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Disruptions to the information processing system result in disturbing memories that aredysfunctionally stored as they were experienced and perceived at the time of the eventAs the perceptions of the present link to the memory networks, various components ofthe previously unprocessed memories are experienced (e.g., emotions, physicalsensations, thoughts/beliefs) –Triggers“The past is present”: Perceptions of current situations link into the networks ofphysically stored memories in order to be interpreted. If a memory network contains anunprocessed memory, the current perceptions are informed by the earlier dysfunctionalemotions, thoughts/beliefs, sensations of the past event(s)Processing is viewed as the forging of adaptive associations between networks ofinformation stored in the brainEMDR facilitates an associative process that allows the relevant connections to bemadeThe unprocessed components/manifestations of memory (image, thoughts/sounds,emotions, physical sensations, beliefs) change/transmute during processing to anadaptive resolutionWhat is useful is stored, available to inform future experiences; what is no longeradaptive is discarded (e.g., physical sensations, irrational beliefs)Memory networks are viewed as the underlying basis of pathology and mental healthDisruptions of processing may be caused by high levels of disturbing emotions–canblock experiences from being adaptively processedExamples:Early childhood attachment issues:o Childhood trauma or neglecto “t” life eventso “T” criterion “A”1. Childhood humiliation experiences2. Accidents/Injuries/Illness3. Loss of parent/sibling or significant other4.5.7

EXPERIENTIAL CONTRIBUTORSWe use the term “trauma” to refer to the ubiquitous life experiences that have a lasting,ongoing impact on people in order to sensitize clinicians to this notion.EMDR targets the memories that contribute to dysfunction and to health.COMPONENTS OF MEMORY STORED INFORMATION Sensory Input (images, sounds, smells, tastes)ThoughtsEmotionsBody SensationsBeliefsMemory Networks: Memories with similar information (senses, thoughts, emotions, body sensations andbeliefs) are linked by their channels of associationAdaptive memory networks are the primary basis of learning, self-esteem, and otherpositive resources and behaviorsMaladaptive/dysfunctional memory networks are the primary basis of pathologyMaladaptively stored memories are etiological to client’s presenting concernsMemory networks form the basis arget The node is the memory designated for therapeutic targeting. It is a biologically storedexperience, which represents a memory network Touchstone Memory–earliest recalled experience that laid the foundation for the client’spresenting problem Memories are considered “dysfunctional” because they are physiologically stored in away that does not allow them to link to any positive/adaptive networks8

EMDR PROCEDURES ACTIVATE THE TARGET MEMORY AND STIMULATE THEADAPTIVE INFORMATION PROCESSING SYSTEM Negative, disturbing memories that are inadequately processed are reprocessedProcessed memories are integrated into adaptive memory networksENHANCEMENT AND DEVELOPMENT OF POSITIVE NETWORKS Positive memory networks need to be present and accessible for reprocessing to occurPositive life experiences and adaptive memories (senses, thoughts, emotions, physicalsensations, beliefs), when accessed, are strengthened and enhanced through theaddition of BLSTherapeutic relationship as a positive memory networkREPROCESSING Maladaptive/dysfunctional memory networks, when accessed and processed, link withexisting positive, adaptive, and functional memory networkso Accessing experiences (positive and negative) allows for the linkages betweenconsciousness and where information is stored.o EMDR- activated processing is metaphorically like moving down a train track towardsa more adaptive/functional resolution.o Each stop allows linkage to existing adaptive positive networks.BY-PRODUCTS OF EMDR- ACTIVATED ADAPTIVE INFORMATION REPROCESSING Desensitization of emotional and physical disturbanceEmergence of insight and positive changes in physical and emotional responsesIntegration: new learning becomes available in the current life contextEMDR IS AN INTEGRATIVE PSYCHOTHERAPY APPROACHInterventions, such as, self-soothing techniques or the development of new skills can beincluded in EMDR therapy using the precepts of the AIP Model. Additional interventions maybe needed to provide comprehensive treatment or to fully assimilate changes that occur duringEMDR reprocessing. They are all applied through an understanding of the AIP model.Dysfunctional memory networks are reprocessed and positive ones are integrated andenhanced.9

