An EMDR Therapy Primer: From Practicum to Practice

by Barbara J. Hensley PhD

Overview

"With this Second Edition of An EMDR Therapy Primer, Dr. Hensley has created a very clear step-by-step guide to assist the newly trained EMDR clinician. Not only will it help transition training into practice but also help those trained earlier who are looking to update their skills. I highly recommend this book for any EMDR clinician wanting to assure fidelity to the model and methods." —Rosalie Thomas, RN, PhD

"I believe that Dr. Hensley has written a book that is simple, basic, and can mentor therapists who are EMDR trained and yet intimidated.This book brings us back to the basics." - Jennifer Lendl, PhD

This is a step-by-step overview of the foundations of EMDR Therapy presented in easily accessible, conversational language. It helps both new and experienced clinicians to maximize their preparation and skills in using EMDR safely, confidently, and effectively. The second edition is fully revised to reflect the evolution of EMDR to an integrative psychotherapeutic approach and is intended for use as a companion to Francine Shapiroís seminal EMDR texts. It has been enriched with several new case histories along with extensive examples of successful EMDR reprocessing sessions. An abundance of new information addresses EMD versus EMDR; research on the mechanism, model, and methodology of EMDR Therapy; bilateral stimulation; ancillary targets; the why and the how of many key EMDR Therapy components; protocol for single and recent traumatic events; updated information about the cognitive interweave, future templates; and much, much more.

The book provides concise coverage of the AIP model and EMDR principles, protocols, and procedures and addresses the types of targets accessed during the EMDR process. The book summarizes the Eight Phases of EMDR Therapy and the Stepping Stones of Adaptive Resolution the components of the standard EMDR protocol. The building blocks of EMDR Therapy past, present, and future are assessed with regard to appropriate targeting and successful outcomes, as are abreactions, blocked processing, and cognitive interweaves. Detailed case studies demonstrate strategies to assist the client in reaching adaptive resolution of trauma.

New to the Second Edition:

• Completely revised and updated
• Reflects the evolution of EMDR to an integrative therapeutic approach
• Expands specialized EMDR techniques
• Includes new strategies to overcome obstacles
• Presents new transcripts and case studies
• Provides "Derailment Possibilities" to alert clinicians of potential obstacles to therapeutic success
• Extensive appendices include definitions for EMDR Therapy, EMDR Therapy scripts, and additional resources

Product Details

ISBN-13:	9780826194558
Publisher:	Springer Publishing Company
Publication date:	07/28/2015
Sold by:	Barnes & Noble
Format:	eBook
Pages:	520
File size:	5 MB

About the Author

Barbara J. Hensley, EdD, is a Clinical Counselor in Cincinnati, Ohio and a Board-Certified Diplomate for the American Academy of Experts in Traumatic Stress. She served on the EMDR International Association Board of Directors as President and Treasurer and has represented EMDRIA in Stockholm, Sweden, and Brussels, Belgium.

Table of Contents

"

Barbara J. Hensley, EdD, is a Clinical Counselor in Cincinnati, Ohio, and a Board-Certified Diplomate for the American Academy of Experts in Traumatic Stress. She served on the EMDR International Association Board of Directors as President and Treasurer and has represented EMDRIA in Stockholm, Sweden, and Brussels, Belgium. She is currently a board member for the EMDR Research Foundation.

Dr. Hensley is an EMDRIA Certified Therapist and Approved Consultant and Regional Coordinator for the Greater Cincinnati EMDR Regional Network. For the past 17 years, she has been a facilitator and logistician for EMDR trainings in Japan and throughout the United States and has served as a facilitator for Trauma Recovery/EMDR-HAP.

She is the creator of the Francine Shapiro Library, an online resource of EMDR research and writings. She is also the 2009 recipient of the distinguished Francine Shapiro Award for her extraordinary service and contributions to EMDR. Dr. Hensley is the co-founder of the Cincinnati Trauma Connection in Cincinnati, Ohio, an EMDR-based trauma center.

Contents

Foreword

Preface

Notes From the Author

Contributing Editors

Acknowledgments

1. EMDR Therapy Overview

Reintroduction to EMDR Therapy

Trauma

What Is Trauma?

Types of Trauma

Adaptive Information Processing—“The Past Drives the Present”

Model, Methodology, and Mechanism of EMDR Therapy

Model—How?

Methodology—How/What?

Mechanism—Why?

Three-Pronged Approach

Past, Present, Future

Three-Pronged Targets—Experiential Contributors to Present-Day Problems

The Importance of Past, Present, and Future in EMDR Therapy

Targeting Possibilities

Targets May Arise in Any Part of the EMDR Therapy Process

Targets From the Past

Targets From the Present

Targets From the Future

Other Potential Targets

Bilateral Stimulation (BLS)

What Does It Do?

