1 EMDR in the Addiction Continuing Care Process Case Study of a Cross-Addicted Female s Treatment and Recovery Jamie Marich PsyCare, Inc., Youngstown, OH, and Capella University, Minneapolis, MN There have been suggestions in the literature since 1994 that eye movement desensitization and reprocessing (EMDR) may serve as an effective adjunct to the addiction treatment process; however, follow-up research in this area has been limited. This case study of a cross-addicted female includes a case review illustrating how EMDR was used in the continuing care process and a semistructured phenomenological interview conducted at 6-month follow-up. Prior to this course of treatment, the participant was treated 12 times with traditional approaches but was unable to achieve more than 4 months of sobriety at any given time. Following EMDR, the participant reported 18 months of sobriety and important changes in functional life domains. The phenomenological interview revealed six critical themes about the addiction and recovery process that can offer insight to clinicians treating co-occurring addiction and trauma. Keywords: cross-addiction; addiction; PTSD; relapse prevention; phenomenology Many individuals in early sobriety return to using drugs or alcohol for two primary reasons: first, they find it difficult to address their past and take appropriate responsibility for their actions, and, second, they are overwhelmed by the shame-based ideologies that they acquired as part of their trauma (Miller & Guidry, 2001; Najavits, Weiss, & Shaw, 1997; Ouimette & Brown, 2002).The comorbidity between addiction and trauma-related psychopathology is a phenomenon that has been observed in the addiction treatment field (Cox & Howard, 2007; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Shapiro, Vogelmann-Sine, & Sine, 1994; Zweben & Yeary, 2006). This trauma can warrant a formal diagnosis of posttraumatic stress disorder (PTSD) according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision; DSM-IV-TR ), or it can be what Shapiro (2001), developer of eye movement desensitization and reprocessing (EMDR), referred to as small-t trauma, which are life events that, when unresolved, cause disturbance. However, these small-t events would not warrant DSM-IV-TR distinction as a criterion A trauma that is necessary for a formal PTSD diagnosis. Relapse is common in many behavioral disorders, especially addiction ( Joseph, Breslin, & Skinner, 1999). Although various models abound to define and explain relapse, there is consensus that low self-efficacy and a high volume of negative emotion, coupled with poor coping skills, put an individual at greatest risk for relapsing on alcohol or other drugs following a period of sobriety (Allsop, Saunders, & Phillips, 2000; Connors & Maisto, 2006; Donovan, 1996; El-Sheikh & Bashir, 2003; Marlatt & George, 1984; Moos & Moos, 2006; Tapert, Ozyurt, Myers, & Brown, 2004; Walitzer & Dearing, 2006; Walton, Blow, Bingham, & Chermack, 2003). Connors and Maisto (2006) noted that relapse has received considerable attention because of the high rates of relapse that follow the initiation of a period of abstinence (p. 107). Miller and Guidry (2001) contended that traditional models of addiction recovery and relapse prevention fail to appropriately consider the significant role that unresolved trauma plays in an addicted individual s attempt at recovery, especially among women. Of patients in substance disorder treatment, anywhere from 12% to 34% have PTSD; these numbers can be as high as 33% to 59% in women (Najavits, 2006). Miller and Guidry, whose ideas are compatible with common relapse themes in the literature, called for a more holistic approach to the treatment of co-occurring trauma and addiction. A holistic approach means that treatment needs to extend beyond 98 Journal of EMDR Practice and Research, Volume 3, Number 2, EMDR International Association DOI: /
2 the cognitive interventions that have traditionally been used in relapse prevention counseling, or the 12-step methods associated with the Minnesota model. Using EMDR in the addiction process may provide solutions to the problems of addiction relapse and lack of adequate care for traumatized alcoholics and addicts. Literature Review Treatment of Co-Occurring Trauma and Addiction Miller and Guidry (2001) developed the addiction and trauma recovery integration model in response to their concerns about traditional approaches being insufficient for trauma work with addicts. Other treatment approaches that emerged in the 1990s to address co-occurring trauma and addiction included Evans and Sullivan s (1995) integrated model; Coffey, Dansky, and Brady s (2002) exposure-based therapies for co-occurring PTSD and substance use disorders; and Najavits s (2001) Seeking Safety program. Treatment guidelines published by Brown, Read, and Kahler (2002) suggested the importance of fostering coping skills in clients with comorbid PTSD and addiction, and recommendations from