Self-regulation skills - external and internal challenges to emotional stability and currentlevel of functioning (add or enhance access to positive networks)Skills building - fill in developmental deficits or learning specific skills (develop positivememories which incorporate new learning)EMDR is compatible with elements of other clinical approaches. However, it is a distinctform of psychotherapy which directly addresses the physiologically stored memories.Changes in the present occur because of the reprocessing of the targeted memorynetworks.EMDR therapists come from various theoretical approaches and backgrounds.Practitioners from all orientations can successfully integrate EMDR principles andprocedures into their clinical practice.GOAL OF THE EMDR APPROACH TO PSYCHOTHERAPY To achieve the most effective and efficient treatment effects while maintaining clientsafetyTo achieve appropriate, adaptive and ecological resolution of presenting problemsTo incorporate new skills, behaviors and beliefs about self, optimizing clients’ capacityto respond adaptively in the current context of their livesEMDR ACTIVATING COMPONENTS Access “frozen” dysfunctional memoryStimulate the information processing system (keep it dynamic)Move information to adaptive (appropriate/positive) resolutionREPROCESSING LEARNING10

EIGHT PHASES OF EMDR TREATMENT Phase One: History Phase Two: Preparation Phase Three: Assessment Phase Four: Desensitization Phase Five: Installation Phase Six: Body Scan Phase Seven: Closure Phase Eight: Reevaluation11

PHASE ONE: HISTORY-TAKINGChapter 4 (Shapiro, 2001)GOALSTo gather customary information about the client via the therapist's usual history-taking and toprovide the client with all information typically required for informed consent.To consider special EMDR criteria related to client selection and readinessTo identify potential treatment targets from positive and negative events in the client's life(past, present, future).OVERVIEWEMDR Treatment Plan as part of a comprehensive treatment planEvaluate:– Client’s integrative capacity– Affect tolerance– Current internal and external resources– Attachment history– Readiness for change– Current psychosocial factors– Level of complexity/resources determine paceAIP- INFORMED CASE CONCEPTUALIZATION Current symptoms are caused by earlier experiences that were not adequatelyprocessed due to trauma or insufficient information.What experiences have set the groundwork for pathology? Trace present reactions topast experiences.Assess strengths as well as developmental deficits and establish the necessaryconditions to move the client toward health.What memories need to be targeted that will fill in deficits and bring the client to health?Identify needed skills and behaviors.Is the client able to access the experiences and allow reprocessing to occur?Conduct Psychosocial/Diagnostic Intake Interview to evaluate the clinical landscape,self-soothing skills, and readiness for EMDR processing. When clinically appropriate,gather information necessary for EMDR case conceptualization and TreatmentPlanning.o Information may include early childhood strengths and resources as well as negativeevents–abuse and/or neglect, problems with significant attachment figures,developmental milestone deficits.12

o Develop collaboratively with the client, a Treatment Plan consistent with theirtreatment goals.POSSIBLE CLINICAL PRESENTATIONS (in order of complexity): Single Incident Presentations:1. Acute Stress Response: An acute traumatic event (“T”) that occurred within a fewdays and is represented by a set of symptoms that are directly related to a singleevent.2. Recent Event: A traumatic event that occurred within a two-to-three month period. Single Dominant Issue/Symptom:1. A disturbing life event or a series of events that are organized around one dominanttheme represented by a single symptom such as, a core negative belief, pervasiveemotional state, body sensation, pattern of behavior, etc. May be exacerbated by ‘t’events from early childhood.2. Posttraumatic Stress Disorder (PTSD): A disturbing life event (“T”) or series ofevents over a prolonged period that meets DSM Criterion A for PTSD. Client suffersfrom intrusions, hyper arousal, and/or avoidance of stimuli that trigger negativesymptoms. Origin may be in adulthood or early childhood experiences to include:a. Accident(s)b. Major life changes (e.g., loss of loved one, serious illness or injury to self orother)c. Physical or sexual assaultd. Ware. Natural disasters Multiple Issues/Symptoms Presentations:1. Depression, anxiety, panic reactions, interpersonal problems,some dissociativeprocesses, less severe characterological issues. Numerous experiences over timehave produced pathology, but client does not meet the full diagnostic criteria forPTSD.2. Complex PTSD: Complex presentation of traumatic life events, extreme stress overa prolonged period of time. Symptoms may include more severe personality anddissociative phenomena. More preparation required. Note: Complete EMDR BasicCourse with specialty training in the field.13

