EMDR Therapy, Addiction + Compulsion Protocols + Brainspotting
EMDR is an acronym for Eye Movement Desensitization and Reprocessing and is a technique used as a primary therapy or as an adjunct form of treatment. As a Level II EMDR specialist, I am able to offer this effective intervention to alleviate symptoms related to trauma as well as other distressing symptoms such as:
- Phobias, anxieties, fears, panic disorder, obsessions
- Depression, dysphoria, sadness
- Eating disorders, body image concerns
- Medical trauma, medical diagnosis, chronic pain
- Sexual, physical and emotional abuse
- Relationship issues, family of origin difficulties
- Identity and sexual problems
- Self-defeating patterns, self sabotage, poor self-esteem
- Accidents, natural disasters, survivor guilt
- Performance problems, public speaking, creative blocks
- Anger, rage, feeling unsafe
- Triggers for addictions
- Negative thoughts, patterns
- Attachment, interpersonal and relationship challenges, barriers to intimacy
This treatment modality is based on the neuroscience of the brain and uses bilateral stimulation to process through the memory networks and release the emotional charge associated with the experiences that create obstacles to emotional health and healthy relationships. Compared to traditional forms of cognitive behavioral therapy, EMDR has proven to be extremely effective in treating even the most problematic issues in a relatively short amount of time. Clients utilizing EMDR appear to have less chance of their problems returning in the future after treatment is complete, because healing is believed to take place at the level of the nervous system. EMDR is effective for changing negative thought patterns, emotional reactions, entrenched habits and even physical discomfort that people can’t “think" their way out of using traditional "talk therapy." EMDR has given clinicians and their clients the ability to essentially reverse all those negative patterns and responses that have developed in the brain, body, and nervous system. I incorporate EMDR into psychotherapy sessions as needed and desired by my clients.
More about EMDR...
Negative experiences and emotions often become trapped in the brain and poorly integrated between the left and right hemispheres causing distressing somatic and emotional symptoms. The technique of EMDR is believed to stimulate an intrinsic capacity of the human brain to resolve emotional disturbance and gain adaptive and more helpful insights, not unlike what occurs spontaneously during dreaming or REM (rapid eye movement) sleep. EMDR therapy uses bilateral stimulation, right/left eye movement, or tactile stimulation, which activates alternate sides of the brain. This process is thought to release emotional experiences that are "trapped" in the nervous system. This assists the neurophysiological system, the basis of the mind/body connection, to free blockages and more fully integrate experiences. As troubling images and feelings are processed by the brain via the bilateral stimulation of EMDR, resolution of the issues and a more peaceful state is restored at the level of the nervous system.
EMDR is the most researched of the power therapies (Somatic Experiencing or SE, Advanced Integrative Therapy, Emotional Freedom Technique EFT, Thought Field Therapy TFT, Brainspotting BSP, Energy Testing and others), and has the validation of the American Psychological Association, the American Psychiatric Association, the Department of Defense and the Veteran’s Administration, as it relates to treatments for Post Traumatic Stress Disorder, or PTSD. In addition to trauma resolution, EMDR is now successfully used as a performance enhancement tool and to assist individuals in a variety of high stress situations such as:
- Participating in competitive sports and other high-stress situations
- Public speaking and presentations
- Undergoing job interviews
- Taking standardized tests such as SAT's, professional examinations, test anxiety
- Performing in artistic and creative performances, writer and artistic blocks
People who have participated in performance enhancement therapy such as competitive athletes and performers often report that they are more self-confident and that unconscious blocks to performance are greatly reduced.
For more information about EMDR you can visit the EMDR Institute.
What follows is a more comprehensive list of problems and concerns that are helped by EMDR...
The studies to date show a high degree of effectiveness with the following conditions:
- Childhood trauma or traumatic memories
- Anxiety or panic attacks
- Anger and rage problems
- Intense anxiety, phobias and fears (fear of flying, bridges, tunnels)
- Social anxiety
- Fear of being alone or abandoned
- Feeling unlovable
- Unrealistic guilt and shame
- Addictions and smoking cessation
- Compulsions and habit control
- Chemically dependent clients
- Dissociation, DID
- Managing anger and rage problems
- Insomnia and sleep disorders, relaxation difficulties
- Medical/surgical/diagnosis trauma
- Attachment concerns
- Eating disorders (Anorexia, Bulimia, Binge Eating Disorder) and body image issues
- Performance and test anxiety
- Sexual abuse and/or physical abuse
- Surviving an assault, robbery or rape
- Witnessing violence, victim of a crime
- Loss or injury of a loved one, injury to self
- Childhood trauma, neglect, abuse or traumatic memories
- Surviving an accident
- Low self-esteem
- Motivation and procrastination
- 911 victims, police officers, firemen, rescue workers with violent memories
- Difficulties with trust
- Relationship problems and interpersonal difficulties (work and professional)
- Life transitions such as divorce recovery, childbirth and aging
Feeling State Addiction Protocol (FSAP)--EMDR Therapy for Addictions & Compulsions
For years the addiction field has held that addictions were caused by genetics. We now know that, while the gene may be passed from parent to child, the expression of a gene can be influenced by negative and positive environmental factors. The Feeling State Addiction Protocol or FSAP developed by Dr Robert Miller works from the theory that addictions and compulsions develop in the moment an individual experiences an intensely desired positive feeling while engaging in a specific behavior. The intense positive feelings that are experienced in that moment are powerful, and when combined with the individual's unique history and emotional vulnerability, the positive "feeling state" (e.g. "I'm okay," "I am loved," or "I'm a winner") becomes neurologically wired with the problem behavior. As a result, the individual will compulsively seek to recreate the gratifying "feeling state" by engaging in the behavior (e.g. gambling, sex addiction, shopping, shop-lifting, exhibitionism, voyeurism, substance use, overeating or restricting), while compromising healthy psychological development.
