Healing Complex PTSD with EMDR Therapy
The other day a colleague sent me a link to a website offering virtual EMDR Therapy. In disbelief, we both remarked on the inappropriateness of such an offering for it misses an essential component of healing…the therapeutic relationship.
Recovery from developmental trauma requires that you have a reparative experience in relationship. Within the ground of another—in this case, a compassionate therapist—you embrace experiences of confusion, discomfort, anger, grief, shame, and pain. A compassionate therapist offers a container of sorts for the feelings and memories that you might be unable to handle alone. And together, you’ll build trust, gain perspective, and find healing tools that work best for you.
In my presentation for the Colorado Counseling Association conference, I discuss the process of healing from complex PTSD and dissociation with relationally based EMDR Therapy. This post provides a summary of the talk for those who attended and those who couldn’t make it in person.
“Whether you are a therapist helping others recover from childhood trauma or you are an individual walking the healing path this post provides valuable guidance. When you are empowered with knowledge and awareness, you can deepen your self-acceptance and reduce the difficult emotions that often accompany developmental trauma. With a greater understanding of complex PTSD and dissociation, you will come away with a deepened appreciation for why EMDR Therapy only makes sense within a relational context.”
-Dr. Arielle Schwartz
Types of Trauma
Traumatic experiences are, by their very definition, frightening and overwhelming. PTSD is often associated with events such as car accidents, natural disasters, or acts of violence. It is common after experiences like these to feel flooded with powerful emotions such as fear or sadness, and to begin avoiding situations that remind you of the trauma. PTSD refers to the presence of these symptoms well after the event is over. Chronic trauma occurs as a result of long-term exposure to traumatic stress, rather than in response to a single incident. Complex PTSD typically arises as a result of ongoing stress or repeated traumatic events that occur during childhood. This next slide summarizes the common symptoms:
The Window of Tolerance
The “window of tolerance” was developed by clinical psychiatrist Dr. Daniel Siegel. It refers to an optimal zone of nervous system arousal where you are able to respond effectively to your emotions. When you are outside of your window of tolerance, you will go into survival modes. Feeling anxious, overwhelmed, or panicked is a sign that you are hyper- or over-aroused, whereas feeling shut down, numb, or disconnected is a sign that you are hypo- or under-aroused. It is common with C-PTSD to alternate between the two extremes or to feel stuck in one or the other.
Healing involves developing the capacity to stay within the window of tolerance by cultivating mindfulness of the fluctuations in your sensations, thoughts, and emotions. Through this, you increase awareness of the subtle signs of dysregulation and you can engage self-care resources before you get overwhelmed or shut down.
Dissociation is a biological protection that disconnects you from threatening experiences creating a division between the part of you involved in daily living and the part of you holding emotions of fear, shame, or anger. Dissociation exists on a continuum from relatively mild sensations of fogginess, sleepiness, or having difficulty concentrating to feeling numb or cut off. In the most extreme situations, you might have lapses of memory or “lost time.”
Healing dissociation asks you to accommodate the reality of childhood neglect or abuse. In doing so, you develop the capacity to recognize that traumatic events happened that they are over now. You can differentiate the past from the present, which gives you access to choices now that were not available to you then.
Healing developmental trauma asks you to relate to injustice, unfairness, or suffering as it exists in your life or in the world. However, phobias can maintain dissociation. Fears of confronting traumatic memories and their related emotions or sensations can feel overwhelming. As a result, it is common to avoid relating to parts of self that carry shame and to cut off from the world hoping to eliminate the possibility of facing disconnections, further loss, or unwanted change.
Healing Complex PTSD
Healing complex PTSD involves learning to respond effectively to emotions, memories, and sensations.
The goal is not to get rid of memories, emotions, or sensations rather it is to increase your tolerance of these experiences. You work to become less reactive to the past and therefore which gives you a greater ability to choose behaviors that best support you now. To do so you develop the capacity to tolerate complex experiences such as uncertainty, ambiguity, disappointment, loss, conflict, difference and paradox.
The Healing Relationship
A core dilemma of complex PTSD is that your longing for connection conflicts with memories that tell you relationships aren’t safe. It can be a challenge to develop healthy relationships. Initially, you may re-create relationships that match what you already know. Perhaps you unintentionally push people away and then feel angry that nobody ever calls you. Maybe you tend to choose partners who treat your poorly because deep inside this feels familiar.
In contrast, a healing relationship such as one with a trusted therapist, will allow you to gently recognize and take responsibility for any part you may play in perpetuating unhealthy dynamics. In a trusting relationship, you can expose your fears and learn that you will not be rejected or harmed. Slowly, you’ll learn to allow another person to witness your confusion, discomfort, anger, grief, or shame.
Even the healthiest of relationships have moments of disconnection or unintentional misunderstanding. A healing relationship will allow you to stay in the relationship until connection is regained and the relationship bond is repaired. Although nobody likes conflict, there is an intrinsic value in healthy conflict, for this process will actually help retrain your nervous system as you build trust in your capacity to successfully navigate through interpersonal challenges. Ultimately this process will help you to form new relationship expectations that lead to healthier relationships in your life.
EMDR Therapy in Relationship
Eye movement desensitization and reprocessing (EMDR) therapy, developed by Dr. Francine Shapiro, is a comprehensive approach to therapy that integrates elements of several different therapies. EMDR Therapy is structured to treat PTSD by identifying triggering memories, emotions, beliefs, and sensations. It relies on the concept that with sufficient support, you’ll have the capacity to process and digest traumatic events and as a result, let go of self-critical beliefs and painful emotions.
When it comes to working with complex PTSD, we must remember that many with a history of developmental trauma never felt understood, wanted, received. The essence of them as a person may have been denied, not allowed, rejected.
Think of a time when you have been received as you are. In what ways were you seen or deeply appreciated for your gifts? How did that feel? In what ways were you changed as a result?
As therapists our task is to show up in our own humanness and receive the humanness of the person in front of us—to cultivate a state of appreciation for who they are and what they have endured. In this way, we must understand that EMDR Therapy is not an intervention, it is a therapeutic modality which understands that recovery from developmental trauma requires a reparative experience in relationship. As a result, both client and therapist are changed by the exchange.
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.