Ouimette, Moos, and Brown (2002) emphasized participation in self-help groups and family treatment as an adjunct to PTSD treatment in substance abusers in addition to keeping such patients in outpatient treatment for 3 months or longer. Ouimette et al. contended that longer engagement in outpatient treatment yields better outcomes. EMDR Treatment of Co-Occurring Trauma and Addiction EMDR is a psychotherapeutic approach that was developed to resolve trauma-related disorders (Shapiro, 2001). Numerous randomized clinical trials have established its efficacy in the treatment of PTSD, and it is now recognized worldwide as a first-line treatment for PTSD (for reviews, see Bisson & Andrew, 2007 ; Maxfield, 2007). There have been suggestions in the literature and in clinical sources for some time that EMDR can be incorporated as an effective adjunct to the addiction treatment process (Brown, 2003; Henry, 1995; Popky, 2005; Ricci, Clayton, & Shapiro, 2006; Shapiro et al., 1994; Vogelmann-Sine, Sine, Popky, & Smyth, 1998; Zweben & Yeary, 2006). Despite the historical lack of empirical validation with addicted individuals, clinicians have been using EMDR with recovering addicts because of the well-established comorbidity between substance use disorders and PTSD (Kessler et al., 1995; Najavits et al., 1997; Ouimette & Brown, 2002). There is one randomized controlled study evaluating EMDR treatment with the addicted population. Hase, Schallmayer, and Sack (2008) demonstrated that a group that received treatment as usual along with EMDR showed a significant reduction in addiction craving 1 month posttreatment compared to the group receiving only treatment as usual and a significant difference in relapse at 6-month follow-up. A recent case series by Brown and Gilman (2007) demonstrated the positive impact of EMDR treatment on completion of a county drug court program. Cox and Howard (2007) presented a case study showing the merits of using EMDR in treating a sexually addicted client, and they called for further research in using EMDR as part of the overall recovery process, not just in treating PTSD. Despite the plethora of case research that has been published on using EMDR with various populations, no articles on using EMDR with chemically dependent individuals were found in a literature search of peer-reviewed journals. Some cases and proposed protocols, such as Popky s desensitization of triggers and urge reprocessing (DeTUR), have been presented in books (Parnell, 1997; Popky, 2005; Shapiro & Forrest, 1997). Barbieri s (2008) urge reduction by growing ego strength protocol incorporates basic concepts from EMDR (p. 116) along with hypnotherapy, ego state therapy, and energy psychology techniques, to treat concurrent trauma and sexual addiction, but her approach differs from traditional EMDR developed by Shapiro. A need still exists for expanded, systematized research on using EMDR with chemically dependent and addicted individuals. This case study adds to the qualitative body of knowledge in this area. Qualitative EMDR Studies The qualitative follow-up interview utilized in this case study represents a major step in gathering a body of knowledge on EMDR that is truly phenomenological, that is, data on experience, not just on perceptions of effectiveness or reduction of symptoms. There are two major qualitative studies that were found in the EMDR literature aside from case studies: one examined women who were survivors of sexual assault (Edmond, Sloan, & McCarty, 2004), and the other examined sexual offenders (Ricci & Clayton, 2008); both populations were treated with EMDR in their respective studies. These qualitative studies offered a high degree of thematic insight into clients treated with EMDR, which is why more qualitative, specifically phenomenological research is needed to enhance clinical understanding of the client experiences. Journal of EMDR Practice and Research, Volume 3, Number 2, EMDR in the Addiction Continuing Care Process
3 White and Kurtz (2006) stressed that recovery stability following addiction treatment must be measured by monitoring the whole person (p. 46). White and Kurtz suggested that this monitoring must not consist simply of quantitative measures such as counting attendance at Alcoholics Anonymous (AA) meetings or tallying days sober. Monitoring the whole person and his or her growth as a recovering individual can be achieved at a level of greater depth when employing qualitative, phenomenological methods of inquiry that emphasize the unique experience of the recovering person. Research Purpose The purpose of this study is (a) to demonstrate the impact of EMDR on a cross-addicted female s overall treatment and initial recovery experience and (b) to explore the case s lived experience with EMDR as part of her treatment and early recovery process as reflected on in a follow-up interview 6 months after termination of treatment. Method This study s procedure was divided into two separate yet related