Preferred Means of Bilateral Stimulation (BLS)

Shorter or Longer? Slower or Faster?

Continuous Bilateral Stimulation (BLS)

How to Do Eye Movements

Is Bilateral Stimulation (BLS) EMDR Therapy?

Important Concepts to Consider

Memory Network Associations

Stop Signal

EMDR Therapy Is Not Hypnosis

What Once Was Adaptive Becomes Maladaptive

Developing and Enhancing Adaptive Networks of Association

State vs. Trait Change

Dual Awareness—Internal/External Balance

Ecological Validity (i.e., Soundness)

Side Benefits of EMDR Therapy

Holistic Nature of the Approach

Useful Metaphors

Train Metaphor

Tunnel Metaphor

Ancillary Targets

Secondary Gains

Blocking Beliefs

Subjective Units of Disturbance (SUD) and the Emergence of Blocking Beliefs

Validity of Cognition (VoC) and the Emergence of Blocking Beliefs

Body Scan and the Emergence of Blocking Beliefs

Feeder Memories

To Intervene or Not to Intervene

EMD vs. EMDR Therapy

Assessment Phase

Desensitization Phase

Practical Tips to Remember

Practice, Practice, Practice

Follow the Script Verbatim

Know Your Client

Stay Off the Tracks

Tracking the Client

Power of Now

One More Time

Solo Run

Summary Statements

2. Eight Phases of EMDR Therapy

Phase 1: Client History and Treatment Planning

Informed Consent and Suitability for Treatment

Client Selection Criteria

Client’s Suitability and Readiness for EMDR Therapy

Screening for Dissociative Disorders

Client Willingness to Do EMDR Therapy

Assessment

Treatment Planning in EMDR Therapy

Elements Pertinent to EMDR Therapy

Candidates for EMDR Therapy

               Case Example 2A: Isabella

               Case Example 2B: Marie

Phase 2: Preparation

Setting the Stage for Effective Reprocessing

               Maintaining a Safe Therapeutic Environment

               Explanation of the EMDR Process and Its Effects

               Calm (Safe) Place and Other Coping Strategies

Calm (Safe) Place—Stabilization and Assessment

Resource Development and Installation (RDI), Dissociation, and Ego State Therapy

               Resource Development and Installation (RDI)

               What Is Dissociation?

               Ego State Therapy

Container

Addressing the Client’s Fears and Expectations

               Client Expectations

               Client Fears

Mechanics of EMDR Therapy

               Seating Arrangement

               Range, Distance, Speed, Direction, and Number of BLS Sets

Phase 3: Assessment

Identify, Assess, and Measure

               Identifying the Target

               Identifying the Image

               Assessing the Negative and Positive Cognitions, Emotions, and Location of the Physical Sensations

Measuring the VoC and the SUD

Phase 4: Desensitization

What About Reprocessing?

Purpose of the Desensitization Phase

Associative Processing

Evaluating Channels of Association

End of Channel?

When to Return to Target?

What to Do If the Subjective Units of Disturbance (SUD) Becomes Stuck

How Long Does It Last?

When to Proceed to the Installation Phase?

Taking a Break

Phase 5: Installation

What Occurs?

Evaluate Appropriateness of Original Cognition

Validity of the Positive Cognition

Link to Original Target

When Is Installation Complete?

How to Discern the Presence of a Blocking Belief

Phase 6: Body Scan

Phase 7: Closure

Levels of Closure

Strategies for Closing Sessions

               Completed Session

               Incomplete Session

Assessment of Client’s Safety

What Can Happen After a Session?

Phase 8: Reevaluation

What Has Changed and What Is Left to Do?

Resuming Reprocessing in an Incomplete Session

Reevaluation of Treatment Effects

Reevaluation and Treatment Planning

Final Reevaluation Stage

Pivotal Points in the Reevaluation Phase

Summary Statements

3. Stepping Stones to Adaptive Resolution

Assessment Phase

Back to Basics

How Much Do You Need to Know?

Target Assessment

Effective EMDR Therapy Equals Effective Targeting

Characteristics of Effective Targets

How Is the Memory Encoded?

               Case Example 3A: Jennifer

Appropriateness of the Target

Elements of Negative and Positive Cognitions

What Is a Cognition?

