DIFFERENCES BETWEEN EMDR AND ART

Transcription

1 DIFFERENCES BETWEEN EMDR AND ART The book used for ART s Comparison to EMDR is Eye Movement Desensitization and Reprocessing Basic Principles, Protocols, and Procedures. By Francine Shapiro, Second Edition copyright Page numbers from this book are noted accordingly. EMDR = pg. 90 The activation of the client s innate self-healing processing should be done with minimal clinical intrusion. Pg.321 Clients are instructed to simply notice their internal experiences and are asked What do you get now? at the end of every set of eye movements, which automatically brings new pieces of information to mind. These are targeted in the order of their appearance. Clients may spend very little time exposed to the details of the presenting trauma and may, instead, move sequentially through related material. This sequential targeting may be a much more effective way to access the most relevant distressing material than the procedure (used in systematic desensitization or direct therapeutic exposure) of returning repeatedly to the initial traumatic image (see Rogers & Silver, in press). Free association appears to ensure that the salient aspects of the entire memory network are accessed and processed. This is certainly an aspect of therapy well recognized in the psychodynamic traditions. (Wachtel, in press). ART = ART guides clients and is directive with many interventions specific to ART that facilitate and enhance processing in every step of the process. ART does sequentially focus on the traumatic images from the presenting problem. Using ART s Voluntary Memory/Image Replacement (VMR/VIR) clients are instructed on how to eliminate these distressing images or closely connect them to positive images of the client s choice. Occasionally there will be an opportunity, when it is suspected there is an underlying problem scene or the sensations are not moving, to match sensations to another scene and process the underlying scene first. By staying focused on the scene that is distressful, the scene can be fully processed, along with any root scene that comes up with ART s Scene Match and, as the disturbing images disappear, the symptoms of the problem often disappear with them. By skipping around and going with the free association method, the client

2 2 may introduce a situation reminiscent of Attention Deficit Disorder (ADD) and what they bring up may have no real relevance or may be better off processed during another session. Again, if the sensations do not pass with sets of eye movements, then the clinician can avail themselves of a Scene Match and get to the underlying scene or scenes that are directly connected. It is important to the ART therapist that they try and complete the scene(s) that are at hand and involve the presenting problem before exploring other material exhumed from a free association method. In addition to being more effective and often bringing instant relief to the client, it also serves to keep the client comfortable through the process. The clinician does not want to leave the client half processed through their presenting issue. Other issues, beside the scenes from a Scene Match, can be noted and explored during a future ART session. Anything else that comes up naturally while the client is focused on the presenting scene can be assessed for its relevance and a decision can be made whether to follow that scene during the current session or do that at a later date if it is deemed necessary to process at all, after completion of the presenting scene. Processing the presenting scene often takes care of many other scenes that were associated with it. It usually takes only one to three scenes to completely process one client problem or issue. Very importantly, you cannot accomplish the desired results for certain problems and disorders without direction. For example, directing the client to see their replacement scene numerous times is indicated for a disorder such as Obsessive Compulsive Disorder (OCD) where ART is, in essence, reprogramming the brain to replace the OCD ritual with a healthy behavior. The more the healthy behavior scene is reinforced, the higher the likelihood of success in alleviating symptoms. Client s cannot free associate while their goal is to change ritualistic behaviors. ART s Voluntary Memory/Image Replacement (VMR/VIR) which allows clients to delete/diminish negative images, while strengthening the positive images, could not work without guidance from the therapist and repetition of images. Many of the amazing possibilities with the use of eye movements to augment the ART therapy require the clinician to direct the sessions and could not be accomplished with free association in lieu of direct guidance. The direct guidance piggy backs off the client s needs as the needs unfold during treatment. The clients are

3 3 empowered to make the changes themselves but the clinician must guide them through the process to find their relief. EMDR = pg. 88 Because EMDR is not a regimented approach, no two treatment sessions will be the same. ART = ART is procedural as well as creative and clinicians can often predict results from some of ART s steps in the protocol. For example, using ART s Voluntary Memory/Image Replacement, the client will most often not be able to pull up the images that are distressful or those images will be closely related to positive images, and the client s affect will change. Clients most often say they feel instant relief at that point. The fact that ART is regimented also helps to keep the fidelity of the model intact and assists in the training of therapists in this model. Another nice bi-product of the procedural ART approach is that the therapy results can be more easily studied using scientifically based criteria because of the uniformity in its steps and ART s effectiveness can be more easily assessed. ART therapists often obtain similar results using ART, to date averaging three ART sessions to complete the presenting problem. EMDR pg. 88 Refrain from viewing EMDR as a race to achieve treatment effects. ART = ART is closure oriented, which is one of the five C s of ART. ART therapists are interested, and have as one of their goals, to try to complete processing of a problem, or at least the segment of the problem they are focused on during the session. This will ensure that clients will not leave the session distressed in the middle of processing a problem or scene of a problem. Clinicians watch the time during the session in an effort to complete processing the problem targeted during that session. EMDR pg. 146 Alternating eye movements and instructions also provides the client with small exposure to the target and enables the clinician to assess progress. ART = ART uses horizontal eye movements only and specific amounts of eye movements for adults and specific amount of eye movements for younger