phases. In the first phase of the study, analysis of the client s clinical record was conducted to present a comprehensive case study. The case was a former client of the primary investigator. Approval to analyze the clinical record and conduct a follow-up interview after the termination of formal treatment was granted by the institutional review board of the primary investigator s academic institution. The former client fully consented to having her client record reviewed and to participating in the follow-up interview. In the second phase, a semistandardized phenomenological interview was constructed by the primary investigator to obtain data that would fulfill the second purpose of this study: to explore the case s lived experience with EMDR as part of her treatment and early recovery process. Guidance from McCracken s (1998) The Long Interview was implemented in the construction of this original, 13-item instrument, and other interviews, such as the one conducted by Ricci and Clayton (2008), were consulted to assist with style and form. The descriptive phenomenological psychological method (Giorgi, 1997; Giorgi & Giorgi, 2003) was selected prior to the follow-up interview as the system for qualitative analysis because of its high level of utility in evaluating phenomenological data. Case History Nancy (not her real name) presented for treatment in February 2007 following her third operating a vehicle intoxicated (OVI) conviction. A 44-year-old White female, she was ordered to complete a drug and alcohol assessment by the municipal court in a midwestern urban area. Nancy was employed but without insurance at the time of her conviction, so she presented to a county-funded community agency that offered both traditional treatment and EMDR. Nancy estimated that she had received 12 courses (both inpatient and outpatient) of treatment for alcoholism and addiction over a 12-year period. Nancy identified as an alcoholic/addict at time of assessment and also admitted to a problem with compulsive sex. She reported intermittent involvement with Alcoholics Anonymous (AA) since her first treatment in 1995, although she was never able to obtain more than 4 months of sobriety at any given time. Nancy s father was an alcoholic, and she disclosed that she took her first drink at age 12; her drinking escalated to what she identified as alcoholic consumption by the age of 16. Nancy revealed that she had been sexually assaulted by a sister s husband at the age of 12, which was ignored by her family. Nancy dropped out of high school at the age of 16 to marry her husband, who was also an alcoholic/addict. Nancy described a tumultuous marriage in which she was sexually assaulted by her husband on numerous occasions and in which their mutual drug and alcohol use yielded more than 20 years of unhappiness. Nancy divorced her husband 7 years prior to this treatment episode, at which time her alcohol and drug addiction seemed to further fuel her sexually compulsive behavior with other addicted men. Nancy revealed that she and her husband had three children who were now young adults. Nancy openly identified that her addictions had strained her relationship with her children and her elderly mother. Course of Treatment Intake Assessment At the time of intake assessment, Nancy was diagnosed with alcohol dependence, cannabis dependence, sedative dependence, and PTSD according to DSM-IV-TR criteria. Nancy s sexual assault at the age of 12 was identified as the primary criterion A trauma. Nancy s sexually compulsive behavior was coded on axis IV. Treatment in a 12-Step Facilitation Model Nancy did not meet criteria for detoxification at the time of assessment and was thus assigned to an 8-week outpatient treatment program based on Nowinski 100 Journal of EMDR Practice and Research, Volume 3, Number 2, 2009 Marich
4 and Baker s (2003) 12-step facilitation model. Nancy successfully completed this program without unusual incidents, and all her drug tests (urine and saliva) were negative. Completion of this program fulfilled the requirements of the municipal court. Nancy also reestablished contact with several AA groups during this treatment program, and she established a successful working relationship with an AA sponsor. As her 12-step facilitation program neared its end, Nancy requested to receive individual counseling at the agency after her court requirement was completed. It was at this time that the primary investigator suggested EMDR to Nancy. EMDR Treatment Nancy accepted the recommendation for EMDR largely because she had maximized benefit from other attempts at cognitively oriented talk therapies. Nancy had first heard about EMDR years before at an inpatient facility, and she remembered hearing positive feedback about the treatment. Nancy was assessed to be sufficiently stable with good access to sober support when the possibility of EMDR was presented to her; she was 3 months sober at the time EMDR commenced. After the EMDR history taking, Nancy