When successful, the Feeling State Addiction Protocol breaks this neurological welding, similar to the way standard EMDR frees the “stuck” traumatic memory at the level of the nervous system. As the positive feeling state and the behavior becomes "de-linked," individuals find that their urges to engage in the addictive and compulsive behaviors diminish and may even disappear. As a result, the individual's vulnerability and original trauma creates discomfort and can no longer be numbed with the familiar addictive and compulsive behaviors. A return to the standard EMDR Protocol can then be used to resolve the painful experiences that led to the "need" that are at the root cause of many addictions.
Some clients may benefit from this type of innovative, intensive treatment, but many will need a more comprehensive, supportive and stabilizing environment for medical and psychiatric reasons. This will afford the individual a greater range of modalities and supportive measures to ensure a lasting and successful recovery. Optimal recovery can be achieved when a rehab facility acknowledges how co-occurring disorders may contribute to the progression of addictions and compulsions and not just label the individual "an addict," focusing only on stopping the behavior. Trauma and long-standing psychiatric issues, which may not have been properly identified or treated successfully in the past, are referred to as co-occurring disorders.
Examples of co-occurring psychiatric conditions are:
- Panic and anxiety disorders
- Attention deficit disorder ADD
- Bipolar disorder
- Borderline personality disorder BPD
- Eating disorders
- Post-traumatic stress disorder PTSD
- Obsessive compulsive disorder OCD
- Sleep disorders
- Substance abuse or dependence
EMDR Therapy and Brainspotting
Brainspotting was discovered by David Grand, Ph.D. in 2003. Since then, Brainspotting has developed into an in-depth therapeutic process that can be integrated with psychotherapy sessions in either individual or couples therapy. Dr. Grand believes that “Brainspotting taps in to the body’s natural self-scanning and self-healing abilities”.
Brainspotting therapy is a new and powerful method of healing developed from EMDR. Brainspotting as a technique is used in psychotherapy and trauma resolution therapy to help release depression, fear, anxiety, grief, loss, phobias and addictions. It is possible to release the trauma or traumatic event from either a distressed or calm place in the body. The power of BSP is that one does not necessarily have to relive the traumatic event at the same level of intensity as the original trauma. BSP is especially helpful for pre-verbal traumas, that is, traumas that occurred before the child had language to organize the experience. Because of this, it is possible to resolve the trauma in a safe and contained manner. Trauma and stress can often overwhelm the nervous system. With the support of an experienced EMDR and Brainspotting therapist, BSP helps the client discharge the trauma and calm the nervous system. BSP helps clients identify, process, and release core neurophysiological sources of emotional or physical pain, trauma, dissociation and a variety of other challenging psychiatric and somatic symptoms.
Brainspotting (BSP) functions as a neurobiological tool to support the therapeutic relationship in which the therapist’s mature, nurturing presence and ability to engage the client creates a healing space. It is theorized that Brainspotting, like EMDR, triggers the body’s innate self-scanning capacity to process and release focused areas (systems) which are in a maladaptive form (frozen primitive survival modes). This may also explain the ability of Brainspotting to often reduce and eliminate body pain and tension associated with chronic physical conditions.
Generally, the brainspot is located by finding an eye position where the emotion is most strongly felt. A brainspot can also be located from the calmest place in the body. Pinpointing the brainspot is done through noticing an increase in reflexive eye or body movements, such as blinking, swallowing, yawning, head or body twitches. Neurologists state that the location of the brainspot “is related to the area or region of the patient’s experience or perception of the traumatic event and represents procedural memory for that somatic experience.”
Brainspotting can be accompanied by the use of biolateral sounds. Biolateral sounds can be music, tones or even nature sounds that move from ear to ear alternately in order to activate each hemisphere of the brain. Dr. Grand developed a series of biolateral CDs that can be used during a Brainspotting session. Initially developed for use with EMDR, these sounds help to calm the sympathetic nervous system (which is the fight or flight response), and engage the calmer parasympathetic nervous system.
Brainspotting is unique from other therapeutic techniques in that it is being used not only in trauma and healing work, but also in the areas of performance enhancement and sports psychology. Therapists are utilizing BSP with professional athletes, actors, writers, musicians, as well as with clients who experience stress during public speaking. Meditation practices can also be enhanced through the use of Brainspotting.
David Grand, PhD, the developer of Brainspotting, is an internationally recognized trauma expert. He has devoted his life to advancing, expanding, and communicating about state-of-the-art tools available for healing trauma and enhancing performance. He is the author of Emotional Healing at Warp speed: The Power of EMDR, and trains health care professionals around the US, Europe, South America and the Middle East
EMDR Therapy and Somatic Experiencing Techniques
Somatic Experiencing is a form of therapy aimed at relieving and resolving the symptoms of post-traumatic stress disorder (PTSD) and other mental and physical trauma-related health problems by focusing on the client’s perceived body sensations or somatic experiences. It was introduced in Dr. Peter Levine's 1997 book "Waking the Tiger." In it, he discusses at length, his observations of animals in the wild, and how they deal with and recover from life-threatening situations. He concludes that their behavior gives us "an insight into the biological healing process" (p.98), and that "the key to healing traumatic symptoms in humans lies in our being able to mirror the fluid adaption of wild animals" (p.17-18) as they avoid traumatization in reacting to life-threatening situations. The theory postulates that the symptoms of trauma are the effect of a dysregulation of the autonomic nervous system (ANS). It further postulates that the ANS has an inherent capacity to self-regulate that is undermined by trauma, and that the inherent capacity to self-regulate can be restored by the procedures of Somatic Experiencing or SE.
The procedure, which is normally done in a face-to-face session similar to psychotherapy, involves a client tracking his or her own "felt-sense" experience. SE is considered by practitioners to be effective for "shock" trauma in the short term (typically one to six sessions). It is also considered effective for developmental trauma as an adjunct to or instead of more conventional psychotherapy that may span years. Somatic Experiencing is very effective when combined with EMDR sessions and traditional talk therapy or psychotherapy.