o Depth and comprehensiveness of history-taking determined by the client’sinternal and external resources (i.e., emotional regulation, affect tolerance, socialsupports, etc). Evaluate need for resource development and stabilization.o Use clinical judgment when inquiring about earlier events by evaluating theclient’s ability to maintain dual awareness without flooding or dissociating duringinterviewing.o Important to titrate history-taking over time while preparing for memoryprocessing work with EMDR.o Use clinical judgment to determine what memories to process and in what ordero Ongoing reevaluation of overall treatment plan and targeting sequence strategiesmay be necessary as treatment evolves.14

THREE-PRONGED PROTOCOL PASTo What etiological incident(s) set the groundwork for pathology (Touchstone memory,or other experiential contributor)?Link present reactions/symptoms to pastcontributing experiences.o What skills and behaviors are needed to stabilize and resource the client sufficientlyto begin reprocessing and adaptive learning? PRESENTo What present experiences are causing disturbing symptoms and reactions? FUTUREo What is the client’s positive vision for the future?o What is the client’s capacity to allow a positive, more adaptive set of responses to bedeveloped and acted upon?o What are the potential future challenges that could occur?15

PROCEDURES TO IDENTIFYMEMORIES FOR REPROCESSINGAIP: To access a memory or memories in a memory network that is the basis of theclient’s current dysfunction.GOAL: Identify earlier memories within the identified memory network; can be usedduring History-taking; to identify a feeder memory during processing; to bring to awarenessa memory causing a blocking belief, etc.,Asking clients to access a current experience of the problem; identifying earlier experiencesthat are similar or relate in some way that can be targeted for reprocessing.DIRECT QUESTIONINGFLOAT BACK TECHNIQUE (Browning & Zangwill)Uses the associational processes of the brain to access other memories that areconnected to the client’s current experience of the problem. Best to use during Historytaking with more highly resourced clients. Use caution with clients who have pervasivehistory of abuse or neglect or who may be dissociative.“As you bring up the recent experience of , notice the image that comes tomind, the negative belief you’re having about yourself along with any emotions andsensations, and let your mind float back to an earlier time in your life when you mayhave felt this way before and just notice what comes to mind ”AFFECT SCAN (Shapiro, 1995: independently developed andhypnotic/reliving component contained in Watkins and Watkins, 1971).withouttheNote: Affect Scan is particularly useful to apply when the NC is unclear, when an earlymemory is not accessible by other means, and during reprocessing sessions whenclient’s process is stuck and you are checking for an earlier feeder memory.“Bring up that experience, the emotions and the sensations that you¹re having now, andallow yourself to scan back for the earliest time you experienced something similar.”16

EMDR PSYCHOSOCIAL INTERVIEW AGENDA(Client Selection Criteria)ADAPTIVE INFORMATION PROCESSINGExcluding situations caused by insufficient information/organic deficits, the cause of presentdysfunction is based in physiologically stored memories. Evaluate history accordingly.What targets have set the groundwork for pathology? Trace present reactions to pastexperiences.What targets will fill in deficits and bring the client to health-identify needed skills andbehaviors?Is the client able to access the experiences and allow processing to occur?PRESENTING COMPLAINT (ISSUE)CLIENT-CLINICIAN RELATIONSHIPTrust and safety have been established in the clinical relationship. Client agrees to giveclinician accurate feedback about client’s private internal experiences regarding thereprocessing of the memory.CLINICAL LANDSCAPEUse clinical judgment regarding the timing and pacing of gatheringinformation about early childhood attachment and development;life experiences, family of origin, peer relationships; cultural, gender,ethnic and religious influences.17