established two core treatment goals: (a) to remain abstinent from all alcohol and euphoria-producing drugs as evidenced by negative urine and saliva screens and (b) to address issues connected to self-image, especially those affected by her alcoholism, as evidenced by confronting issues connected to her self-image and her past, which would positively impact her ability to abstain from addictive behaviors. Nancy completed 15 EMDR sessions over a 9-month period, including five sessions of future template work. Nancy chose to use tactile stimulation for her EMDR treatment after being presented with available options (eye movements, audio tones, tactile) during the preparation phase. Sessions 2 and 3 were the only 90- minute sessions; all others lasted 50 minutes. Nancy began EMDR with the original negative cognition of I am shameful. The cognition was fully resolved, and it generalized nicely since shame proved to be at the root of many of Nancy s self-image problems and perceptions of her sexuality. Session 1 was devoted to preparation; Nancy s questions about EMDR were answered, and she successfully developed and held a safe place that she called My Serenity Hut. Sessions 2 to 6 focused on processing what Nancy assessed to be the negative cognition most inhibiting her progress in sobriety (i.e., I am shameful ). Although she identified the sexual assault at age 12 as being her earliest memory of sexual trauma, a floatback was used to determine Nancy s earliest experience of I am shameful. The identified touchstone event was when Nancy s peers pressured her into sexual activity with other neighborhood children at age 10 (Subjective Units of Disturbance = 8 initially; Validity of Cognition (VOC) = 4 of positive cognition, I am honorable ). At the end of session 2, Nancy engaged in a prolonged set of cathartic tears, noting relief that she was finally able to tell somebody the secret of what happened at age 10. The experience at age 10 seemed to affect the shame-based cognition even more than the blatant sexual assault at age 12 because of the secrecy factor. Nancy had managed to talk to certain individuals, albeit in a superficial manner, about the sexual assault (age 12) over the years, but she maintained that the EMDR session was the first time that she ever voiced what happened to her at age 10. This touchstone opened up many sessions of shame-based sexual memories, such as the sexual assault by a family member at age 12. At the beginning of session 3, the SUDs had increased to 10, and the VOC decreased to 2. Session 3 was very intense in terms of affective expressions of sadness, remorse, and guilt. By the beginning of session 4, the SUDs had decreased to 5, the VOC increased to 3 to 4, and material connected to the physical and sexual assaults by her ex-husband surfaced in this session. By the end of session 6, the SUDs had decreased to 0, and the VOC had increased to 7; the client successfully installed the positive cognition I am honorable and reported a clear body scan. Sessions 7 and 8 were devoted to future template work on how to best face the consequences of her OVI conviction. In sessions 9 to 11, Nancy worked on another negative cognition that emerged as she attempted to do her fourth AA step: I m a failure. A touchstone memory from her marriage was used (initial SUDs = 5; VOC = 4 on positive cognition I am capable ). Throughout these three sessions on the new target, less affective disturbance was observed when compared to the processing of I am shameful. Session 12 addressed future template work that related to dealing with her mother s belittling style of communication. Following session 12, Nancy took a hiatus from EMDR for two and a half months and worked on delivering her fifth AA step to her EMDR therapist; Nancy felt it was important that someone with a trauma-sensitive perspective who already knew her secrets hear this step. Step 5 of the AA program is Admitted to God, to ourselves, and to another human being the exact nature of our wrongs (Alcoholics Anonymous World Services, 2001, p. 59), and it is permissible for a therapist to hear this step. Journal of EMDR Practice and Research, Volume 3, Number 2, EMDR in the Addiction Continuing Care Process
5 Other behavioral memories connected to her promiscuous sexual behavior while in active addiction also surfaced during the verbal delivery of her fifth step, and she reported relief after getting the secrets out, which is how she also felt at the end of session 2. Sessions 13 to 15 focused on EMDR closure, evaluating how she can apply her newly obtained beliefs I am honorable and I am capable to future scenarios in relationships, sexuality, work, and family relations. Post-EMDR Assessment Toward the end of her EMDR experience, Nancy was able to leave a job where she felt devalued, and she sought more meaningful employment. She attributed this exit to believing that she no longer had to tolerate being put down by others. Nancy was able to do the