Somatic Experiencing attempts to promote awareness and release of physical tension that proponents believe is stored and remains in the body in the aftermath of trauma. This occurs when the survival responses (which can take the form of orienting, fight, flight or freeze) of the ANS are aroused, but are not fully discharged after the traumatic situation has passed. The process involves a guided exploration of the nature and extent of the physical dysregulation that is harbored in the body as a result of trauma. Another notion is that the client's experience should be "pendulated." Pendulation refers to the movement between regulation and dysregulation. The client is helped to move to a state where he or she is believed to be somewhat dysregulated (i.e. aroused, distressed or frozen) and then helped to return to a state of regulation (loosely defined as not aroused or frozen). "Resources" are defined as anything that helps the client's autonomic nervous system return to a regulated state. In the face of arousal, "discharge" is facilitated to allow the client's body to return to a regulated state. Through this process the client's inherent capacity to self-regulate is believed to be restored.
Somatic Experiencing is considered by practitioners to be useful for two broad categories of trauma: shock trauma and developmental trauma. Shock trauma is loosely defined as a single-episode traumatic event such as an accident, natural disaster, battlefield incident, etc. Developmental trauma refers to various kinds of psychological damage that occur during child development, such as: chronic abuse, insufficient attention and neglect from primary caregivers and insufficient nurturing relationship with the parent.
What's being said about EMDR:
- "EMDR therapy was determined to be an effective treatment of trauma." American Psychiatric Association (2004). Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Post-traumatic Stress Disorder. Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Post-traumatic Stress Disorder. Arlington, VA: American Psychiatric Association Practice Guidelines.
- "EMDR therapy was placed in the "A" category as “strongly recommended” for the treatment of trauma." Department of Veterans Affairs and Department of Defense (2004). VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress. Washington, DC
- EMDR is a therapy is listed in the new Department of Veterans Affairs & Department of Defense Practice Guidelines "A" category as "highly recommended" for the treatment of trauma.
- It has received a high level of recommendation by the American Psychiatric Association and by the mental health departments of Israel, Northern Ireland, United Kingdom, France, Sweden and more. For a full listing visit http://www.EMDRHAP.org/researchandresources.htm to learn more.
- EMDR is also listed as an effective form of therapy, backed by research, on a new National Institute of Mental Health sponsored website: Check under "Adult MH Therapist for Post-traumatic Stress Disorder."
The History of EMDR
Eye Movement Desensitization and Reprocessing (EMDR) is a therapy developed by psychologist Dr. Francine Shapiro. She made the chance observation that eye movements can reduce the intensity of the disturbing thoughts when she noticed her own stress reactions diminished when her eyes swept back and forth as she walked through a park one day. EMDR involves recalling a stressful past event and “reprogramming” the memory in the light of a positive, self-chosen belief, while using rapid eye movements to facilitate the process. Theories as to why EMDR works are still evolving, but many people have found EMDR to be extremely beneficial.
8 Phases of Treatment
The amount of time the complete treatment will take depends upon the history of the client. Complete treatment of the targets involves a three pronged protocol (1-past memories, 2-present disturbance, 3-future actions), and are needed to alleviate the symptoms and address the complete clinical picture. The goal of EMDR therapy is to process completely the experiences that are causing problems, and to include new ones that are needed for full health. "Processing" does not mean talking about it. "Processing" means setting up a learning state that will allow experiences that are causing problems to be "digested" and stored appropriately in your brain. That means that what is useful to you from an experience will be learned, and stored with appropriate emotions in your brain, and be able to guide you in positive ways in the future. The inappropriate emotions, beliefs, and body sensations will be discarded. Negative emotions, feelings and behaviors are generally caused by unresolved earlier experiences that are pushing you in the wrong directions. The goal of EMDR therapy is to leave you with the emotions, understanding, and perspectives that will lead to healthy and useful behaviors and interactions.
Phase 1: History and Treatment Planning
Generally takes 1-2 sessions at the beginning of therapy, and can continue throughout the therapy, especially if new problems are revealed. In the first phase of EMDR treatment, the therapist takes a thorough history of the client and develops a treatment plan. This phase will include a discussion of the specific problem that has brought him into therapy, his behaviors stemming from that problem, and his symptoms. With this information, the therapist will develop a treatment plan that defines the specific targets on which to use EMDR. These targets include the event(s) from the past that created the problem, the present situations that cause distress, and the key skills or behaviors the client needs to learn for his future well-being. One of the unusual features of EMDR is that the person seeking treatment does not have to discuss any of his disturbing memories in detail.
Phase 2: Preparation
For most clients this will take only 1-3 sessions. For others, with a very traumatic background, or with certain diagnoses, a longer time may be necessary to create a sense of safety. Basically, your clinician will teach you some specific techniques so you can rapidly deal with any emotional disturbance that may arise. If you can do that, you are generally able to proceed to the next phase. One of the primary goals of the preparation phase is to establish a relationship of trust between the client and the therapist. During the Preparation Phase, the clinician will explain the theory of EMDR, how it is done, and what the person can expect during and after treatment. Finally, the clinician will teach the client a variety of relaxation techniques for calming himself/herself in the face of any emotional disturbance that may arise during or after a session. Learning these tools is important for everyone and especially and EMDR client. One goal of EMDR therapy is to make sure that the client learns self care, self soothing techniques and relaxation.
Phase 3: Assessment
Used to access each target in a controlled and standardized way so it can be effectively processed. Processing does not mean talking about it. The therapist identifies the aspects of the target to be processed. The first step is for the person to select a specific picture or scene from the target event (which was identified during Phase One) that best represents the memory. Then the client chooses a statement that expresses a negative self-belief associated with the event. Even if he intellectually knows that the statement is false. These negative beliefs are actually verbalizations of the disturbing emotions that still exist. Common negative cognitions are "I am helpless," " I am worthless," " I am unlovable," " I am dirty," " I am bad," etc. The client then picks a positive self-statement that he would rather believe. This statement should incorporate an internal sense of control such as "I am worthwhile/ lovable/ a good person/ in control" or "I can succeed." "I am in danger" can be considered a negative cognition, because the fear is inappropriate - it is locked in the nervous system, but the danger is actually past. The client will then be asked to rate the cognitions as well as identify any body sensations associated with these cognitions.