Teasing Out Negative and Positive Cognitions

Informational (Cognitive and Emotional) Plateaus

Assessment of the Validity of Cognition (VoC)

VoC Scale

Assessment of Emotions

Emotion

Assessment of Current Level of Disturbance

Subjective Units of Disturbance (SUD) Scale

Assessment of Physical Sensations

Body Sensations

Case Examples

Case Example 3B: Terry

Case Example 3C: Mariko

Case Example 3D: Geraldo

Case Example 3E: Henri

Recent Traumatic Events and Single-Incident Traumas

Recent Traumatic Events Protocol

               Case Example 3F: Patrick

               Caveats When Using the Recent Traumatic Events Protocol

               How Do You Know When Its Use Is Appropriate?

Single-Incident Traumas

Single Traumatic Event Protocol

               Case Example 3G: Rayshawn

Treatment Planning Guide (TPG)

Summary Statements

4. Building Blocks of EMDR Therapy

EMDR Therapy Is a Three-Pronged Approach

Building Blocks of EMDR Therapy: Past, Present, and Future

Clinical Presentation Possibilities

Single Incident Presentations

Single Dominant Issue/Symptom Presentations

Multiple Issues/Symptoms Presentations

Vague or Diffuse Presentations

Complex Posttraumatic Stress Disorder (C-PTSD)

First Prong: Earlier Memories/Touchstone Events

Touchstone Event

Strategies for Accessing the Touchstone Memory

               Direct Questioning

               Floatback Technique

               Affect Scan

               Case Example 4A: Betty

               

               Identifying the Touchstone Event Using Affect Scan

Touchstone Revisited

Second Prong: Present Events and Triggers

What to Look Out For

How Can Triggers Remain Active After So Much Processing?

               Case Example 4B: Peter

Assessment

Desensitization

Installation

Body Scan

Closure

Present Triggers Subsumed by the Reprocessing of the Touchstone Event

Third Prong: Future Events and Future Templates

Goals of the Future Template

Skills Building and Imaginal Rehearsal

Steps Needed Prior to Creating a Positive Template

Procedural Steps for Installing Future Templates: Desired Outcomes and Problem-Solving Situations

               Desired Outcomes

Problem-Solving Situations

Third Prong: Misunderstood, Disregarded, and Forgotten

Future Template—Examples

               Case Example 4C: Michael

Desired Outcome

Problem-Solving Situation

Modifications of the Three-Pronged Approach

Summary Statements

5. Abreactions, Blocked Processing, and Cognitive Interweaves

When the Engine Has Stalled

Stalled Processing

Abreaction

What Is It?

Preparing the Client for Abreactions

What Happens When a Client Abreacts?

Abreaction Guidelines

Strategies for Maintaining Processing

Overresponders and Underresponders: Guidelines for Clients Who Display Too Little or Too Much Emotion

Cautionary Note

Returning to Target Too Soon?

Blocked Processing

Identifying Blocked Processing

Primary Targets for Blocked Processing

Ancillary Targets for Blocked Processing

The Art of the Cognitive Interweave

What Is a Cognitive Interweave?

Using a Cognitive Interweave Effectively

When to Use a Cognitive Interweave

               Case Example 5A: Renee

Choices of Cognitive Interweaves

               Case Example 5A: Renee (Continued)

Comparison Between Strategies for Blocked Processing and Cognitive Interweaves

Responsibility/Defectiveness, Safety/Vulnerability, and Power/Control (or Choice)

Responsibility/Defectiveness Interweaves

Safety/Vulnerability Interweaves

Power/Control (or Choice) Interweaves

               Case Example 5B: Susie

Responsibility/Defectiveness

Safety/Vulnerability

Power/Control (or Choice)

Use the Cognitive Interweave With Complex Trauma

Summary Statements

6. Past, Present, and Future

EMDR Therapy Case Examples

Questions

Past

               Case Example 6A: Airi

               Case Example 6B: Karen

Present

               Case Example 6C: Delores

               Case Example 6D: Breanna

Future

Future Template—Desired Outcome/Problem Solving

Future Template—Anticipatory Anxiety

               Case Example 6E: Jimmy

Use of the Cognitive Interweave Demonstrated

               Case Example 6F: Kevin

Use of Eye Movement Desensitization (EMD)

