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How IFS-Informed EMDR Can Make Trauma Processing Safer and More Effective

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What is EMDR?

EMDR is a type of therapy that is utilised to help individuals process traumatic or unpleasant material that is still affecting their lives. It works by using bilateral stimulation (e.g., following a hand or dot that moves left and right, or a sound that alternates between left and right at a fast speed) while the client holds in mind a difficult memory or event. Over time, the memory becomes less upsetting, becomes integrated with other memories, and no longer affects the individual. For more detailed information on EMDR, please click here.

What is Internal Family Systems?

IFS is a therapeutic approach that understands the human mind as made up of parts, as opposed to being a single entity (a monolithic mind). Parts may have different agendas (e.g., to protect) or carry burdens (e.g., traumatic experiences). The ultimate aim of IFS therapy is to heal the traumatic wounding inside the client by including all parts involved in the process. This promotes collaboration among parts, both with one another and with the Self of the client at the core of the internal system. For a more elaborate description of IFS, please click here.

How can you integrate IFS with EMDR?

In my practice, when I use EMDR, I often look at the client’s presentation through an IFS lens. This makes the process gentler and more respectful of the client’s pace and emotional needs. From the beginning, I help clients make sense of their inner world by familiarising them with the concept of internal parts and befriending parts that are involved in the client’s manifestation of symptoms.

There are different schools of thought on how to integrate IFS with EMDR. My approach is a combination of the various approaches I’ve studied and my own clinical experience.

What a typical IFS-informed EMDR session looks like

I start by helping the client map their parts, whether it’s just via talking or by externalising parts using objects or drawings — this depends on each client’s preferences and style.

Once the relevant parts are mapped out, we begin with EMDR. This is particularly helpful because, often during the processing of traumatic memories, some parts of the client’s internal system might influence or slow down the processing because they are concerned. For example, it often happens that during the processing, clients become numb. This is often considered a big impasse in EMDR, because without emotional activation, there is very little — if any at all — processing. When this happens, there are usually straightforward techniques to get over the impasse, such as grounding the client or changing the type and speed of bilateral stimulation. However, it often happens that the numbness persists and the processing becomes stilted and arduous. In this case, it is very helpful to bring the client’s attention to their internal family systems and identify the part that is ‘interfering’ with the processing.

Parts interfere with the traumatic processing because of safety reasons

It is very often the case that such a part is disconnecting the client from the traumatic material because it is concerned about their safety. For example, it worries that the client will become emotionally overwhelmed. So, why would we want to remove such protection and jeopardise the client’s emotional safety? Instead, why not collaborate with such a part in order to make the process safer and smoother? It is important to keep in mind that parts have a lot of wisdom within themselves and can be great travel companions when it comes to trauma processing.

The importance of the therapist’s attitude

It is also vital that the therapist is open to any potential impasses they might encounter during EMDR processing, because any antagonism or annoyance noticed by parts — whether it comes from the therapist, the client, or both — will stall the processing. In this case, it is as though the part is thinking: these people are trying to break through the defence that I am placing, and therefore they are not trustworthy — so I must intensify the protection I provide.

This is to say that it is helpful to know the framework and techniques of any therapeutic approaches like EMDR and IFS, but if we are too agenda-driven (e.g., “I must get rid of this emotional suffering at all costs”), chances are that we encounter obstacles on our way. These obstacles are not there to make the client’s life more painful, but to guarantee safety.

Want to know more about IFS-informed EMDR?

What I described above is just a small example of how to integrate IFS and EMDR. It would take a whole book to include everything there is to say. I hope it suffices to make sense of how IFS and EMDR can be integrated.

If you are a mental health professional who wants support in assisting your clients, or a potential client who would like to benefit from IFS-informed EMDR, click the button below to get in touch with me and discuss your needs.

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What happens in an EMDR therapy session?

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When prospective clients contact me to embark on Eye Movement Desensitisation and Reprocessing (EMDR) therapy, they often ask: 

What’s a typical EMDR treatment session like? 

Below I will illustrate how I usually conduct an EMDR session. Before you read on, it is important to note that I always tailor my approach to the client’s needs, which means that both pace and intensity of each session are adjusted according to the client’s preparedness for therapy, their resilience in facing a wide range of emotions, and their therapeutic goals.

What’s EMDR therapy? 

EMDR is a type of therapy that was created to treat symptoms of Post-Traumatic Stress Disorder (PTSD). According to the theoretical framework behind EMDR, when one experiences psychological trauma, she or he might become stuck in the trauma, which means that the traumatic experience gets frozen in time and it feels like it is often repeated in the present. Typical symptoms of PTSD are: flashbacks, nightmares and constant emotional and physiological intrusive memories of the trauma. When PTSD symptoms persevere for more than a month, trauma-focused therapy – such as EMDR – can be extremely helpful in helping the person process the traumatic experience.

