EMDR treatment for PTSD in Children – Case Study

Billy’s Story* How EMDR can Change your Child’s Lifechild in thought

*Billy is not an actual person, but a composite of several patients Dr. Schwartz has seen over the past several years. Identifying details have been changed to protect their privacy. The treatments and outcomes are real.

Phase 1 – Taking a In-Depth History

Billy is a 7-year-old boy in first grade. I met with his parents for the first session and received a thorough history of Billy’s life. I learned that his mother had no complications during his pregnancy and birth. They shared that he had no known cognitive or social delays. When asked why there were bringing him into therapy at this time, they stated that over the last 4 months Billy was fearful going to sleep at night and he was increasingly anxious separating from his parents during his transitions to school. When asked about significant historical events, his parents stated that when Billy was four his father had been in a car accident and had been in the hospital for about 2 weeks following the accident. Billy and his mother were at home at the time and did not witness the accident but his parents wonder about the impact this accident may have had on Billy.

In order to provide the foundation for successful EMDR treatment for PTSD in children, it is necessary to take the time to develop an in-depth history. I will generally meet with parents first without the child present to inquire significant life events, family systems dynamics, birth and developmental milestones, medical issues, and social and/or cognitive concerns. It is important to for me to understand what are your concerns and goals of therapy. I also want to hear about the strengths of your child so that we can build on what is already working.

Phase 2 – Preparation for EMDR

My first meetings with Billy introduced him to my office, allowed us to get to know each other, and gave me an opportunity to learn about him through conversation and play. As we continued to get to know each other I shared that this is a place where he can talk about his feelings.  To start, we talked about the times and places where he feels calm and safe. Billy brought his stuffed animal in to sessions and we introduced EMDR to his bear. He liked how the “buzzers” felt in his hands. We practiced exercises that Billy can do at home when he feels scared or angry and worked together to find a list of his calming activities for home and school.

As we prepare for EMDR therapy, I work with your child to build a tool kit that helps him or her better manage big emotions. We develop a set of “resources” that your child will use when we get into the “yucky” feelings that can come up when processing a scary event.

Phase 3 – Assessment and Setting an EMDR Target

Now that Billy is comfortable with coming into therapy, we start to talk about the “scary” feelings he has when he goes to bed, has nightmares, or leaves for school in the morning. Billy didn’t want to talk about his feelings but preferred to draw them. When asked what he was most afraid of, he shared that he was afraid that something might happen to his parents while he was at school. He drew a picture of his mom crying and his dad lying on the ground. He said it felt very yucky and drew a picture of himself crying too.

At this point in EMDR treatment for PTSD in children I will start with the symptom that is bothering your child. In Billy’s case, we worked with his fearfulness when going to school. While I had not directly brought up the accident that his father had his drawings indicated that his fearfulness may be connected. I shared this information with his parents and encouraged them to talk to him about the event. In the next session, Billy was able to talk about how his dad had a big, scary accident and that he was scared that something like this might happen again.

Phase 4 – Desensitization  

I asked him to draw a picture now of how he feels when he thinks of dad’s accident. photo 2 (3)He drew two cars hitting each other and mom and him crying. Using bilateral buzzers that Billy could hold on to he focused on the “yucky feelings” in his body. Billy squeezed the buzzers tight and scrunched up his face. I reminded him that he can have these big feelings and still be OK. After a little while I gave him a new piece of paper and had him draw how he felt now. This time the drawing changed; his mom and he were hugging and he put a doctor next to his dad. We continued to alternate between buzzer time and drawings, and each time he shared that it didn’t feel so scary anymore. Eventually, he drew a picture of he and his parents hugging and smiling. He was smiling at me too, and got up to do a victory march saying that he felt better.

By using bilateral stimulation, we rhythmically alternate between the two hemispheres of the brain while thinking about a scary event. We know that trauma is primarily stored in both the limbic or mid-brain and in the right hemisphere of the brain. However, we need our entire brain and body to process traumatic events so that the feelings and memories from the past can be resolved. Desensitization of a target can occur in a single session or across multiple sessions but often kids process single event traumas quickly when given the right support.

Phase 5 – Installationphoto 1 (3)

Billy was able to think about the accident and feel better but our work wasn’t done yet.  Now, I asked Billy to think about going to school in the morning. At first he said that he was still afraid to leave. When I asked him how he would like to feel he said, I want to feel strong and powerful. I asked him to draw a picture of himself feeling powerful. He drew himself standing on a stage holding a gold medal. I had him imagine his mother dropping him off at school while he looked at his “powerful” picture. We used the buzzers several times until he said the it felt true! We repeated this process with him going to bed at night too.