4 4 children who may process more quickly. The specific amount of eye movements facilitates processing while this amount does not flood the client with information. The ART clinician does expose the client to their problem scene and images but by processing the sensations each step of the way, the client can be comfortable with the process as they approach their problem directly and head on. ART clinicians do not move forward with the next step until the client verbalizes that they are comfortable in doing so, after using the sensation focused eye movements. These eye movements are used to stabilize clients after each set of eye movements. EMDR = EMDR clients may get stuck at the beginning of a session while learning how to process information with eye movements, or other methods that EMDR uses such as hand clickers, during processing of information. IA common complaint that I have heard among EMDR therapists is that clients may also frequently get stuck throughout the session while they are using EMDR s free association method. They then are trained to give minimal direction to attempt to get a client back to processing. When the client gets stuck that is the only time an EMDR clinician is instructed to intervene and come up with the least intrusive intervention possible until the client is able to move on. The EMDR clinician then goes back to the use of free association as the client is instructed to guide themselves by using the client s last response. ART = A small portion of clients may get stuck at the very beginning of the session while they are learning to process information while following with the eye movements. The ART clinician is trained to aid the client in relaxing with the eye movements to begin processing. Clients continue on to process there problem and rarely get stuck because ART clinicians guide them and offer direction as therapy proceeds. EMDR = Pg. 147 When the clinician repeats the client s words, even a slight shift in intonation can change the meaning. Although this technique is used widely in other forms of psychotherapy where therapeutic gains rely largely on verbal reassessments, it is antithetical to EMDR treatment effects.

5 5 ART = Repeating clients words reinforces and enhances processing. Clients also feel heard and they get more time to focus on the positive changes in their thinking if responses are repeated. ART clinicians, in fact, may have the clients think about the positive or negative statements they make or the feelings that emerge and focus on them while they are using a set of eye movements. EMDR = pg. 148 Another approach that can hinder rapid EMDR treatment is a clinician imposed attempt to explore the meaning of any symbols, memories, thoughts, feelings and so on, that arise for the client during the sets. ART = ART actually asks the client to check in with their oracle (higher functioning intellectual side) for meaning and to search for answers and make new connections in the brain. ART also explores the meaning of dreams, which can further empower the client to gain control of their issues. Clients can accept or reject any suggestion or interpretation the clinician might offer and the clients often find the suggestions stimulating and helpful. Although not always necessary, gaining a further an understanding of an issue often aids with resolution of a problem EMDR = PG. 249 The suggestions made should be limited to Think of That or Notice that or Go with that. If a client gets stuck in processing a problem, only then can a minimal suggestion be made until the client s processing begins again. After processing resumes, the clinician would be limited to one of the three aforementioned responses. There should be limited conversation in between eye movements. Conversing negatively impacts processing. Pg. 249 The cognitive interweave is an EMDR strategy that was developed to handle challenging sessions with highly disturbed clients.remember to use the cognitive interweave selectively so that the client s own processing system can do the work necessary for the full integration of the information. The cognitive interweave suggestions are designed to be sparse and limited to the minimum amount of help necessary to get the client to revert back to processing using free association method when possible. ART = The ART clinician often stops and discusses what the client experiences. The ART clinician adds many creative interventions and makes suggestions along

6 6 the way, from the beginning of the session, based on clients responses as they go along. ART does not have just three basic statements to engage a client, it has many creative interventions that have proven to aid the client as they resolve their problem. These interventions are give the clinician tools to spark the client s creative side in creating solutions. There may even be discussions, similar to traditional talk therapy discussions, for a short time in between eye movement sets. This break does not disrupt processing and clients go right back to the place they left off with processing once the eye movements are resumed. EMDR = EMDR may process sensations after every three or four sets or not until the end of what they are processing. There is no set frequency for using the eye movements and, in fact, the eye movement process is kept varied. For example, in using EMDR on clients who have had a recent trauma pg. 225 The body scan, however, should not be used until the final segment of the memory has been treated and all of the targets have been addressed, for only then can one expect all associated body tension to disappear. ART = ART processes sensations after almost every set of eye movements. The clinician never waits especially when the client is in distress with their body sensations. The sensation focused eye movements serve as an aid to lowering any heightened affect and serve to aid in processing by keeping the affect in check. Clinicians check in with clients each step of the way to make sure the client is ready to move on to the next step in processing the issue. EMDR = Utilizes positive and negative cognitions that the clients focus on during the session as part of its eight phase protocol. The client may be asked to hold that cognition in their mind while also focusing on other thoughts. Pg. 64 The client is asked to hold in their mind the picture of the memory and the negative cognition, to name the emotion felt, and to give a subjective unit of Disturbance (SUD) Scale (Wolpe, 1958) rating for how it feels now. ART = ART s sessions will naturally change the client s negative cognitions to positive without having to focus on them, although the ART therapist may decide to focus on a client s cognition about themselves if they choose to do that and it arises naturally during the session. It is, however, often an unnecessary step and