AA inventory steps (4 and 5) and amends steps (8 and 9) for the first time in 12 years of recovery attempts. Nancy recognized that the shame blocks had kept her from doing these steps during past attempts at recovery. When treatment terminated in February 2008, Nancy had been free of alcohol and drug use for more than a year, she no longer met criteria for PTSD, and she had also refrained from sexually acting out since the beginning of her treatment. At the time of termination, she reported that she finally felt worthy of a healthy relationship in which a man respects my total self as God does. Follow-Up Interview Analysis Nancy was interviewed 6 months after EMDR closure. As verified by her AA sponsor, Nancy was still clean, sober, and free of sexually acting out behaviors. Nancy continued to maintain employment at the job she acquired while in treatment, and she had made significant strides in repairing her relationships with all three of her children. During the hour-and-a-half interview, Nancy freely addressed the questions that were asked of her about her active addiction, treatment, and recovery experiences. In the analysis of the interview text using the descriptive phenomenological psychological method (Giorgi, 1997; Giorgi & Giorgi, 2003), the following major themes were identified: escape, transformation, addiction recovery as a life-or-death matter, EMDR an important part of addressing past issues, a combination of factors necessary for successful treatment, and restoration. Escape Nancy initially began to use alcohol, drugs, and sex to escape feelings of pain that she experienced, primarily as a result of her various, sexually traumatic experiences. Nancy could not talk to her parents about her pain, and it was not within her understanding as a youth to seek help from a counselor. In the conceptualization of Shapiro s (2001) adaptive informationprocessing model, Nancy was not able to process her traumatic experiences, and they became stuck, thus causing her to seek out maladaptive ways to address the unprocessed pain. For Nancy, these maladaptive ways were alcohol and other drugs and seeking validation in an unhealthy relationship with another alcoholic/addict: I felt so insecure and then so overwhelmed with feelings of shame and of pain, like I didn t understand why things had happened to me and I couldn t talk about them to anyone and I didn t know how. I didn t know how it processed in my mind. From having experience with drugs and alcohol, I knew that when I did that, those feelings left me. And so, that was that is how I think I started to relate with the way to escape. Transformation When Nancy s using to escape became an addictive process that progressively worsened, she was transformed from the person that God made her to be into a broken individual whom she described as insane, crazy, selfish, unloving, hateful, and uncaring: Very hateful, very mean, very negative attitude, I hated life, I hated myself I just hated myself, I couldn t I hated what I had become during my addiction and the only way I could describe it is I just didn t want to live with myself anymore and I felt like the biggest failure. I had tried so many times to get out of it, to get sober and I never could and I just felt hopeless. I felt totally hopeless, devastated like the only way that it was ever going to end was death. Addiction Recovery as a Life-or-Death Matter Nancy s initial transformation in addiction progressed to the point where she saw death as her only way out, her ultimate escape. In contrast, Nancy also recognized that a major roadblock to her previous attempts at recovery was that she did not view her addiction as a life-or-death matter: I just hoped everyday that death would come. That totally devastated my life and that s how it made me feel. I really never thought in a million years that I would ever be able to get sober and stay sober. 102 Journal of EMDR Practice and Research, Volume 3, Number 2, 2009 Marich
6 EMDR an Important Part of Addressing Past Issues Nancy described EMDR sessions as taking the garbage out ; she left sessions feeling emotionally and mentally drained, yet with each session, it was like experiencing more of a load lifting each time. This initial drain resulted in a feeling of freedom at the end of the process. In the interview, Nancy was very enthusiastic as she reflected on her total EMDR experience. Nancy believed that self-examination was impossible before this treatment episode because she had such a distorted view of herself. She believed that EMDR freed her from the victim role and made it easier for her to self-examine in a more rational way: [EMDR] dug deep into my soul or into my mind. And along with the trash came the pain, the shame, the guilt, the remorse, whatever went along with the situation. When I faced it, and I dealt with it, and I talked about it, and I analyzed it, and then I was able to release it and forgive myself and others for what had been done to me and