For a single trauma reprocessing is generally accomplished within 3 sessions. If it takes longer, you should see some improvement within that amount of time. Phases One through Three lay the groundwork for the comprehensive treatment and reprocessing of the specific targeted events. Although the eye movements (or taps, or tones) are used during the following three phases, they are only one component of a complex therapy. The use of the step-by-step eight-phase approach allows the experienced, trained EMDR clinician to maximize the treatment effects for the client in a logical and standardized fashion. It also allows both the client and the clinician to monitor the progress during every treatment session.
Phase 4: Desensitization
This phase focuses on the client's disturbing emotions and sensations as they are measured by the SUDs rating. This phase deals with all of the person's responses (including other memories, insights and associations that may arise) as the targeted event changes and its disturbing elements are resolved. This phase gives the opportunity to identify and resolve similar events that may have occurred and are associated with the target. During desensitization, the therapist leads the person in sets of eye movement (or other forms of stimulation) with appropriate shifts and changes of focus until his SUD-scale levels are reduced to zero (or 1 or 2 if this is more appropriate). Starting with the main target, the different associations to the memory are followed. For instance, a person may start with a horrific event and soon have other associations to it. The clinician will guide the client to a complete resolution of the target. Examples of sessions and a three-session transcript of a complete treatment can be found in F. Shapiro & M.S. Forrest (2004) EMDR. New York: Basic Books.
Phase 5: Installation
The goal is to concentrate on and increase the strength of the positive belief that the person has identified to replace his original negative belief. For example, the client might begin with a mental image of being beaten up by his father and a negative belief of "I am powerless." During the Desensitization Phase he will have reprocessed the terror of that childhood event and fully realized that as an adult he now has strength and choices he didn't have when he was young. During this fifth phase of treatment, his positive cognition, "I am now in control," will be strengthened and installed. How deeply the person believes his positive cognition is then measured using the Validity of Cognition (VOC) scale. The goal is for the person to accept the full truth of his positive self-statement at a level of 7 (completely true). Fortunately, just as EMDR cannot make anyone shed appropriate negative feelings, it cannot make the person believe anything positive that is not appropriate either. So if the person is aware that he actually needs to learn some new skill, such as self-defense training, in order to be truly in control of the situation, the validity of his positive belief will rise only to the corresponding level, such as a 5 or 6 on the VOC scale.
Phase 6: Body scan
After the positive cognition has been strengthened and installed, the therapist will ask the person to bring the original target event to mind and see if he notices any residual tension in his body. If so, these physical sensations are then targeted for reprocessing. Evaluations of thousands of EMDR sessions indicate that there is a physical response to unresolved thoughts. This finding has been supported by independent studies of memory indicating that when a person is negatively affected by trauma, information about the traumatic event is stored in motoric (or body systems) memory, rather than narrative memory, and retains the negative emotions and physical sensations of the original event. When that information is processed, however, it can then move to narrative (or verbalizable) memory and the body sensations and negative feelings associated with it disappear. Therefore, an EMDR session is not considered successful until the client can bring up the original target without feeling any body tension. Positive self-beliefs are important, but they have to be believed on more than just an intellectual level.
Phase 7: Closure
Ends every treatment session The Closure ensures that the person leaves at the end of each session feeling better than at the beginning. If the processing of the traumatic target event is not complete in a single session, the therapist will assist the person in using a variety of self-calming techniques in order to regain a sense of equilibrium. Throughout the EMDR session, the client has been in control (for instance, he is instructed that it is okay to raise his hand in the "stop" gesture at anytime) and it is important that the client continue to feel in control outside the therapist's office. He is also briefed on what to expect between sessions (some processing may continue, some new material may arise), how to use a journal to record these experiences, and which techniques he might use on his own to help him feel more calm.
Phase 8: Reevaluation
Opens every new session At the beginning of subsequent sessions, the therapist checks to make sure that the positive results (low SUDs, high VOC, no body tension) have been maintained, identifies any new areas that need treatment, and continues reprocessing the additional targets. The Reevaluation Phase guides the clinician through the treatment plans that are needed in order to deal with the client? s problems. As with any form of good therapy, the Reevaluation Phase is vital in order to determine the success of the treatment over time. Although clients may feel relief almost immediately with EMDR, it is as important to complete the eight phases of treatment.
Past, Present and Future
Although EMDR may produce results more rapidly than previous forms of therapy, speed is not the issue and it is important to remember that every client has different needs. For instance, one client may take weeks to establish sufficient feelings of trust (Phase Two), while another may proceed quickly through the first six phases of treatment only to reveal, then, something even more important that needs treatment. Also, treatment is not complete until EMDR therapy has focused on the past memories that are contributing to the problem, the present situations that are disturbing, and what skills the client may need for the future.
Above excerpt from: F. Shapiro & M.S. Forrest (2004) EMDR: The Breakthrough Therapy for Anxiety, Stress and Trauma. New York: BasicBooks.
Books about EMDR therapy found at Amazon.com
Calm and Confident: Overcome Stress and Anxiety With EMDR -Mark Grant. Two guided visualizations, soothing music, and EMDR combine to help listeners relax and feel more confident about dealing with stress and anxiety-producing situations. A instruction booklet included.
EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma -Francine Shapiro, & Margot Silk-Forrest. EMDR explained and includes many case histories.
EMDR: Transforming Trauma - Laurel Parnell. Basic EMDR information for the general public as well as psychotherapists. Dr.Parnell writes from a transpersonal perspective about her experiences with EMDR.
Small Wonders: Healing Childhood Trauma with EMDR - Joan Lovett, M.D. Collection of stories about children, adolescents and adults who have puzzling symptoms and anxiety. It offers therapists who treat children and do inner child work, a unique look at the EMDR process and valuable clinical histories. EMDR information is explained in a easily understandable way for clients. She is adept at integrating EMDR into multidimensional therapeutic contexts.
Helpful Books for EMDR Clinicians:
Finding the Energy to Heal: How EMDR, Hypnosis, TFT, Imagery, and Body-Focused Therapy Can Help Resolve Health Problems - Maggie Phillips. An excellent book for EMDR practitioners. The author explains concepts like positive image installation, positive target image, conflict free image, resource interweave, ego state therapy during EMDR without hypnosis, re-nurturing interweaves, developmental learning interweaves, concepts and procedures related to the safe place and safe place image, temporal resource interweaves, and many concepts and resources that can be useful to the EMDR clinician.