CHECKLIST: The following may be treated as a clinical checklist or worksheet:OKPCHas been addressed and is favorable for EMDR useProblem: Wait until completion of course or until further preparation and stabilizationhas occurred.Consultation indicated with EMDR clinician with expertise in area of concern.CLINICAL CONCERNSCLIENT STABILITY / DEVELOPMENTAL DEFICITS / ABILITY TO MANAGE STRESS OK PROBLEM CONSULTATIONClient has been screened for Dissociative Disorder. DD rules out use of EMDR byWeekend 1-trained clinicians. See Clinical Signs of Dissociative Disorders and DES inAppendix. In addition to a Mental Status Exam, the DES should be used for every client.Special preparation for DD clients is needed to establish their capacity to maintain dualawareness in order for reprocessing to occur. Indicators of poor psychic developmentinclude but are not limited to: Years of unsuccessful psychotherapyDepersonalization and/or derealizationMemory lapsesFlashbacks and intrusive thoughtsSomatic symptomsChronic instability at home and/or at workSecondary gain issues identified and appropriately addressed.Clinician and client have considered severity of issues which may be exacerbated based onhistory and clinical diagnosis.ACUTE PRESENTATIONS OK PROBLEM CONSULTATIONThe following situations require caution and case consultation: Life threatening substance abuseSerious suicide attemptsSelf-mutilationSerious assaultive behaviorDissociative disorders18

STABILIZATION OK PROBLEM CONSULTATION Adequate stabilization/self-control strategies in placeClient must have a workable means of dissipating disturbance ifor between sessionsClient has adequate life supports (friends, relatives, etc.)Systems/issues that might endanger client have been addressedClient able to call for help if indicatednecessaryduringMEDICAL CONSIDERATIONS OK PROBLEM CONSULTATIONGeneral physical health/medical condition/age considered (possibleexacerbation with stress)MedicationsInpatient if necessary to manage danger to client or othersEye pain contraindicates EMs until cleared by physician (use alternate forms ofstimulation)Any neurological impairment or physical complication inappropriate for Weekend 1/Part1 cliniciansTIMING CONSIDERATIONS/READINESS OK PROBLEM CONSULTATION Timing of life events (projects, demands, work schedules, vacations, etc)Availability of both therapist and client for support and/or follow-upWillingness/ability to continue treatment as indicated90 minute sessions (if possible)19

DEVELOPING AN AIP-INFORMED TREATMENT PLANSYMPTOM CLUSTERS THAT CAN BE USED TO ORGANIZE A TREATMENT PLAN: Irrational negative beliefs about self (Part One focus)BehaviorsEmotionsBody sensationsSenses (tastes, odors, sounds)People, places, or thingsOtherTHREE-PRONGED PROTOCOL Pasto First experience (Touchstone Memory)o Worst experienceo Other contributing past experiences Present Triggerso Current triggers that remain due to second-order conditioning (may need to betargeted separately)o Recent experiences that occur such as accidents, injuries that do not have ahistorical component but have generated symptoms that need to be treated Future Templateso Desired outcomes for the future; preparation for potential challengeso Anticipatory anxietieso Develop alternative patterns of response that are more adaptive to the clientIRRATIONAL BELIEFS ABOUT THE SELFDistorted conclusions about the self are based on the disturbing affects and the incomplete orinaccurate information that was available at the time of the experience (usually based inchildhood).These “informational plateaus” are a result of experiences where the adaptive information ismissing. These experiences are considered inadequately processed and maladaptively stored.20

NEGATIVE BELIEFS ABOUT THE SELF Are the meta-perception (or conclusion) of the maladaptively stored experiences. Are the symptom, not the cause of the client’s distress about themselves. Are the verbalization of the stored affect; a conclusion about the self, based on the “feltsense” of the experience. Can be used to organize the treatment plan (Part One focus).CHARACTERISTICS OF NEGATIVE BELIEFS(referred to as Negative Cognitions in EMDR):o Negative, irrational, self-referencing (an “I” statement)o Presently held belief (when focusing on the picture/incident)o Accurately reflects the client’s presenting issueo Generalizable to related events or areas of concerno Resonates with client’s associated affectDEVELOPING APPROPRIATE NEGATIV

WEEKEND 1 TRAINING MANUAL OF THE TWO PART EMDR BASIC TRAINING . AGENDA DAY 1 8:00-8:30am REGISTRATION 8:30-10:15am Lecture 10:15-10:30am BREAK 10:30-12:00 Lecture 12:00-1:00pm LUNCH . Manual for the Dissociative Experience Scale 144 DES 148 A General Guide to the Use of EMDR in the Dissociative Disorders 152 .