During the Installation Phase of EMDR treatment for PTSD in Children, I invite a child to strengthen the positive beliefs and feelings and to connect these back to the present life challenges. In Billy’s case, he felt more confident that he could go to school and separate from mom and dad during the day and expressed greater confidence that he could approach them his new found sense of capability.

Phase 6 – Body Scan

I gave Billy a flashlight and asked him to imagine that he could shine into the top of his head. I asked him to check inside of his body to see if there is any leftover “yucky” feelings. He said there was just a little bit so we stood up and shook them out. We laughed!

We use the body as a gauge to verify the successful completion of the EMDR process.

Phase 7 – Closure

Before leaving the session, I invited Billy to think about his calm place and we took a few deep breaths.

Closure is essential to successful treatment in that it allows the challenging work of desensitization to be contained between sessions. When a child still has distress at the end of a session we have a practice to help put them away between sessions. I invite a child to draw a box or we make it with a shoebox so that the “yucky” thoughts, feelings, and memories can stay in a safe place until next time.

Phase 8 – Re-evaluation

In the following session, I asked Billy’s parents and Billy to tell me about his week. I learned that Billy had a much easier time going to school in the morning but he was still scared to go to bed by himself. This let me know where to focus next.

The purpose of re-evaluation allows us to assess the effectiveness of the treatment and address and residual or unresolved feelings.child running

In Billy’s case EMDR was a very successful treatment of choice. While it is not for every child, EMDR has been well researched and is considered an evidenced based trauma treatment for PTSD in children. Depending on the age and maturity, some children respond better to non-directive play therapy approaches and others respond well to a combination of EMDR and Play Therapy.

Further Reading:

Raising Resilient Children – Dr. Arielle Schwartz

Resilience Informed Parenting

Resilience is our ability to adapt well in the face of adversity; it means “bouncing back” from difficult experiences. As a strength-based psychologist, I apply research on resilience to my work with children and families. Caring adults raise resilient children by assisting them to make sense of their lives and feel more capable within their social, emotional, and cognitive development.  As parents, compassionate support systems help us access our resiliency so that we can help our children develop their resilience. child as superhere

Are Children Naturally Resilient?

As parents, we want to trust our children’s capacity to handle life’s difficulties; we do not want to over-protect them. If we, as parents, jump in too quickly to solve problems for our children we may hinder their ability to develop their own problem solving skills. As children learn how to solve problems, they develop their capacity to be creative and realize they have an impact in their world. The world we live in is not always safe and kind and we need to have confidence that our children can ultimately handle this imperfect world as it is. Ideally, we aim to give children the right amount of independence and challenge balanced with sufficient support and safety.

When children have faced an overwhelming life event they often need help processing what they have seen and how they feel. When a child faces stressors or challenges, we do not want to over-estimate their ability to handle it on their own.  The consequence of not supporting children to process traumatic events may be a loss of creative, intellectual, or social potential.

comfortResilient children are nurtured by caring adults who can help them actively express their experience. 

  • Younger children may better express themselves through play or drawing their experience with an attentive adult.
  • Older children benefit from conversations that reflect emotions, explore difficult decisions, and examine the meanings children make about their experiences.

When Children Throw you a Curve Ball

Being with a child who is struggling leads most parents to feel angry or scared. Especially when:angrykid78700769

  • “My child won’t go to sleep or stay asleep!”
  • “My son is aggressive and is hitting me or his younger sister!”
  • “My daughter used to go to school just fine and now she clings and won’t separate from me when I drop her off for first grade!”
  • “My child is tuning me out and just doesn’t listen to me!”

Sometimes we react or shut down our children because of our fears and uncomfortable emotions. To want to push our children away or run away from our children is a normal and biologically driven response when we are afraid. However, I invite you to view your child’s “curve balls” as a call to engage your child, to look beneath the behavior, and to connect to their inner world.

Knowing that you sometimes experience anger when you are vulnerable and afraid can help you reflectively turn towards your child’s difficult behaviors that arise out of their vulnerabilities and fears.

Resilience is for Parents Too

For parents, resilience allows us to respond creatively to the challenges inherent in raising our children.  Parents need support through compassionate relationships with partners, other parents, and when necessary, therapists, to help us explore the deeper themes of reactions to children and how this may be connected to the past.  Being a resilient parent family connection imagemeans:

  • Getting support to learn from your obstacles so you can support your children to learn from thier struggles.
  • Accepting that you are imperfect so you can be kinder towards your children’s mistakes.
  • Recognizing that you do not have all the answers so that you are more accepting when children feel lost or confused.
  • Remember that you like being loved and known for who you are so that you can aim to love and know your children for who they are.

On an airplane, they will always tell the adults to put their oxygen mask on first – then help your child to put theirs on. The same is true with resilience: When adults feel supported they are better able to support their children.