EMDR in the Treatment of Adults Abused as Children - Laurel Parnell, Ph.D
A Therapist's Guide to EMDR: Tools and Techniques for Successful Treatment. Laurel Parnell, PhD.
EMDR and Psychotherapy Integration: Theoretical and Clinical Suggestions With Focus on Traumatic Stress - Lipke, H. Lipke integrates EMDR practice with behavioral, dynamic, and humanistic psychotherapy.
EMDR Solutions: Pathways to Healing. Robin Shapiro
Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures - Francine Shapiro. Theoretical conceptualization of EMDR is outlined by Dr. Shapiro. Most of the information presented at the Level I and II EMDR trainings.
Eye Movement Desensitization Reprocessing EMDR) in Child and Adolescent Therapy - Ricky A. Greenwald, PsyD.
Extending EMDR: A Casebook of Innovative Applications - Philip Mansfield.
Healing the Divided Self: Clinical and Ericksonian Hypnotherapy for Post-Traumatic and Dissociative Conditions - Maggie Phillips & Claire Frederick. This book doesn't discuss EMDR, specifically but it does discusses Ego State Therapy as well as dissociation, hypnosis, and other relevant topics to EMDR Therapists.
Pain Control With EMDR - Mark Grant. Designed to minimize all kinds of pain, including chronic, postoperative, and migraine, the cassette and booklet contain two visualizations of pain-relieving imagery.(audio cassette)
Counselors, and Student Service Professionals - Kendall Johnson. This book is for the professionals who treat children and adolescents. The second edition includes information about the advances in the understanding of memory and Post-traumatic stress in children. Includes a chapter on EMDR therapy.
Transforming Trauma: EMDR: The Revolutionary New Therapy for Freeing the Mind, Clearing the Body, and Opening the Heart - Laurel Parnell, Ph.D. Dr. Parnell takes the reader into her own experience as a EMDR therapist and her clients abuse histories sharing how traumatic events frozen in time are released by using EMDR method.
Through the Eyes of a Child: EMDR with Children - Robert H. Tinker, Sandy A. Wilson, Robbie Dutton, Sandra D. Wilson. This books shows how EMDR can be successfully applied to helping children over come childhood trauma. The EMDR protocol is modified so it can be applied to children as young as two years old. There are many case examples including, phobias, auto accidents, breavement, ADHD, anxiety, depression and reactive attachment disorders and eating disorders.
Neurobiology & Attachment Books
The Developing Mind: Toward a Neurobiology of Interpersonal Experience - Daniel Siegel Skills Training Manual for Treating Borderline Personality Disorder - Marsha M. Linehan. DBT solutions and support for psychotherapists working with clients diagnosed with Borderline Personality Disorder
OTHER PROFESSIONAL SERVICES in addition to emdr therapy
Individual Therapy, Group Therapy, Relationship Counseling, Consulation, Supervision, EMDR + Adjunctive EMDR Therapy + Online Counseling Sessions
As an integrative psychotherapist, I'm delighted to offer a unique approach to emotional health and healing. My goal is to blend contemporary psychological practices, intuitive guidance and the wisdom of the ancient healing arts. The heart and soul of my approach is to help clients develop insight, self-awareness, self-acceptance, authenticity, self integration, respect for one's body, embodiment, healthy boundaries and self-care practices.
Psychotherapy For Adolescents + Adults
Individual adolescent and adult therapy is provided in my Manhattan office, and depending on client concerns, online using Skype or a HIPPA compliant platform. An initial consultation is the best way to determine if your particular needs and goals can be addressed using short-term or long-term psychotherapy. I have advanced post-graduate training in a variety of helpful techniques such as: EMDR Therapy, Cognitive Behavioral Therapy or CBT, Dialectical Behavior Therapy or DBT, Psychoanalytic Psychotherapy, Interpersonal Psychotherapy, Solution-Focused Therapy, Focusing, Gottman, Emotionally Focused Therapy or EFT and Mindfulness. After an initial assessment, I will give you my opinion, and together, we can discuss your needs and create a treatment plan. We will also consider the duration of treatment and the approach or combination that will serve your goals. I have expertise in anxiety and mood disorders, addictions, compulsions, eating disorders, relationship problems, sexuality, identity concerns, self-defeating patterns and self-sabbotage, lack of purpose, goal setting, spirituality, family of origin issues, trauma/PTSD, attachment issues, self-esteem, transitions, loss, wellness coaching and an integrative therapy approach that addresses chronic pain and medical challenges.
Coaching, Strategizing + Mentoring
Coaching is not therapy. Coaching clients are goal-oriented individuals who seek results in their lives. Hiring a coach who is skilled to uncover obstacles, as well as guide and support your "best self," is a powerful resource. Having support and guidance as you practice new behaviors can be incredibly helpful. Some individuals seek an expert "strategist" to guide efforts towards growth and change. Coaching unearths the stubborn and often hidden, negative self-concepts that keep people anchored in their present reality. Identifying these unhelpful concepts helps clients move forward. Often, a positive and renewed sense of energy will emerge as soon as one begins the coaching process. Partnering with a life coach can be supportive, encouraging and empowering, and can help clients navigate change, restoring or creating balance and fulfillment. Whether it’s taking control of one's health, losing weight, career issues, focusing on goal-attainment, repairing a relationship, getting "unstuck" or transitioning to a new chapter in life, coaching can provide the needed inspiration and support one desires. Working with a licensed trained psychotherapist can yield exceptional results. Therapists have the necessary skills and tools that can be used when longstanding and resistant patterns interfere with progress. I regularly offer EMDR for blocks and peak-performance enhancement, mindfulness, meditation techniques, solution-focused strategies or cognitive and behavior techniques to my clients, combined with coaching strategies to help "stuck" clients move forward.
