Fourteen years ago, when I was first trained in EMDR therapy, there was less of an understanding of its benefits, as well as a lot of confusion about what eye movement desensitization and reprocessing actually was. One thing it’s never been is a quick fix. And while I make it a point to educate people about this reality, I have found there is another layer to that common misunderstanding: lack of awareness that the existence of complex trauma, as opposed to single-incident trauma, can make EMDR an even longer-term treatment.
When working with those with single-incident trauma—a survivor of a car accident, for example—the standard eight-phased, three-pronged EMDR protocol has the potential to guide the treatment process in a relatively straightforward manner. Treatment can also be more clear-cut and focused when there are multiple traumas that can be grouped into the same category. Someone who reports being raped at various times in their life would be an example of this. Neurologically, the traumas can travel down a similar “track” when processed.
However, it is usually the cumulative effect of multiple traumas, of multiple kinds and categories, that brings folks to my office. The majority of those who are engaging in ongoing therapy have symptoms driven by foundational experiences—developmental traumas that impact their worldviews. These experiences affect their ability to feel safe, not only physically but also emotionally. These people are seeking to heal from a history of complex trauma.
Complex trauma is identified by Judith Herman and other leaders in the field of traumatology as “the existence of a complex form of posttraumatic disorder in survivors of prolonged, repeated trauma” (Herman, 1992). An example of a history of complex trauma would be a woman who was adopted at birth, experienced sexual abuse by her brother, experienced ongoing physical abuse by her mother, and perhaps had a series of abusive relationships throughout her teenage and early adult years. She has an extensive history of interpersonal traumas at various ages and developmental stages, and spanning multiple categories.
The majority of those who are engaging in ongoing therapy have symptoms driven by foundational experiences, developmental traumas that impact their worldviews. These experiences affect their ability to feel safe, not only physically but also emotionally. These people are seeking to heal from a history of complex trauma.
As part of our healing journeys, we must pay attention to traumas of both omission and commission; both matter and can impact a person’s mental health. Neglect and abandonment, among others, are traumas of omission. Sexual abuse, physical abuse, and violence are clearly acts of commission. Perhaps a person experienced ongoing parental misattunements, significant attachment losses, a parent’s hospitalization or depression, or witnessed a mother grieving the loss of a sibling. These and myriad other experiences are examples of traumas that, at the time, impacted the person’s sense of emotional and physical safety and, more often than not, included caregivers. If they happened in childhood, they may greatly impact the person’s perceptions of the world today. All of this adds up to complex trauma.
Many leaders in the field of trauma treatment believe the newest diagnostic criteria for posttraumatic stress (PTSD), as outlined in the DSM-5, are not comprehensive enough. Although an improvement over the DSM-IV, the latest guide for mental health practitioners does not account for the full clinical picture when it comes to developmental trauma.
The term “complex trauma” didn’t even make it into the DSM-IV; instead, “DES NOS” (disorders of extreme stress not otherwise specified) was often used in clinical application. In the DSM-5, some of the symptoms of DES NOS, such as re-experiencing, avoidance, negative cognitions and mood, and arousal, were included in the PTSD criteria.
Which brings us back around to EMDR therapy. Yes, it is possible to heal from a history of complex trauma. Doing so just takes a conscious, methodical, and phased approach to treatment. If you are considering EMDR and have a history of complex trauma, I highly recommend ensuring that your therapist has experience in working with both. Make sure, also, that your therapist talks to you about extensive preparation and stabilization; these aspects will be a necessary part of your healing journey.
Herman, J. (1992). Trauma and Recovery. New York: HarperCollins.
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What to Expect for the Length of Treatment in EMDR Therapy
“How long does it take?” Is one of the most frequently asked questions when individuals inquire about EMDR Therapy. This video helps to address that question and give more information about the EMDR Process.
The short answer to this question is roughly, “I really don’t know.”
Everyone’s experience with EMDR Therapy is wonderfully unique and different. The length of treatment varies from person to person, especially since there are so many different factors that decide the length of treatment.
For a single incident trauma…
This means there’s one isolated incident that you’ve experienced, such as a car accident or sexual assault, treatment can be between 8 to 12 sessions (each session being 90 minutes).
That being said, I rarely encounter individuals who have only have ONE terrible thing happen to them in their lives. More often than not, a stressful experience can trigger other earlier life experiences that had a lasting effect on us, but it wasn’t in our conscious mind.
For Complex/Developmental Trauma…
In cases of more complex trauma, the process can take longer, and for good reason.
Developmental Trauma includes persistent and pervasive experiences from childhood, including emotional abuse and emotional neglect, to name just a few. This can often cause symptoms of dissociation, which is why it’s so important to understand the structural dissociation model.
In these cases, it’s so very important to go slowly with the EMDR process. I always say (a lot of my consultees hear me saying this all the time)
don’t skimp on the resourcing and the history taking!
These early stages of EMDR are so important to make sure you get a comprehensive history of a clients background and understand how it’s impacting the client’s current level of functioning. This is the basis of the AIP Model (Adaptive Information Processing).
There’s so much more on dissociation and trauma that I will explain in a future post about…
As a client, you want to be sure to ask questions about the EMDR process and address any concerns you may have about proceeding. It’s important for you, as the client, to understand that it’s not q “quick fix” therapy, especially in cases of complex trauma. While it is a highly effective treatment method, it’s so important to go slower so you can experience the real benefit of how effective it really is.
You don’t have to be moving your eyes to be doing EMDR!
Phase 4 of EMDR is known as the Desensitization/Reprocessing Phase. This is the part of EMDR Therapy were you move your eyes. Keep in mind that EMDR is an 8 phase therapy, and phase 4 is only one part of that.
If we rush into phase 4, it can actually make things worse. As the therapist, if you talk about something in detail or jump into phase 4 without the right resourcing in place,
you can either re-traumatize a client, or, if they have dissociation or some dissociative phobia, you may actually grow the phobia and make it worse.
This is why it’s really important to know the full history of your clients and lay very strong ground work of resourcing and stabilization. EMDR is meant to be effective,
but it’s only effective when it’s done when a client can maintain dual awareness.
This means the ability to have one foot in the [therapy] room and one foot in a memory.
As a client, you really want to be able to conceptualize,”Okay, I’m aware of my presence in the therapists office, but I also I can think about the memory while staying grounded.”
Dual awareness is when a client is able to stay in the window of Tolerance.
This is the ability to talk about something, while feeling the emotions and sensations connected to the experience, while staying grounded and observant to the process.
So How Long Does it Take?
Short answer is: we don’t know. The length of treatment varies for each client. A single incident trauma can be as little as eight to twelve (90 minute) sessions. For complex and developmental trauma, the process is longer and depends on so many factors (previous experiences in therapy, level of resiliency, symptoms of dissociation, etc.)
The bottom line is, slower is always better. It not good to rush anything, especially when it comes to mental health.
About the Author
Dana Carretta-Stein is a Licensed Mental Health Counselor and founder of Peaceful Living Mental Health Counseling, PLLC, and Carretta Consulting in Scarsdale, NY. She specializes in clinical psychotherapy to treat children, adolescents and adults with anxiety, behavior and trauma difficulties.
She is a certified EMDR therapist, consultant in training, and Regional Coordinator of the Westchester EMDR Regional Network. Dana is also a business coach for wellness practitioners who are looking to build and grow their private practice.
For more information, visit dana.carretta.com
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