what I had done to other people. And then I felt a great sense, I felt freer. Nancy expressed her belief that the trust she established with her EMDR therapist, a recovering female, was also critical to the success of the therapy. Being able to relate to her therapist was important to Nancy. Combination of Factors Necessary for Successful Treatment Nancy noted that EMDR helped her to better work the 12 steps of AA. Nancy attributed the combination of EMDR, 12-step work, opening up to a sponsor, seeing addiction as a life-or-death matter, her willingness to change, and deepening her spirituality as factors that worked together to get her sober and well. Nancy was also able to recognize the synergistic effect of the different factors working together. For instance, she knows that her trauma history made it difficult for her to get through the 12 steps of AA before: You can t put anything in the proper perspective. And you can t really get a heads up on what really happened because you were so traumatized and you had such bad experiences and like in my case, I had the trauma then I had the I call it the aftereffect of my ex-husband pounding over and over and over and over it for like 14 years after that. I took so much responsibility for it. It was almost like I victimized myself all over again in my mind. Restoration Nancy viewed her recovery as a restoration to the person whom God intended her to be. She noted several concrete examples of change (e.g., holding down a good job, being there for her children and her elderly mother) in addition to an overall change in attitude and personal development. Nancy described EMDR as helping her put the sum total of her life, including her demons and secrets, into proper perspective so that she could finally face the past and move on: The obsession and all the bad memories and the pain were replaced with hope and faith, and a sense of: I m not crazy, I m not insane. I m okay, I m getting well, I m getting back to sanity. Discussion The beauty of any case study is that it can allow us to explore a person s treatment in greater depth. For clinicians who routinely work with addictions, Nancy s case illuminates the possibilities of using EMDR to treat a female in addiction recovery, and it offers them suggestions for how and when to best implement EMDR in working with a case like Nancy. Nancy s EMDR treatment commenced when she was sober for 3 months, and the preparation stage of her EMDR treatment was relatively short (one session). Although some clinicians may be hesitant to begin EMDR so soon into sobriety, Nancy was ready for the treatment because enough foundational elements were in place, specifically, access to sober supports via her AA groups and an AA sponsor. Moreover, Nancy presented for treatment with a high degree of awareness about what barriers existed in previous attempts at recovery and an equally high degree of willingness to address these myriad barriers, especially as they related to past trauma. Arguably, Nancy s insight and willingness served as an ideal canvas for her EMDR experience, and EMDR clinicians working with addicts must be able to evaluate these factors to determine if EMDR is appropriate for a recovering addict or to determine how much work needs to be done in the preparation stage. Lack of insight and willingness does not necessarily rule out the possibility of using EMDR with a recovering addict. However, more intensive preparation, including resource development and installation or alternate protocols such as DeTUR may be warranted. Value of EMDR in Addiction Treatment In a general sense, Nancy s case helps confirm some of what has been written about using EMDR with Journal of EMDR Practice and Research, Volume 3, Number 2, EMDR in the Addiction Continuing Care Process
7 addiction in both a popular and a scholarly sense. For instance, Shapiro and Forrest (1997) contended that EMDR should never be used in a vacuum but rather as a part of a system designed to make the client feel safe and supported. It works best when it is used in conjunction with counseling groups that provide a nurturing atmosphere, such as group therapy, Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) (p. 178). Nancy s case offers full support to this contention. Additionally, Nancy s case demonstrates the degree of difficulty that recovering alcoholics and addicts with traumatic stress issues can have in terms of working programs of recovery, such as the 12 steps of AA. However, Nancy s case also establishes that the clinician can take a proactive approach in using EMDR to help a client get through the 12 steps. Phenomenological Themes This article stretched beyond the scope of a standard case study by including the follow-up interview component. The themes that were extrapolated from Nancy s sharing of experience correspond significantly to issues that have been raised in the literature on EMDR. Brown (2003) contended that EMDR may be the missing piece in the addiction