Relationship Counseling + Couples Therapy
I've successfully worked with many couples who desire a healthier and more satisfying relationship. I work with many high-functioning couples who would like to enhance their relationship and reestablish intimacy and connection. I also work with individuals at various stages of relationships including: newly-formed relationships, couples seeking pre-marital counseling and guidance, new parents seeking support, those considering separation or divorce and the newly single and ready to date. I draw from attachment-based theory, helping couples understand their own attachment style as well as that of their partner. Clients can learn to communicate their needs and "hear" the needs of their partner, as well as develop a shared vision or goals, learn acceptance and compassion for self and the other, heal from infidelity and develop new skills. Clients also are guided to identify and de-escalate triggers, address sex and intimacy concerns and understand how the past and family of origin issues may be impacting the relationship in the present. I use my training from The Gottman Institute, as well as Emotionally Focused Therapy or EFT and Non-Violent Communication or NVC to support my work with couples.
EMDR Therapy + Brainspotting
As an EMDRIA-approved, level I + II trained EMDR therapist, I have enjoyed great success with clients using EMDR therapy for a variety of chronic, longstanding difficulties as well as recent traumatic incidents. EMDR psychotherapy can be a stand-alone treatment or integrated into ongoing talk therapy sessions to speed the healing process. As a New York City-based EMDR specialist, I provide trauma resolution for PTSD symptoms, and healing for attachment deficits, developmental traumas, medical trauma and chronic physical and emotional abuse. Additionally, EMDR is an effective therapy for anxiety, obsessions, phobias, compulsions, panic attacks, depression, self-esteem, eating disorders, addictions and more. For individuals with anxiety, emotion regulation problems and in addiction recovery, elements of EMDR therapy can help clients develop and strengthen self-soothing inner resources. A combination of EMDR and coaching is an effective treatment combination for sports and peak performance enhancement and creative and performance blocks. Brainspotting, another technique developed by David Grand, PhD, combined with EMDR psychotherapy is a technique I use to address attachment issues, unresolved trauma, pre-verbal trauma and performance problems.
Consultations + Referrals
I provide consultation sessions that are time-limited and problem or goal-focused. Some individuals and families consult with a mental health professional for educational purposes, a clinical assessment or diagnosis, a second opinion, help with a personal or life challenge, support for a difficult transition or crisis and to obtain resources to other collateral support such as psychiatrists or treatment facilities such as rehabs for addictions and eating disorders. Clinical consultations allow a client, parent or family member to explore concerns, probem-solve with a professional and make decisions or changes in their lives that move them forward when they feel unsupported or "stuck." I am delighted to share my trusted resources to complementary, alternative and conventional medical referrals in New York City and beyond. Consultations are not psychotherapy and can be done long distance using an online service such as Skype, Google, FaceTime or via telephone sessions.
Integrative Therapy-Coaching, Mindfulness, Stress Reduction + Self-Care Practices
My interest in mind-body techniques and complementary medicine has allowed me to journey to some amazing places including workshops and training opportunities. Using my training with the Urban Zen Foundation and my yoga therapy training (RYT 200 + 500 hours), I help clients address anxiety insomnia, stress, trauma and chronic illness using a combination of guided imagery, breathing techniques, body scans, meditation and mindfulness. I've studied aromatherapy and Reiki and still enjoy both, including self-Reiki and Reiki with clients, friends and family. Using the brilliance of neuroplasticity, western psychological theory, and the power of cutting-edge nutrition, yoga therapy, chakra work and other somatic psychotherapies, I truly enjoy helping clients who are open to these techniques heal on many levels. Together we can decide what would work best for your particular needs. Some examples of integrative therapy include: mindfulness training, lifestyle recommendations (nutrition, meditation, exercise, yoga and sleep), boundary work, creative play, journaling, somatic therapy and more.
Supervision + Private Practice Development
I enjoy helping new practitioners such as social workers, marriage and family therapists, licensed professional counselors, licensed mental health counselors and psychologists develop and build their private practices. I am happy to provide clinical supervision for cases, and I especially enjoy helping interested therapists blend mind-body medicine and complementary techniques into their existing psychotherapy practices.
Psychotherapy, Coaching + Consultation Services
- Depression and mood disorders
- Anxiety and compulsive disorders
- Eating disorders, emotional eating and body image issues
- Borderline Personality Disorder BPD
- Adolescents problems (behavioral, emotional, family, academic challenges)
- Marriage, couples, relationship problems
- Celebrity, gifted and talented individuals
- Grief, loss, bereavement, life transitions
- Attention Deficit Disorder (ADD), Attention Deficit Hyperactive Disorder (ADHD)
- Addictions, drug addiction, process addictions, substance abuse, behavioral disorders, alcoholism
- Sexual addiction
- Adult survivors of abuse
- Adult children of alcoholics (ACOA)
- Dissociation, complex PTSD, emotion regulation difficulties
- Childhood, developmental trauma, traumatic events, accidents, medical trauma
- Self-harm, Self-sabatage, self-defeating behaviors
- Self-esteem issues, negative self-concept
- Performance blocks using EMDR therapy
- Surviving and managing relationships with borderline or narcissistic individuals or partners
- Men’s issues, career concerns, sexual difficulties, work/life balance
- Women’s issues, career concerns, transitions, parenting, caretaking, hormone imbalance
- Environmental stressors, crisis management
- Phase of life issues, aging
- Sexual and relationship issues for individuals and couples
- LGBT concerns, alternative lifestyles
- Work, creativity and career issues
- Life purpose, existential, spiritual concerns
- Individual, couples, marital, family, group therapy
- Weekend intensive workshops for couples
- Coordination of services with school, medical practitioners, legal counsel, etc
- Consultation and evaluation for potential in-patient residential treatment
- Parent and new parent education, coaching
- Addiction evaluations, assessments, referrals to medical and allied professionals in New York City and beyond
- Executive coaching
- Peak performance coaching
- Clinical supervision, private practice building business, consulting
- Presentations, workshops
- Mindfulness, meditation instruction, stress management
- Recovery support for individuals including their families.