Resilience Informed Therapyconnection 2

As human beings we can all get “stuck” sometimes. There is no need to feel ashamed or embarrassed to ask for help whether it is for yourself or your child. Resilience informed therapy recognizes that when parents and children feel safe and supported you are able to access your creativity, strength, and capacity to handle life’s challenges.

Further reading:

Parenting a Child with Dyslexia – My Story

My Story of Raising a Child with Dyslexia

Demystifying the early signs of Dyslexia is challenging and navigating treatment options can be overwhelming. As a parent of a dyslexic child and a psychologist, I know the challenges that are familiar among families raising a child with a learning disorder. Dyslexia is confusing, painful, hidden, and real. Through the lens of my journey raising my son, this post explores how awareness, resilience, creative responsiveness, and early interventions can make a huge difference in the life of a child with dyslexia.

child with dyslexia

Early Signs of Dyslexia

Our son had been already been identified with Child Find at 18 months for Sensory Processing Disorder and speech language delays. By the time he was 6 we had already received years of interventions from speech pathologists and occupational therapists. There was something else wrong that we were missing.

In pre-school, he was the child who never sang his ABC’s. In kindergarten, he never remembered the days of the week.  And, by the time he was in first grade he told me he was “stupid”. Every day, after school, he brought home his “reader”. He was at level “C” but the other kids were at “J” and “K”. He said, “the other kids can do something I can’t, mom.” As a six-year-old boy, he was smart enough to know that something wasn’t right. I listened.

The Raw Truth about Parenting a Child with Dyslexia

dyslexia 2We sat down side by side on the couch so he could read to me; that was his only first grade homework, 15 minutes of reading a day. But my son had stories to tell so I listened to those first and he closed his book. Then I would open his book and he would yawn and say he was tired or suddenly have so much energy he would jump off the couch and run around the living room. I corralled him back to the couch, “I want to read in my room, instead.” We get comfy upstairs but the avoidance behaviors continued.  Then we would finally break down a word, “his,” “the,” or “what.” Success! However, the same word was on the next page and we would have to start over, every time.  It was nearly impossible to remain patient. We would melt down in frustration, tears, and anger. Was he just being defiant? Couldn’t he just try a little harder? I had already been through early reading stages with my older child and it wasn’t like this.

Identifying and Demystifying Dyslexia

By mid-year of first grade we had my son tested by a neurons 3neuropsychologist whose testing supported our experience.  What I loved about having my child tested was the ability to see his strengths as well as his challenges. He is very smart, has visual-spatial strengths, has an extraordinary memory, and generally is a delight to be around. He has Dyslexia.  He didn’t have the neurological capacity to develop meaning associated with the symbols that are the basis of letters, phonics, words, and language itself. Until this point, I had taken for granted how we learn to read.

Shortly after my son was given his diagnosis I sought out opportunities to educate myself as his parent.  I heard Jonathan Mooney (author of The Short Bus: A Journey Beyond Normal) speak about his journey from a dyslexic, 6th grade drop-out to international speaker and published author. I took my son to watch the movie “The Big Picture: Rethinking Dyslexia.” at a local sold out showing. We looked around the theater with over 500 attendees and I said, “All of these people are here because they either have dyslexia themselves or love someone that does.”  After the movie, he turned to me with a big smile and said, “I’m not alone.”

Creative Responsiveness and the Power of Early Intervention

As a result of early intervention and a profound journey providing him social and emotional support, my son is currently completing 3rd grade and is reading at grade level.  Here is what worked for us:dyslexia 5

  • I had to learn to be flexible and creative as his parent in order to support his learning. I have learned to trust my instincts as his mom.
  • I understand that no one can learn when in fight/flight activation and that connection and calming down must precede schoolwork.
  • I’ve had to educate myself in order to be an advocate for his learning needs with his school such as appropriate IEP services and classroom accommodations. We approach his school with gratitude for all that they can do and recognize that his classroom and special education teachers are caring human beings with real life constraints of high demand, limited supply, and limited budgets.
  • In addition to school interventions, we chose to work with after school teachers and tutors to provide homework support and one-on-one direct instruction methods that are well researched for dyslexia. (This significantly reduced the homework struggles at home and improved the quality of our family time).
  • Most importantly we found that teaming up with our child’s educators allowed them to connect to my son in a kind and compassionate manner and helped him to feel safe to learn at his own pace.

The “Gifts” of Dyslexia

There is a lot written about the “gifts” associated with dyslexia such as inherent right-brained, out-of-the-box thinking. While these traits will indeed allow him to bring his creativity into the world, in our experience thus far, the most valuable long-terms gifts are related to the development of strength of character such as:ian and mom 3

  • The recognition that not everything comes easy and that hard work pays off.
  • That he learns differently than other children in his class and it is important accept who he is rather than compare himself to his peers.
  • To focus on his strengths rather than his weaknesses
  • To trust himself and his pace

While good grades in math or reading are important, the wisdom gained from facing learning obstacles builds a person capable of handling life’s challenges.