treatment puzzle, and Zweben and Yeary (2006) surmised that EMDR treatment may maximize their [clients ] chances of success (p. 125) in an addiction setting. Nancy s comments on the importance of EMDR in addressing her past and on EMDR being one of a combination of factors leading to her recovery and wellness offer a client s confirmation of these previously written contentions. Cox and Howard (2007) asserted that for years, therapists have overlooked or at least minimized the role of trauma in maintaining the addiction cycle. It is this trauma that oftentimes keeps clients stuck in the addiction and ultimately causes repeated relapses (p. 15), and Nancy s reflections on the role her trauma played in stifling her previous recovery attempts are in total agreement with this statement. Nancy also commented on the role that her connection with her EMDR therapist played in helping get the most out of the treatment experience, reflections that are concomitant with Dworkin s (2005) work on the relational imperative. Nancy makes several comments throughout the interview that further support and illuminate how Shapiro s (2001) adaptive information-processing model manifests in an addicted client. The adaptive information-processing model contends that problems arise when an experience is inadequately processed, and dysfunctionally stored memories are understood to lay the foundations for future maladaptive responses, because perceptions of current situations are automatically linked with associated memory networks (Shapiro & Solomon, 2008, p. 316). Nancy identified that she was unable to talk to anyone in her childhood environment about the sexual experiences at age 10 and age 12, and she was thus unable to make sense of the experiences in her mind despite their being stuck there. When Nancy discovered drugs, alcohol, and a risky relationship as a teen (i.e., future maladaptive responses), she found a way to escape the material that she was unable to process through to an adaptive resolution. Moreover, the adaptive information-processing model elegantly explains why Nancy s prior attempts at completing the AA inventory steps were impossible for her; her recovery program proved to be the current situation, which was linked with associated memory networks. As Nancy identified, these associated memory networks made it impossible for her to put anything, even her recovery program, into proper perspective. Limitations and Future Directions The primary investigator acknowledges that Nancy s case provides just one viewpoint, and because EMDR was a success for Nancy, her comments are more likely to be positive about EMDR than someone who did not benefit as much from the therapy. Additionally, the client identified her own willingness as one of the combination of factors that helped her recover, and it is possible that a client with less willingness may not have benefited as fully from the EMDR experience as Nancy did. The entire issue of willingness in treatment is potent, and the impact of client willingness on EMDR treatment is an area that warrants further exploration in EMDR research. The research presented in this article will be expanded into a full dissertation research project within the next year. The same basic, semistandardized phenomenological interview will be used (with some slight modifications), but a larger sample size will be included to obtain the experiential viewpoints of more recovering alcoholics/addicts. In an attempt to further minimize bias, this larger sample will be comprised of former clients who were not treated by the primary investigator. Phenomenological-based inquiry is an important area that needs further exploration in the realm of EMDR research. Expanding this inquiry will help clinicians and program developers understand the client experience in greater depth and can lead to new knowledge on bridging research and practice, respecting the relational elements between client and 104 Journal of EMDR Practice and Research, Volume 3, Number 2, 2009 Marich
8 therapist, and evaluating how well EMDR treatment has been implemented into practice settings. Exploring the role that EMDR can play in the addiction recovery process needs to be further researched. This research article has taken a qualitative approach, and a case has been made for how further qualitative inquiry can promote new knowledge about the recovery process. There are a variety of other designs that can be implemented to further the research in this area, such as utilizing independent assessors to evaluate reduction in PTSD symptomatology and length of sobriety between two groups (e.g., recovering addicts treated with and without EMDR at a fixed point in the recovery process). Nancy s case is a clear case of an addicted woman who experienced a criterion A trauma warranting a formal PTSD diagnosis; future studies need to evaluate the use of EMDR with addicts who present with small-t traumas. 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