- Self-care, well-being, burnout support and coaching
- Psychodynamic, relational, interpersonal psychotherapy
- Mindfulness, meditation support
- EMDR therapy
- Focusing techniques
- Crisis counseling
- Short-term, goal-oriented therapy
- DBT skills
- Marriage and relationships
- Clinical supervision
- Online via telephone, Skype, FaceTime or a HIPPA compliant service
Helpful information About An Integrative Psychotherapy Practice
Psychodynamic psychotherapy is an evidence-based and active therapy that has a long history and tradition used in both short and long-term treatment. Psychodynamic sessions include the process of increasing self-awareness, encouraging self-expression, understanding conflicts, developing insight into the behaviors of self and other, unearthing unconscious content that can interfere with functioning and understanding patterns and dynamics that may have origins in the past but are played out in the "here and now." This form of therapy uses the relationship between patient and therapist to heal. The interpersonal relationship tends to be the focus of sessions as an active example of other relationships in the patient's life, so that patterns and distress can be "worked through" and not repeated outside of treatment.
CBT or Cognitive Behavioral Therapy
Cognitive Behavioral Therapy focuses on examining and changing maladaptive thoughts and behaviors. CBT tends to be a short-term approach that is highly-effective for many with empirically-tested techniques supporting an increase in skills and a change in behaviors. CBT is an effective solution for a variety of concerns including anxiety, depression and addictions/substance abuse.
DBT or Dialectical Behavior Therapy
DBT was originally developed for the treatment of Borderline Personality Disorder. With time, DBT skills and techniques have been found to be helpful for individuals who struggle in many areas of life including substance abuse and addictions. DBT treatment combines ideas of awareness, acceptance and change and mindfulness with a range of psychological theories. Because DBT skills are practical and can be generalized into many areas of life, DBT can be successfully integrated into treatment plans and used in a variety of treatment settings. DBT uses mindfulness and other skills to help increase emotion regulation, distress tolerance and interpersonal effectiveness with the goal of helping patient's cope, de-escalate, and self-regulate.
Acceptance and Commitment Therapy
Acceptance and Commitment Therapy (ACT) gets it name from one of its core messages which is to accept what is out of your personal control, while committing to action that will improve the quality of life. The goal of ACT is to help people create a full and meaningful life even and especially when the stress and pain of life is a challenge. ACT teaches the psychological skills to manage painful feelings and thoughts in an effort to reduce the impact of suffering. Another aim is to help individuals clarify what is important and meaningful, using that awareness to guide, motivate and inspire them to make important changes that will lead to a better life. ACT supports cognitive flexibility in addition to encouraging individuals to observe and allow difficult thoughts feelings, emotions and experiences to simply occur. ACT also helps patients identify concrete short and long-term goals.
Mindfulness is the practice of moment-to-moment awareness of feelings, thoughts and bodily sensations as well as an awareness of the environment and one's surroundings. Mindfulness, as a philosophy, has more recently become a widely-used and helpful practice in the fields of psychology and psychotherapy. Additionally, mindfulness is an empirically-validated practice with data that supports its efficacy and application in a range of clinical and non-clinical settings. A mindfulness practice includes the observation of feelings, emotions and sensations, a non-judgmental presence and the awareness of the present moment.
EMDR is an evidence-based treatment that targets many symptoms and conditions including trauma, negative memories, phobias, fears, anxiety, addictions, compulsions and performance difficulties. Originally used to treat Veterans, EMDR therapy is now one of the most efficient and effective trauma/symptom treatment methods that allows clients to fully heal from their psychological wounds. EMDR can successfully be integrated into psychotherapy sessions. Many clients find EMDR to be more effective than other forms of therapy including CBT and traditional “talk therapy.”
Psychotherapy for Depression
Clinical depression is a complicated condition that can be treated with interpersonal psychotherapy, medication and a collaborative approach to identify the biological and psychosocial factors that may have contributed to a patient's depressive symptoms. Depression can be mild and show up with seasonal changes and it can be debilitating and interfere with activities of daily living, life skills, relationships, employment, hope and may also include the desire to end one’s life. Depression treatment is generally supportive in nature, and may require help with daily structure and coping skills and often requires working with other mental health professionals. Interpersonal psychotherapy, CBT and EMDR therapy can be effective treatments for depressed patients as can antidepressant use, light therapy, vitamin D and supplements.
Psychotherapy for Anxiety
Anxiety symptoms bring many into therapy for the first time. Not all clients experience anxiety in the same way. For some, anxiety is a distress that presents in a specific situation such as performance, public speaking or test-taking. For others, anxiety may be experienced as chronic and ranging from mild to debilitating, including uncomfortable physical symptoms. Anxiety sufferers are best helped by understanding emotional conflicts, environmental and genetic factors with treatment that may include talk therapy, CBT, stress reduction techniques, Somatic Experiencing (SE) and EMDR Therapy to target early trauma, memories and present-day distress.
Trauma Treatment and PTSD
Early trauma and chronic developmental traumas that have impacted a patient's development and attachment relationships are the most difficult to heal. Psychotherapy can help validate the patient's experience, work through any feelings of shame and confusion that may have been internalized, process the traumatic experience or event and help them understand how their current life is impacted by traumatic experiences. Psychotherapy can help individuals identify triggers in daily experiences that create symptoms and contribute to familiar self-defeating patterns and dynamics. While talk therapy can be a good place to begin for some trauma patients, EMDR is the treatment of choice to provide symptomatic relief and truly heal from trauma.
Loss and Bereavement
Losing something or someone is difficult and complicated for many reasons. Loss can include a loved-one, pet, health, job, lifestyle, home, identity, status, and more. Loss, especially when significant to the individual, requires mourning and grieving that loss, experiencing the associated feelings, and eventually, moving forward. Psychotherapy can give the individual a safe place to grieve and feel the sadness. The healing process is different for everyone as is the length of time required to heal.
What happens in therapy?