               Case Example 6G: Harlan

Derailment Possibilities

Summary

Conclusion

Appendices

Appendix A: Definition of EMDR

For Clinicians

For Laypeople

Treatment Description

               Phase 1

               Phase 2

               Phases 3 to 6

               Phase 7

               Phase 8

EMDRIA Definition of EMDR

Appendix B: Exercises

Grounding

Grounding Exercise

Diaphragmatic Breathing

Breathing Exercise

Chin Mudrā as an Alternative to Teaching Client Diaphragmatic Breathing

Anchoring in the Present

Calm (Safe) Place

Identify the Image

Identify the Associated Emotions and Sensations

Enhancing the Sensations

Establishing a Cue Word

Self-Cuing Instruction

Cuing With Disturbance

Self-Cuing With Disturbance

Sacred Space

Grounding the Client in the Moment

Finding Sacred Space

Preparing the Sacred Space

Getting Comfortable in Sacred Space

Preparing the Way for Wisdom’s (or Guidance’s) Message

Listening for Wisdom’s (or Guidance’s) Message

Closing the Sacred Space

Appendix C: EMDR Therapy Scripts

Resource Development Steps—Affect Management and Behavior Change

Container Exercise

Breathing Shift

Spiral Technique

Lightstream Technique

Lightstream Transcript

Future Template

Future Template Script

Introduction

Steps for Recent Traumatic Events Protocol

TICES Log

Treatment Planning Guide

Presenting Issues

Treatment Planning Guide (TPG) Script

               Presenting Issue (Complaint)

               Incident

               Negative Belief

               Positive Belief

               First Incident (Touchstone Memory)

               Worst Incident

               Other Incidents

               Future Desired Outcomes

Treatment Plan

Cautionary Note

Symptom Reduction vs. Comprehensive Treatment?

Phobia (and Anxiety) Protocol

Steps for Processing Phobias

Appendix D: Informed Consent and EMDR Therapy

Appendix E: EMDR Therapy–Related Resources

EMDRIA, EMDR Research Foundation, Trauma Recovery/EMDR-HAP, and the EMDR Institute: What Is the Difference?

EMDR International Association (EMDRIA)

EMDR Research Foundation (ERF)

Trauma Recovery/EMDR-HAP

EMDR Institute, Inc.

Francine Shapiro Library (FSL)

Resource Development and Installation (RDI)

Dissociative Disorders

Clinical Signs and Symptoms of Dissociative Disorders

Dissociative Experiences Scale (DES)

Scoring the DES

Interpreting the DES

Ego State Therapy

Schema Therapy

Appendix F: Efficacy of EMDR Therapy

Appendix G: History of EMDR Therapy

Glossary

References

Index

"

Editorial Reviews

Reviewer: Gary B Kaniuk, PsyD (Cermak Health Services)
Description: This volume serves as an introduction to EMDR (eye movement desensitization and reprocessing) therapy. It explores theoretical underpinnings, techniques, various phases, and difficult issues in the therapeutic process. This is the third edition, after the second was published in 2015.
Purpose: According to the book, "Barbara Hensley's book, An EMDR Therapy Primer: From Practicum to Practice, is written as a primer and companion to Francine Shapiro's EMDR text. It is a step-by-step overview of the foundations of EMDR therapy presented in easily accessible, conventional language, and helps both new and experienced clinicians to maximize their preparation and skills in using EMDR safely, confidently, and effectively." These are very worthy objectives. The book meets the stated objectives.
Audience: According to the book, "a goal of this primer is to target those clinicians who have completed the EMDR therapy two-part basic training, 10 hours of supervised consultation, and have read Dr. Shapiro's basic texts (Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures, 3rd edition (2018) and Getting Past Your Past (2012)), but still want additional information on using it skillfully" (p. xxiv). I agree with the target audience described above and the book meets the needs of its intended audience. The editor is a credible authority in the subject matter of the book. Though the book does not list her credentials, she has edited all three of these volumes. The contributing authors have extensive experience using EMDR in private practice and/or as trainers of this method.
Features: The book begins with an overview of EMDR. It was developed in 1989 by Dr. Francine Shapiro. EMDR consists of eight phases to address trauma. The therapist must have comprehensive knowledge of the client, along with forming a positive therapeutic alliance. There is a difference between the assessment phase and treatment planning phase. The target of therapy is a specific issue. EMDR focuses on the past, present, and future. A future template is established for each trigger, which is identified in the treatment planning phase. Clinicians use eye movements to address blocked processing. One important intervention is the cognitive interweave. Therapy goals are reassessed on a continuing basis. A session is considered successful if the client achieves understanding and self-efficacy. The book emphasizes that EMDR will not help all clients, though EMDR has been found to be effective worldwide. Some clinicians have found that they would rather utilize other techniques as opposed to EMDR. It is essential that informed consent be obtained before therapy formally begins. This volume is very readable and contains numerous figures/tables, which help clarify the text. It also has "summary statements" at the end of each chapter.
Assessment: The book is excellent because it provides a step-by-step approach of the EMDR process. The editor is an expert in the field and has been involved in all three editions of this book. There are also helpful case examples. Early career professionals and experienced clinicians will benefit from this volume. The third edition justifies replacing the second because the chapters have been revised, new material has been introduced, and the needs of special populations have been addressed.

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