7 7 sometimes it is difficult for the client to figure out a cognition that makes sense. Adding the cognition which they keep in their mind while processing the other EMDR protocol steps may be cumbersome for the client who already has enough to focus on. If an ART clinician chooses to focus on a cognition that arises naturally, that would be the only thing they would focus on for that eye movement set. EMDR = Pg. 178 If eye movements become too predictable the client may anticipate them and perform them mechanically. This should be avoided by alternating the speed of the eye movements. Pg.182 Changing the direction, length, speed and height of the eye movements has the greatest success. ART = ART uses a consistent amount of eye movements. The height and speed may be adjusted dependent on what makes the client comfortable. The client is asked about the distance from the object being followed and whether that is comfortable before starting ART. Clients will get absorbed in the processing and soon forget about the eye movements. Only one time did I have a client count the number of eye movements and he had OCD. After focusing on his need to count and using the eye movements on that, he stopped counting. EMDR = EMDR views treatment as progressing through memory networks. Therefore, if the goal of therapy is for the client to react calmly to the target, it is necessary to clean each channel by reprocessing all of the dysfunctionally stored material connected to that mode. EMDR uses free association to come up with all these veins and not processing them will lead to a negative outcome. ART = ART uses an intervention it calls a Scene Match to get to the root of a problem when the root is not apparent. By matching the sensations a client has to a previous scene, the root scene of that problem often emerges, without processing out all the veins in the memory network. A client will typically need to process an average of one to three scenes to complete a problem. ART s Voluntary Memory/Image Replacement (VMR/VIR) involves a client eliminating the images from the distressing memory by changing those images. Therefore, a client might process one to three most of the most difficult or memorable scenes involving significant differences in those scenes but related to the same problem.

8 8 For example, if a client has been molested there may be one to three scenes that produce ART s Trigger Origin (T.O.) and need to be processed. The rest of the scenes then generalize under the scene(s) and do not need to be processed out. EMDR = Discourages, as aforementioned, active leading by the therapist. ART = Uses, among other interventions, Gestalt to direct the client to go back and repair issues from the past. The client, for example, might be given a suggestion to see a loved one, in their mind, where bereavement at their passing left unfinished business. The clinician can suggest that the client go back and say whatever they wished they could have said to that loved one, guiding them to express themselves which often aids the client in completing the bereavement process. The client feels empowered as it is their brain that is doing the healing. The ART clinician, in metaphorical terms, drives the bus and allows the client to get off and see what they need to see. The client returns to the bus and the clinician takes them to the next stop, based on the client s input. Guiding the client to change their scene by speaking up is very empowering and clients state that frequently. EMDR = insists on a close relationship/alliance between therapist and client for success. Pg. 122 The clinician must establish a relationship with the client that is a firm therapeutic alliance, a recognition of common goals, and an understanding of the need for honest communication. Unless the client and clinician have established a sufficient level of trust, EMDR should not be used.attaining this level of rapport may take many months with some clients; for others, it will be a matter of one or two sessions. Regardless of how long bonding takes, EMDR processing should not be attempted without it, or the client may break off treatment during an abreaction, refuse to continue EMDR, and perhaps terminate therapy altogether. ART = ART focuses on a client s safety from the beginning and screens for such issues as suicidality or dissociation and also for motivation and readiness to improve their life with the aid of eye movement therapy. An ART therapist does not cajole anyone to use ART but offers them the opportunity if they are deemed an appropriate client for this therapy. The client does not need to believe in the

9 9 process for this process to work. Clients are often skeptical of this process from the beginning which is understandable and expected. The therapy is explained to the client thoroughly. Any heightened emotion, or abreaction, can almost always be handled by quick response from the therapist who will utilize sets of eye movements, which will have a very calming effect on the client and will process the abreaction through. It is in experiencing the results of the eye movement therapy, from the very beginning, as disturbing sensations are processed, that the client relaxes and begins to trust the process and the skill of the therapist in using ART. The therapy process itself creates a therapeutic alliance between the clinician and the client. As long as the client is an appropriate candidate, it will never take months to create a bond but, but rather it will occur the during the first eye movement session. With the relief the therapy brings to clients, the trust will be there as therapy proceeds and the clients express gratitude for the relief they ve experienced. Laney Rosenzweig, LMFT ART Founder