As a parent and a psychologist, it is a pleasure to support you to raise your child through his or her unique journey through the increased awareness, creative responsiveness, and early interventions that make the difference in the life of a child with dyslexia.

Further reading:

Assessing and Treating Sensory Processing Disorder and other Related Diagnoses

Parenting a child with Sensory Processing Disorder – My Story

Raising the Highly Sensitive Child

 

Early Childhood Developmental Disorders – Sensory Processing Disorder, ADHD, Autism, Dyslexia, Trauma Exposure, and Anxiety

Assessing and Treating Sensory Processing Disorder and other Related Diagnoses

Differentiating between sensory processing disorder, ADHD, learning disorders, autism, anxiety, and early trauma exposure requires diagnostic skill and accuracy. Once clear about your child’s diagnosis, this knowledge is essential in developing the right treatment plan for your child. Read on to learn interventions drawn from child-centered play therapy and occupational therapy that can help your child with the tantrums, challenging transitions, and anxieties associated with early childhood developmental disorders.

Sensory Processing and the Brain

Historically, sensory processing symptoms were not considered to comprise a standalone diagnosis. Rather sensory challenges were thought of as symptom indicating another diagnose in the same way a fever was a symptom but a virus or an infection was the cause. However, a 2013 study out of UC San Francisco, revealed that sensory processing disorder is linked to quantifiable differences in brain structures and has a biological basis differentiated from other childhood disorders.neurons

Underlying all our sensory systems is the vestibular system which functions within the inner ear which takes in information about our relationship to movement and gravity and provides ongoing feedback between mind and body about where we are in space. The vestibular system gets information from the body through proprioceptors, sensory neurons located within the joints of the body. This sensory feedback helps to organize the the information we receive from the world and how we respond. If we cannot orient to where we begin and end in space we tend to feel anxious. When in fight/flight activation it is difficult to pay attention, learn new information, and communicate effectively about our experience. The brain hijacks higher functioning learning systems and engages lower brain resources as if we are experiencing immediate threat. For a child, this can become a repeated habit repeatedly wiring the brain for survival.

Differential Diagnosis

Sensory Processing Disorder has its own biological and neurological underpinnings; however, our sensory system is complexly intertwined with the neurological mechanisms responsible for spatial awareness, attention, language processing, emotional regulation, and learning. Therefore, sensory processing disorder often accompanies other disorders such as:

  • Speech and language delayschild with dyslexia
  • Dyslexia (reading learning disorder)
  • Dyspraxia (movement and coordination difficulties)
  • Dysgraphia (handwriting difficulties)
  • ADHD and difficulties with focus, attention, hyperactivity, and self-regulation
  • Autism and difficulties with social emotional communications
  • Anxiety and heightened fight/flight nervous system activation
  • Children with early trauma, neglect or attachment disruption often develop sensory integration challenges

Knowing the right combination of symptoms and diagnoses allows you to target the right kind of treatment and to avoid unnecessary ones. For example, SPD can contribute to inattention and hyperactivity but medications that treat ADHD may worsen symptoms, create further agitation, or simply be unnecessary. Recognizing and addressing the underlying nervous system activation often helps children with SPD learn how to focus their minds for learning. If you have a child with multiple diagnoses it is important that all professionals understand the role that sensory processing is playing for the child. A teacher, speech pathologist, or psychologist who can integrate tools for sensory integration can make greater progress towards their learning treatment goals. For example, the speech pathologist working with my son had him wear a weighted vest that helped him feel his body. As a result he could have greater control of his mouth when learning new speech sounds.

Treating Sensory Processing Disorder and Related Early Childhood Diagnoses

Once clear about your child’s diagnosis this knowledge is essential in coordinating efforts among your child’s treatment team. You know your child best and can help teachers and other professionals working with your child understand your child’s sensory world. Here are some interventions drawn from play therapy and occupational therapy that I have found helpful:jumping

  • Create a “sensory diet” for your child. A sensory diet provides your child with regular exercises tailored to meet his or her sensory needs. Examples include skin brushing, jumping on a mini-tramp, listening therapies, and eye exercises. Integrate sensory tools into your child’s school environment by having the teacher provide noise cancelling headphones in your child’s classroom or limit unnecessary sensory stimuli when possible.
  • Understand your child’s triggers. Recognize when they are in fight/flight and emphasize emotion regulation strategies that help them express emotions in healthy and safe ways. Help your child’s teachers and treatment providers recognize these triggers also so they can be aware of the early signs of dysregulation and hopefully avoid the big meltdown.
  • Develop routines. Routines are a way to create more safety and predictability around tricky transitions such as leaving the house or going to bed. Talk your child through these routines and transitions so that they can develop an internal dialogue for themselves.
  • Create a “safe” learning environment. In order to learn, children need to feel safe. When it comes to sensory sensitivity, it is important to reduce distractions such as background noises, visual stimuli, or social interactions that create anxiety. Integrate a body-centered practice such as brain gym before homework sessions, use weighted blankets over your child’s lap when reading together.
  • Integrate play therapy interventions into your home.  Create regular child-centered play times that let your child be in charge while you offer your reflective and attuned presence. Turn off the phone and the computer. Show how you feel when your child behaves in an out of control fashion and model self-regulation techniques.

