Is EMDR Therapy Appropriate for C-PTSD?
Quite regularly I receive inquiries from clinicians and prospective clients asking me if it is appropriate to use EMDR Therapy for complex PTSD and childhood trauma. My short answer is yes, EMDR Therapy is an incredibly valuable therapeutic for treating C-PTSD; however, this powerful modality typically requires careful modification to attend to dysregulated and dissociative symptoms that often accompany early developmental abuse or neglect.
EMDR Therapy is an 8-phase treatment modality that systematically allows clients to process traumatic material and resolve lingering emotional, mental, and somatic distress. This post describes some of the most common modifications as related to the 8-phases that allow clients and clinicians to work together safely using EMDR Therapy for complex PSTD.
“Chronic, early developmental trauma memories are often preverbal and tend to be accompanied with dissociative symptoms. Therapists must emphasize the importance of resource development and careful pacing of EMDR Therapy so that clients feel safe in the present moment. You achieve successful treatment outcomes when you slowly build tolerance for the emotions and body sensations that accompany traumatic memories. The once overwhelming symptoms of C-PTSD can resolve as the client learns to turn toward pain and suffering with greater awareness and compassion.”
-Dr. Arielle Schwartz
Understanding Complex PSTD
Complex PTSD occurs as a result of long-term exposure to unrelenting stressors, repeated traumatic events, or attachment injuries that occur during childhood. Most often the trauma is interpersonal. An individual might have experienced chronic neglect, abuse, or exposure to domestic violence. It is also important to keep in mind that chronic trauma can also come from ongoing experiences of being bullied without protection, having an undiagnosed or unsupported disability, or being discriminated against without an advocate. In all forms of C-PTSD, the injury is repetitive, prolonged, and cumulative. Often the trauma occurs during vulnerable times of development such as in early childhood or during adolescence. These early experiences tend to shape the clients’ identity. (You can learn more about Complex PTSD here.)
EMDR Therapy for Complex PTSD
The goal of EMDR Therapy for complex PTSD is to help clients develop an embodied Self that can compassionately hold their emotions, vulnerable sensations, and young parts in a safe way. The process requires that therapists understand how to work with preverbal or nonverbal memories by integrating a somatic approach because our earliest memories are stored as motor patterns, sensations, affective states, and psychophysiological arousal. Furthermore, given the interpersonal nature of the injuries, it is essential to focus on the relational exchange.
Let’s take a closer look at this approach to working with C-PTSD and attachment trauma across the 8-phases of EMDR Therapy:
- Phase 1 History Taking: The purpose of this initial phase of treatment is for the therapist to gather a thorough history of a client’s life including both positive life events and traumatic experiences. When treating complex PTSD, this phase allows the therapist to observe the client’s capacity for somatic awareness and assess for dissociation. Therapists review the client’s early childhood history to understand how core emotional or somatic patterns and pervasive negative cognitions inform case conceptualization.
- Phase 2 Preparation: During the Preparation Phase, a therapist will help clients develop the necessary resources to help them face difficult memories without getting overwhelmed. This is accomplished through Resource Development Installation (RDI) in which a client practices imagining and feeling connected to a positive emotional state. The most common RDI involves imagining a safe place in which the client identifies a real or imagined place where they can feel calm and relaxed in body and mind. (You can learn how to create a Safe Place resource here.) In addition, therapists help clients identify parts of the self that hold memories of early trauma.
- Phase 3 Assessment: This phase of treatment focuses on identifying the specific traumatic memories that will be worked on during Desensitization Phase. This involves target development in which the therapist helps the client to identify the disturbing image, emotions, beliefs, and body sensations associated with the chosen traumatic event. Here, traditional EMDR Therapy is modified when working with preverbal or nonverbal memories by developing targets from a story about early childhood events, body sensations that have no known origin, or pervasive cognitions that do not resolve after traditional EMDR Therapy.