A number of benefits are available when you engage in the therapy process. Therapy helps people gain relief from unpleasant feelings and thoughts, create more fulfilling and meaningful relationships, and gain more pleasure and control in their lives. Psychotherapy helps clients get to the root of their difficulties and learn ways to become more self-aware, cope with difficult emotions, improve mood, gain control, feel connected to others, develop the skills to handle future problems, and live more fulfilling and satisfying lives. Therapists can provide support, practical problem-solving skills, and enhanced coping strategies for issues such as: troubling patterns and behaviors. a crisis, managing difficult people, internal conflicts, neurosis, life transitions, anxiety, depression, sadness, loneliness self-esteem, relationship problems, unresolved childhood issues, trauma/abuse, grief, stress management, body image issues, eating disorders, feeling lost or stuck, sexuality or identity concerns, addictive behaviors and creative blocks. Many people also find that counselors or psychotherapists can be a tremendous asset to career concerns, managing personal growth, professional relationships, family concerns, marriage issues, parenting challenges, developing healthier habits, connecting to the body, understanding thoughts, feelings and emotions, balancing the stress of daily life and goal-setting. High-achieving, successful individuals often experience emptiness, unhappiness, disappointment, loneliness, stress, anxiety and interpersonal problems which may lead to less than desirable coping solutions such as addictions, alcohol and drug abuse, eating problems and sleep deficits. Therapists can provide a fresh perspective on a difficult problem or help their clients discover helpful solutions. Many lasting benefits can be obtained from personal, couples or group therapy. You can learn more about therapy from the American Psychological Association or APA Learn more here
Therapy and counseling can help clients with the following issues:
- Reframe current life circumstances and gain a different perspective
- Learn to manage difficult work and personal transitions and changes such as marriage, new baby, mid-life problems and aging
- Gain the support needed to get through difficult times such as loss and change
- Learn to feel and live a more authentic life, accept feelings of being “different”
- Develop healthy self-esteem and resolve persistent negative self-states
- Develop healthier coping skills, habits and boundaries
- Have healthier personal and work relationships
- Develop awareness of any repetitive patterns that interfere with success and happiness by understanding how past dynamics interfere with the present
- Manage difficult people personally and professionally
- Develop a path of purpose and life fulfillment
- Heal from past trauma and abuse and process traumatic memories and dissociation
- Increase insight and self-awareness and identify innate strengths
- Improve communication, learn conflict resolution, develop better listening and self-assertion skills
- Address depression, sadness, feelings of despair and isolation
- Learn helpful coping skills for stress, anxiety, phobias and panic attacks
- Relieve stress and insomnia and learn relaxation response
- Manage destructive patterns that include drinking, eating, drugs, addictions and self-harm
- Understand negative and habitual patterns of thinking and behaving
- Resolve writing, creative and other performance blocks
- Mourn losses such as separation, divorce, miscarriage, infertility or the death of a loved-one
- Develop effective parenting skills
- Address problems related to chronic pain, fibromyalgia, autoimmune disorders, medical procedures and diagnoses
- Heal from sexual abuse, emotional/psychological abuse, domestic violence and natural disasters
- Resolve sexual and identity concerns
- Manage feelings of overwhelm, feel more embodied and develop an awareness connection between mind and body, feel more
What can I expect?
If you're considering therapy now, then you're experiencing challenges in your own life or with others. Psychotherapy is not like sharing problems with a trusted friend. It involves looking closely at yourself, your situation and the people around you. This can feel difficult and scary, but therapy with a trained therapist can help people find solutions to problems, relieve distressing symptoms such as anxiety and depression, support good mental and physical health, promote integrity and honesty and help individuals develop intimacy in relationships. Reaching your full potential, understanding yourself and others and removing barriers to happiness and fulfillment are but a few goals of successful, effective therapy. Even though you may have good friends and family members to talk to, a psychotherapist or psychologist with professional training is able to see things from a different lens and even challenge and support you in ways that the people in your life cannot.
How do I know what to look for in a therapist?
When you choose a therapist, you should feel understood and not judged for the concerns that led you to seek counseling. You should feel comfortable sharing your thoughts and feelings with your potential therapist as the process requires an investment of time and emotional energy. Your therapist should have good interpersonal skills as well as empathy and compassion. You should choose a therapist who has training in the areas that you are seeking help with. Some therapists have received specialized training in areas such as trauma, addictions or eating disorders. If your problems are serious enough to impact the quality of your life and your ability to function, you may need to find a specialist or someone who specializes in your particular problem. Many therapists have received general psychotherapy training and consider themselves generalists and are able to treat a range of difficulties. Some psychotherapists have received specialized training in addition to graduate school. This article in Psychology Today explains the process as well as list important qualities to look for in a therapist.
How long will I need to be in therapy?
Your personal needs and goals are always a priority, and will shape the time you spend in sessions. Many individuals desire focused, structured and time-limited sessions with a clear plan targeting specific problems or goals that can be met within a relatively short period of time, while other difficulties require a more intensive focus and may take longer to resolve. This is especially true when people have been struggling for a long time and patterns and habits are rigid and entrenched. Some will do best with once or twice weekly sessions that are consistent—this process allows clients to examine patterns and dynamics that may interfere with healthy functioning.
What kind of therapy should I be looking for?
Increasing insight into problems and self-awareness is one goal of therapy, but unfortunately, that alone does not always lead to the desired change. For this reason, and with certain clients, it may be necessary to implement behavioral changes and track progress between sessions. Some clients need targeted, specific types of therapies that resolve symptoms related to trauma. The duration of treatment is highly variable and depends on many factors, including: the nature of the problem, client motivation and having realistic goals for change. Depending on client needs, one may benefit from a number of different therapeutic strategies and techniques. In your initial consultation, you should work with your therapist to figure out the best approach for you. Therapists may use or combine the following approaches: psychoanalysis, psychodynamic psychotherapy, interpersonal, humanistic, gestalt, Emotion-Focused Therapy [EFT] and relational as well as evidence-based therapies such as EMDR therapy, Somatic Experiencing (SE), Dialectical Behavior Therapy or DBT, Cognitive Behavioral Therapy or CBT to name a few.
Are my sessions confidential?
It is important to know that everything you say during psychotherapy sessions will be kept confidential. The only exceptions are when there is a danger that you may harm yourself or someone else, or in active cases of abuse. Mental health professionals are obligated by law to disclose that information to the appropriate authorities. These situations are rare. Most people find it a great relief to have a safe place where they are able to share what's on their mind with a non-judgmental, supportive and trained professional.