About Dr. Arielle Schwartz

As a play therapist and mother of two, my passion is to teach parents how to integrate the tools of play therapy into your home and through clinical supervision, teach other clinicians how to support families with highly sensitive children. I understand the unique challenges parents can face in raising sensitive children and specialize in working with children with sensory processing disorders, speech/language delays, anxiety, challenging behaviors, trauma exposure, and emotional problems.

Further Reading:

Parenting a Child with Sensory Processing Disorder – My Story

My Story of Raising a Highly Sensitive Child

fingers in ears

When my daughter was born I entered motherhood ready and excited, yet I was also nervous about how the experience would change me. I was grateful to have several close friends enter parenthood around the same time as me. I had hopes and expectations about motherhood that were realistic enough to include the anticipated challenges of sleep deprivation amidst a major life change. What I didn’t expect was the complete overwhelm I experienced associated with raising a highly sensitive child.

crying babyWhen our daughter was born she was strong but fragile and fearful. The car and car seat felt like torture and simple outings to visit other parents or attend an activity led her to cry, scream, shake, or at worst throw up. Vacuuming the house was another ordeal as loud sounds seemed to cause physical pain. I knew that something was different but I didn’t understand what it was.

Her differences became even clearer when I joined my friends to attend early childhood music and gymnastics classes. I watched the other 2-4 year olds dance around the room, shake the shakers, sing along with the music, participate in forward rolls, and jump on the trampoline. However, my daughter clung to me, cried, and put her fingers in her ears and consistently refused to participate. Something was definitely different. Our lives became more and more restricted as we avoided crowds and turned down invitations to circumvent the public tantrums.

Getting the Right Diagnosis Changed our Lives

I spoke to our pediatrician who also noted that her speech was delayed compared to other children and as a result we were referred to the local clinic for an evaluation. It was the speech therapist who put her finger on a diagnosis; Sensory Processing Disorder.

I read about sensory processing disorder in children and I finally had the information I needed to support my daughter and stop blaming myself! My daughter was having neurologically based triggers that were repeatedly activating a fight/flight response. I began to understand her anxious approach to the world.

Early Intervention for Sensory Processing Disorder

This began a five-year process of supporting her development with a caring team of professionals that included play therapy, occupational therapy, speech photo (10)therapy, and an exploration of personal, family and inter-generational patterns.  As a result of early and consistent intervention, my daughter now channels her sensitivity into her creativity, she honors her pace when entering a new environment, and she carries herself with a quiet self confidence.

Further reading:

Raising the Highly Sensitive Child

Raising The Highly Sensitive Child – Sensory Processing Disorder

There are a set of shared experiences among the parents of children with Sensory Processing Disorder and there is comfort in knowing that you are not alone. As a parent of two and a psychologist who works with parents and children, I understand the unique set of challenges faced by families raising highly sensitive children.

The Highly Sensitive Child

Photo of highly sensitive child with sensory processing disorderThe sensitive child is like a unique and multifaceted gem. This child shines brilliantly sometimes allowing you to see into the depth and clarity at the center, and at times reflecting you so intensely that you are called to see yourself in challenging and uncomfortable ways. At times, these children can project diamond quality strength. Other times, the intensity which with they feel the world can result in meltdowns and tantrums and we must help them through these scattered and intensely challenging moments. That is if we haven’t melted down right along with them! Helping the sensitive child make sense of their inner and outer world can take parents to and beyond their limits.

Raising a Child with Sensory Processing Disorder

There are a set of shared experiences among the parents of sensitive children and there is comfort in knowing that you are not alone in the challenges you are facing.  Here is what parents of sensitive children often say:Photo of distressed young girl

  • My daughter is different than other children.
  • My 6 year-old son disrupts our home with his extreme meltdowns; he always needs to be the center of attention
  • My spouse and I are fighting more and blaming each other for our child’s behavior
  • Raising this child takes everything out of me!  I’m exhausted and sometimes feel that I am not cut out for parenting.

