapist will work with clients to conceptualize triggers and levels of urge via ratings of 0 to 10. When EMDR is applied to triggers, levels of urge can reduce in intensity both for desired positive feeling states and for avoidance.
Any identified trauma will be reprocessed or contained. Trauma and negative beliefs about self can be explored when they come up. Clients can name the memories or events, gain some insight, understand their compulsions from a new angle, and then either continue processing this material, or when too disturbing or occurring too late during the session, imagine putting it away someplace safe so that the current work can continue.
At a later date, clients can use opportunities during session to become desensitized to previously-contained disturbances until all that material is reprocessed. When levels of disturbance become low to non-existent, clients are ready to install positive beliefs and positive body sensations related to whatever targets have been chosen.
Clients will be asked how they would prefer to think of themselves. As clients formulate positive beliefs, clients can begin to believe these with their minds, through visualization, and with accompanying body sensations of relaxation or other sensations which feel good and right.
Summary
Clients who work on reprocessing urges, triggers and avoidance during EMDR sessions can benefit from having already installed positive inner resources for protection, nurturing, acceptance, strength and healing, to name a few. Clients will decide which resources are most important to them. Sometimes clients will need some guidance as to what might be most helpful, and the therapist will be fully present to ask the questions which lead to important answers.