- Phase 4 Desensitization: This phase incorporates the use of a dual awareness state, in which the client maintains aware of the present moment experience while simultaneously recalling memories of the traumatic event. Dual attention stimulation (DAS) is amplified in the form of bi-lateral eye movements, pulsers, or tones that alternate between the left and right side of your body. EMDR Therapy for complex PTSD involves careful attention to dissociative symptoms during treatment with an emphasis on keeping the client regulated within the window of tolerance (see below) during processing. This can be accomplished through Somatic Therapy interventions such as pendulation and titration. Therapists can also apply Porges’ Polyvagal Theory as an intervention for successful treatment (see more on Polyvagal theory here.)
- Phase 5 Installation: This phase focuses on strengthening the positive beliefs that become increasingly available after the successful completion of desensitization. For example, once a client no longer holds the misconception that they are unlovable, they can begin to develop and integrate a new positive belief that they are worthy of being loved. Often, there is a new embodied experience of an adult Self that can attend to emotional parts of self with greater compassion and acceptance.
- Phase 6 Body Scan: Here the body is explicitly brought into EMDR Therapy as a way to assess any lingering tension or distress, as well as, enhance the good feelings the client may be feeling upon completion of Desensitization and Installation Phases.
- Phase 7 Closure: Closure is essential to successful treatment and is a way to make sure that the client is grounded before leaving the session. Here the therapist makes sure that if the traumatic material during desensitization is not complete, that the disturbing material will be contained for further processing in the next session (See more about Grounding and Containment resources here). The therapist instructs the client that processing may continue between sessions and that they need to practice their skills of using containment and safe place to ensure the client can function between sessions. This process also frees up the client by inviting them not to think (worry, obsess) about traumatic material between sessions.
- Phase 8 Reevaluation: During the Reevaluation phase, Embodied EMDR therapists review previous sessions and look for any lingering emotional, cognitive, or somatic distress that may lead to further targets. Early childhood and attachment trauma often requires ongoing therapeutic support for integration as the psychophysiological arousal (beliefs, emotions, and sensations) states have been in place for many years.
The Whole is Greater than the Sum of our Parts
It is important to help clients develop awareness of the parts that hold memories of early trauma. Sometimes, a part can have resistance to doing trauma work and can try to sabotage the therapy work. Other times, a part of self is holding the childhood traumatic memories. In EMDR Therapy we resource vulnerable parts with allies to create safety. Resourcing parts can take time; however, when a client has the correct resources, processing traumatic memories can be much gentler and more effective.
As with all EMDR Therapy, it is important to know that the process is not linear. This is especially true for early developmental trauma as the process is often slow moving and requires ongoing stabilization and resource development. A successful treatment outcome requires that you build tolerance for the emotions and body sensations that accompany traumatic memories. The client becomes increasingly able to access a Wise and Whole Self who is able to mindfully attend to the needs of parts while upholding the responsibilities of the adult in the world. The once overwhelming symptoms of C-PTSD can resolve as you learn to turn toward the parts of self that hold pain and suffering with greater awareness and compassion.
Looking for a mind-body approach to healing C-PTSD?
Connect to this post? The Complex PTSD Workbook, is now available on Amazon! Click here to check it out and increase your toolbox for healing. Whether you are a client or a therapist this book will offer a guided approach to trauma recovery.
About Dr. Arielle Schwartz
Dr. Arielle Schwartz is a licensed clinical psychologist, wife, and mother in Boulder, CO. She offers trainings for therapists, maintains a private practice, and has passions for the outdoors, yoga, and writing. Dr. Schwartz is the author of The Complex PTSD Workbook: A Mind-Body Approach to Regaining Emotional Control and Becoming Whole. She is the developer of Resilience-Informed Therapy which applies research on trauma recovery to form a strength-based, trauma treatment model that includes Eye Movement Desensitization and Reprocessing (EMDR), somatic (body-centered) psychology and time-tested relational psychotherapy. Like Dr. Arielle Schwartz on Facebook, follow her on Linkedin and sign up for email updates to stay up to date with all her posts.