Show Notes
Many clients with complex trauma will come to us convinced that they have already failed mindfulness and that they are about to fail EMDR. Some of the approaches that I have seen to teaching mindfulness to clients assume a non-pervasively traumatized nervous system. Which is simply something we should not assume. Many approaches throw the client into the deep end of the present, the body, or noticing without much preparation or guidance almost as though they are running every client through the same mindfulness machine. How we approach a client system with severe trauma needs to be different than how we approach a system that relatively healthy. Our interventions should match the client we are working with. So, maybe the problem isn’t that many clients simply can’t do mindfulness. Maybe they can’t do it the way we have been teaching it.
Complex trauma is not a special case. It’s nearly the only case we see in community mental health contexts globally. A large percentage of pervasively traumatized clients struggle with even the most basic forms of mindfulness for reasons that we will explore, but also because of how we teach it. And, the easiest thing to change in this equation is how we teach it. Even in EMDR Therapy, the assumption that “Ok, now we’re in Phase Two and I’m going to teach you these resources so that you can calm down when you get activated.” This is true, but do you hear the therapist agenda in the way we may be introducing it? As you will see, when we are working with clients with extreme trauma what we are looking for is information about the client’s nervous system and not necessarily the relaxation response. I want to show you how to use that information that surfaces in the service of the client’s recovery.
What We are Asking Clients to Do in Mindfulness Feels Like it Goes Against Common Survival Strategies
The Present
Bodies
Noticing
The Mind is Taxed with Survival Tasks
There is Performance Anxiety in What they Know We’re about to Ask
Add to all of these things the performance anxiety of trying a skill focused on these places of discomfort and knowing that the therapist is going to ask them about their experience with it. These are clients that are accustomed to being what other people need them to be and performance anxiety associated with “Is this working?” “Am I doing this right?” “What does it mean that I don’t find this relaxing?” Etc.
Step One of One Way to Do this Differently: Normalize the Difficulties
Normalize the difficulty using all of the information above and all of the information you have learned about the client’s survival. You know how to do that. Do it. “Of course mindfulness and the way we have been approaching it hasn’t worked well for you. Would you be interested trying this differently?”
Step Two of One Way to Do this Differently: Appreciate the Role of Parts and Get Consent
Step Three of One Way to Do This Differently: “Dip Your Toe In” by Decreasing Exposure Time
Step Four of One Way to Do This Differently: We’re Not Necessarily Looking for Something that is Calming
Step Five of One Way to Do This Differently: Recalibrate what “Working for Me” Means—The Car Metaphor
Step Six of One Way to Do This Differently: Bridge Resources
Step Seven of One Way to Do This Differently: Send Clients Home to Practice at their Baseline, Not When Triggered
Putting It All Together
And while there are a lot of other ways to do the same types of things, what we don’t want to do is simply pronounce that the client isn’t ready. We need to meet them where they are with modifications and accommodations. Otherwise the client will die not ready. We need to identify the difficulties, work on them every session and between sessions until they are prepared enough for trauma reprocessing.
More from The EMDR Podcast
Helping the Predictive Brain Update Bad Memories Turns out, the story that we’ve been telling ourselves about the neurobiology of trauma doesn’t make sense anymore based on what we have learned the past twenty-five years about brain evolution, function, structure, memory reconsolidation, neuroplasticity, and the predictive brain. How we understand perception of our external world and internal worlds and has changed profoundly. There is growing consensus around the core idea that our nervous system is predicting and constructing our reality for us. And while this has some really disturbing implications related to things like our felt sense of free will and our illusion of objective observation, it has potentially remarkable implications for how humans might heal. Predictive processing might be able to do what no other theory of mind has: explain how we construct reality and possibly even our own selves. Central to this understanding is the role that prediction error plays at all levels of abstraction. And for the purposes of what I’m talking about now, the vast majority of predictions and prediction errors occur outside of direct consciousness and awareness. Prediction errors are central to perception, memory formation, learning, movement of all types, and every experience imaginable. We can think of consciousness, awareness, experience, and our own identities as floating on top of our predictive system the way a foam mat floats in a pool.
When Complex Clients Insist on Doing EMDR Processing Immediately
Full text of this podcast is at the EMDR Podcast and EMDR365.com
EMDR Therapy shifts how you think about yourself and the world related to the memory we are working on. Why does it do this? Because that’s a lot of what healing is. Healing shifts how you think about yourself and the world, as well as lots of other things. Wounding is experiential learning and vast regions of our nervous system are organized around meaning-making in the foreground, midground, and background. Healing is also experiential learning. Broadly, in EMDR therapy and other transformational trauma therapies, it is not that difficult to help clients shift an individual memory and the cognitions associated with it.