Understanding Sensory Processing Disorder and Highly Sensitive Children

brain traffic for webOnce I understood Sensory Processing Disorder I finally had the information I needed to stop blaming myself or feeling as though I was crazy! My child was having a neurological “traffic jam” that was the invisible culprit behind her behavioral breakdowns and anxious approach to the world.

Technically, Sensory Processing Disorder and Highly Sensitive Children are two different but related conditions. Sensory Processing Disorder was first identified by A. Jean Ayres an occupational therapist who identified that some children over- or under-respond in one or multiple senses (e.g. tactile sensitivity, sound sensitivity, light sensitivity). The highly sensitive child is a related concept developed by Elaine Aron who describes these children as easily overwhelmed by high levels of stimulation, sudden changes, and the emotional distress of others.The sensory challenges shared by parents and children I work with include:

  • My child says that most clothes hurt her. She will only wear two pairs of pants and I can barely get her to school in the mornings if those pants are not clean.
  • If my child gets bumped while standing in line at school he reacts as if someone hit him purposely.
  • There are sounds that I hardly notice but my child puts her hands to her ears in pain!
  • We can’t go to the movies because my child feels everything so strongly like it is happening to him.

Guidance for Parents of Highly Sensitive Children

  • Stop blaming yourself and/or your partner. Sensory processing challenges are real and require tremendous patience.
  • Get a thorough assessment. Children with Sensory Processing Disorder often have other co-presenting neurodevelopmental challenges such as learning disorders (dyslexia), ADHD, autism, and anxiety. However, getting an accurate diagnosis is important as some children are inaccurately diagnosed with ADHD and are medicated unnecessarily.
  • Trust your child! Highly sensitive children often also have a capacity for deep reflection and empathy when given the time to process their environment.
  • Get down to their level. The language of the younger child is play. Most children with sensory challenges feel out of control much of the time. Let your child take the lead in imaginary play, allow yourself to follow, and give your child an experience of being in charge or his or her world.
  • Parent and child connectionBecome your child’s emotional coach. Help older children talk about their feelings and reflect on what they are experiencing. Validate, reflect, and help them develop problem solving skills.
  • Repair your rocky moments. Reviewing our rough times involves admitting when we parents are not perfect and gives our children permission to make mistakes as well. Good-enough parenting involves ruptures and repair that allows everyone to learn from even our most challenging experiences.
  • Get help. It takes a village and when it comes to raising the highly sensitive child build your team. Often a treatment team involves play therapy, occupational therapy, speech language, and parenting support. Find a support group or online forum to talk with other parents raising children with Sensory Processing Disorder. I am available to help.

Further reading:

Dealing With Grief and Loss – Hanuman’s Story

A Story of the Courage and Healing from the Hindu tradition

Stories and poems offer metaphors providing a language for the soul.  In many stories there is a demon, dragon, or monster that needs to be conquered, a reminder that we need to face our fears and turn towards our challenges rather than avoid our problems. As a Yoga Instructor, I draw upon eastern philosophy as a source of insight. In this story form the Hindu tradition, Hanuman’s journey offers guideposts that help orient us when facing difficult times. This story comes from the Hindu tradition and teaches us about how to find courage and healing when dealing with grief and loss.

Graphic showing the hindu god hanuman Ocean and Shadow Self Dealing with grief and loss

Hanuman and the three obstacles

Hanuman has been set forth on a seemingly impossible task in response to ease the wounded heart, Rama’s loss of his beloved Sita.  In the process of his journey across the ocean, hanuman faces three challenges-those common to when crossing the seemingly endless passage set in motion by loss or trauma.

Hanuman’s First Obstacle

The first challenge Hanuman encounters is the unsurpassable obstacle. As Hanuman prepares to take his leap across the ocean a tremendous mountain rises up from the middle of the ocean. Hanuman could not fight, could not run around this mountain, nor could he fly above. Without any reserves, his only choice was to let go. And as he allowed his weight to rest upon the earth, the Gods spoke to him and he discovered that the mountain offered a place to rest in the midst of the long journey. While he could not stay there (as he did need to continue on his way) he learned the importance of rest pacing himself when faced with great a challenge.

Hanuman’s Second Obstacle

The second challenge faced by Hanuman is that of a fearful serpent demoness who swallows all who come across her path. Trying to avoid this fate, Hanuman tries in every way to enlarge himself…he grows larger yet the mouth of the serpent grows larger as well. He expands even larger and she expands along with him until she swallows him whole. Hanuman was swallowed by the snake. He feels utter despair and in his grief begins to shrink until he was so small that he was as small as a grain of sand, and still he shrinks until he is as small as the tiniest atom; allowing him to squeeze out between her teeth, beyond her lips and escape. Once in the open the demoness acknowledges that he has learned an important lesson about himself.  He could not avoid the truth and had to surrender.

Hanuman’s Third Obstacle

Exhausted Hanuman is released forth to continue his journey, but at this stage he moves forward as if in a dream; in disbelief that we will ever make it through to the other side. He feels unable to proceed and is depleted and yet at this very moment is faced with his third challenge; this time a demoness who has the power to possess the shadow of all who she encounters and pull them into the ocean. She takes hold of Hanuman’s shadow and begins to drag him into the sea. At first Hanuman feels that he has no reserves and that he too will die. However, what is required of him in this final phase of the journey is courage.  Against all odds, he gathered his strength to turn towards his past and his pain. As long as he can see clearly the murky, avoided, or disowned places in himself he can prevent the demoness from having the power to drag him under by his shadow. He takes hold of his shadow and is released to arrive at his destination, complete his journey, and return love to the broken heart.

Dealing With Grief and Loss

Dealing with grief and loss photo of ocean at sunsetWe are reminded that at times that which we perceive as an obstacle is really a reminder of the importance of rest, slowing down, and the careful pacing that is needed to when moving through the disorientation of trauma or grief.  This story also suggests that we cannot outrun or avoid reality as it is. Despite our need to feel powerful and in control there are life events that we have no control over. We cannot bring back a loved one who has died. We cannot reverse time. In these moments we are asked to surrender. There are also times in which we are asked to find our courage and strength. When dealing with grief and loss there is benefit in turning towards the pain, to feel what we perceive is unbearable, even if we are afraid that we will break in two. In these moments we may discover a new found strength, our courage, and a new sense of self more capable of living in this unpredictable yet exquisite life.

Learn More:

Resilience Psychology and Coping with Grief

Finding Hope after Facing Loss

Grief Dr. Arielle Schwartz

At some point in our lives all have had to or will have to confront the loss of a loved one.  When facing the death of a loved one we can feel disoriented, uprooted, and isolated. Sometimes, the loss doesn’t feel real, we feel lost in the dark, or we feel as though the grief will never end. This post shares a very personal loss and offers tools for coping with bereavement.

“My husband and I were married less than a year. We had plans. I was applying for my doctorate in clinical psychology and we were talking about the timing of our first child. Then tragic loss changed everything.  The call came in the middle of the night. A helicopter had gone down during a routine mission and my husband’s brother (a military pilot) was aboard…”
-Dr. Arielle Schwartz Continue reading

EMDR Case Study – Marie

 

Depresses woman EMDRMarie’s Story* How EMDR Can Change Your Life

*Marie is not an actual person, but a composite of several patients Dr. Schwartz has seen over the past several years. Identifying details have been changed to protect their privacy. The treatments and outcomes are real.

Phase 1 – Taking a In-Depth History

Marie had been date raped while in college. Now as an adult, Marie is suffering from anxiety and finds it challenging to develop a meaningful long term relationship. She had been in talk therapy for some time without success. In fact, she never really dealt directly with the trauma surrounding the incident. Marie was very skilled at avoiding dealing with the trauma of this incident.

In order to continue to function after a traumatic event, as a coping mechanism, it is common to bury or avoid dealing with the painful feelings or memories. I will take a thorough life history to provide the foundation for successful EMDR treatment. History taking includes life events, family systems and the strengths and resources that are currently available.

Phase 2 – Preparation for EMDR

Marie had lost a sense of choice or control over her emotional life. She felt flooded with anxiety and needed some resources to help her fell safe again. In our therapy I helped Marie identify times and places in her life where she felt safe. We also gave her tools to use between sessions to help her manage her anxiety. When Marie came back for her next session, she shared that she felt calmer and more in control of her emotions throughout the week.

As we prepare for EMDR therapy, you will build your own tool kit to help you manage overwhelming emotions and your reactions to stressful events. In addition, you will choose the form of bilateral stimulation that works best for you. The methods used are: eye movements, tactile sensations, or bilateral sounds.

Phase 3 – Assessment and Setting an EMDR Target

Marie realized that the rape had a much more profound impact on her life than she had ever allowed herself to feel. She understood that she had internalized the helplessness of that moment and would repeatedly feel helpless when faced with triggering stressful situations at work with her boss and when she was home alone in the evenings. She recognized that she had compensated for the vulnerability she was feeling by pushing people away when they wanted to get close.Marie identified that she wanted to feel capable of taking care of herself and she wanted to allow herself to develop a loving nurturing relationship.

At this point in EMDR treatment we will identify the trauma that will be worked on during desensitization. This trauma is referred to as your target and we will identify the image, emotions, beliefs and body sensations that are associated with that event.

Phase 4 – Desensitization  

Using bilateral eye movements, I asked Marie to think about the rape and the image that represented the worst part of her experience Marie noted that she felt disconnected and numb when she thought of the event. Through careful pacing she began to tolerate the vulnerable and uncomfortable emotions that came up when she thought about the rape. As Marie began to feel the emotions she had a series of memories come forward about what happened that day and associations to other times in her life when she felt helpless. Eventually Marie was able to think about the rape without experiencing any upsetting feelings or thoughts. Furthermore, she began to feel stronger in herself and arrived at a sense of how this event contributed to who she is today.

We know that trauma is primarily stored in both the limbic or mid-brain and in the right hemisphere of the brain. However, we need our entire brain to access the integrative functions of reflective thought and meaning making in order to heal from trauma. By using bilateral stimulation, we rhythmically alternate between the two hemispheres of the brain while thinking about the traumatic event. This process allows the associations, feelings and memories from the past to be brought forward so they can be experienced and resolved. Desensitization of a target can occur in a single session or across multiple sessions.

Phase 5 – Installation

Now Marie was able to think about the rape and feel strong and in control. She recognized that what happened was not her fault and there were changes she could make in how she approached the world today that reflects this new experience of herself. Marie thought about being home alone and the vulnerability she used to feel and allowed a new sense of strength of to infuse her being. She felt more open to the possibility of taking the risk associated with allowing someone to get close to her. She visualized what this would look like in her life today.

During the Installation Phase, I guide you to connect the positive beliefs and sense of self that is achieved through the successful completion of desensitization. We have you imagine the past and present life triggers as you would approach them with this new found sense of capability.

Phase 6 – Body Scan

I invited Marie to scan her body for any lingering areas of tension and to allow any residual distress to release.

We use the body as a gauge to verify the successful completion of the EMDR process.

Phase 7 – Closure

Before leaving the session, I made sure that Marie felt grounded and complete with that day’s process.

Closure is essential to successful treatment in that it allows the challenging work of desensitization to be contained between sessions. Containment is built upon an agreement that we will return to address any remaining distress associated with the traumatic event. This also frees you up by asking you not to think (worry, obsess) about traumatic material between sessions.

Phase 8 – Re-evaluation

In the following session, I asked Marie to check in about how she feels now when she thinks about the rape. Marie shared that she no longer felt any disturbance. She also spoke about feeling lighter throughout the week and that she felt less unprovoked anger toward her boyfriend.

The purpose of re-evaluation allows us to assess the effectiveness of the treatment and address and residual or unresolved feelings.

In Marie’s case EMDR was a very successful treatment of choice. While it is not for every client or every presenting condition, EMDR has been well researched and is considered an evidenced based trauma treatment.

Happy couple

Additional Reading:

Somatic Psychology Interventons and EMDR Training

Attend an EMDR Training in Somatic Psychology Interventions and EMDR Taught by Dr. Schwartz with Maiberger Institute!

What: Two day Training on Somatic Interventions & EMDR (Boulder, CO)
When: July 26 – 27, 2014
Where: Maiberger Institute
2995 Baseline Road, Suite 206
Boulder, CO 80303

Learn More About EMDR

Why Somatic Psychology and EMDR:

The field of somatic psychology explores the relationship between the body and psychological states or processes.  Somatic psychology centralizes body awareness as a primary healing agent in psychotherapy. We cannot always think our way out of a trauma response because the physiological reactions are so central, the heart rate quickens, there are feelings of panic, we feel tension throughout the body, or perhaps we feel stuck and unable to move. Somatic interventions are valuable tools within the therapeutic arena because they work directly with how traumatic events impact our bodies through breath constrictions and tension patterns that are held pre-consciously (just under our conscious awareness). When working with either recent of historical traumatic events, the body provides tremendous feedback about the psychological impact of that event. Tracking the somatic experience in trauma work also gives clear feedback about when the traumatic incident no longer holds power over us. As a result, we have increased access to choice and a greater range of healthy ways to respond to present day challenges.

Photo of Dr Arielle Schwartz teaching EMDR for attachment injury at Maiberger Institute

When combining somatic interventions with the 8-phase treatment model of EMDR, body awareness greatly enhances the effectiveness of both. Adding the technology of bi-lateral stimulation that is central to EMDR amplifies the processing of traumatic events. Likewise, somatic awareness in EMDR brings mindful awareness to the subtleties of trauma release with careful attention to nervous states, the pacing of process, and the relational exchange between therapist and client.

Somatic Interventions and EMDR Training Description:

This two-day workshop is an opportunities for therapists already trained in EMDR to introduce them to somatic interventions for trauma treatment.

As a result of this training, participants will be able to:

  • Summarize a basic understanding of Somatic Psychology in relationship to EMDR
  • Demonstrate at least one somatic intervention for each of the 8 Phases of the EMDR protocol
  • Recognize how self – awareness of nonverbal communication increases therapist’s trustworthiness and facilitates therapeutic alliance.
  • Exhibit how Somatic interventions facilitate client’s ability to self regulate.

Register Here