To read a more detailed description of the theory underpinning EMDR therapy, to learn what EMDR therapy can be used for, and to access a number of frequently asked questions on EMDR, click here.

What happens in a typical EMDR therapy session?

EMDR therapy can be divided in three main parts: assessment, preparation and treatment.

Below, I offer a description of each phase, which includes a vignette of a fictional client, Sarah, who suffers from a number of symptoms following psychological trauma. 

In my practice, each session lasts 50 minutes but can be prolonged if the client prefers it. 

Assessment

During this phase, which usually can last one to three sessions, therapist and client meet to discuss the client’s presenting problems, psychological needs, and history. In EMDR, a strong emphasis is placed on getting to know and understanding the client’s personal history, because it often allows the therapist to make sense of the client’s presenting symptoms.

Here’s a vignette of a fictional client’s presentation:
Sarah comes to therapy following a car accident during which she nearly lost her life. The accident happened 2 months ago and Sarah feels that she cannot ‘get over the trauma’ even though she is physically fine. She explains to me that she is easily startled, has nightmares that are symbolically linked to the accident (being chased by something and dying), and becomes easily upset because fragments of the trauma resurface as she gets on with her day (i.e.: the honking sound of the car before the crash). Sarah has also a history of not feeling secure growing up as she had very critical parents and suffered bullying at school. Sarah would like to move on and finally place the traumatic experience where it belongs: in the past. As her therapist, I listen to her concerns attentively and I ask a number of questions, whilst being respectful of her pain and genuinely curious about her current concerns, her traumatic events and her personal history.

As you can read in the vignette above, the task of the EMDR therapist is to sensitively gather information about the client’s symptoms and then start connecting the dots with their personal history to make sense of their present. 

Preparation

EMDR is a very powerful type of therapy that can bring about significant change in periods of time that can be much shorter relative to other traditional talking therapy approaches. During the EMDR session, the processing of emotional content can happen very quickly and sometimes it can feel overwhelming for the client. This is why preparing clients for the treatment is imperative to keep them safe. In this case, the EMDR therapist will help the client ‘install’ emotional resources that can be used in order to make the client more resilient during the processing. Emotional resources are installed by using imagery techniques. This phase could last 1 to 3 sessions, depending on the client’s need. One might argue that this is also part of the actual treatment because it helps clients become more resourceful when they experience their day-to-day unsettling symptoms.

Here is how the preparation phase could look like with Sarah:
After the assessment, I explain to Sarah what EMDR means and how it can be helpful for her. I guide Sarah through some imagery exercises in order to enable her to connect with a sense of calm and relaxation. In Sarah’s case, she focuses on a time in her childhood when she had a lovely summer holiday with her best friend and felt happy and content. Sarah and I together make this memory more accessible for her so that she can bring it up when she needs it in the future, both in her daily life and during the EMDR treatment sessions.

It is often the case that clients need to install a ‘team’ of resources to use during the most difficult times of therapy.

Treatment

After illustrating both the Assessment and the Preparation phase, now it’s time to describe what the actual processing during EMDR looks like.

As it is suggested in the acronym – EMDR – the eye movements are what is traditionally used to help the person process the traumatic material. Typically, the client is asked to follow the therapist’s hand, as the therapist waves it from left to right in front of them – as fast as the client can manage. During the movements, the therapist reminds the client to just notice the material that comes up in their body and mind without judging it. The material can be in the form of thoughts, feelings, body sensations, etc. During the set of eye movements, the client is asked to remain silent if possible. After each set of eye movements, which usually last up to 30 seconds, the client is asked to briefly describe what they noticed and then the movements are resumed. During the movements, the client is also reminded by the therapist that there is no right or wrong material that might come up, because the work is based on free association. 

Ultimately, the therapy aim is to liberate the client from the emotionally negative intensity of their traumatic memories; therefore, it usually happens that the memory becomes less disturbing as the client keeps moving their eyes. 

This phase can last for the amount of sessions needed to process the traumatic memory – typically 6 to 8 sessions. However, sometimes it can much fewer or more sessions.

In the example of Sarah the following might happen:
After Sarah explains what the worst moment of her traumatic experience is, I ask her to focus on some specific elements of the moment. I then begin that hand movements and ask her to track them with her eyes. During the movements, I gently remind Sarah that there is no right or wrong answer and to just notice with curiosity what comes up for her. After each set of movements, I ask Sarah to take a deep breath and then to describe what she has noticed during the movements. Maybe Sarah remembered something else about the experience, or she feels quite tense in her chest, or she feels fearful? I then ask her to resume following my hand. Every now and then I ask Sarah whether the disturbance of the memory has changed in any way. This will inform how we will carry on with the treatment.

It is noteworthy that – instead of eye movements – self-tapping of shoulders and knees may also be used. This could be a preference of the client or just a practical step to take when, for example, EMDR needs to be conducted online. For further information about how online therapy works, click here.

I hope that the above has shed some light on how a typical EMDR session looks like. If you have any questions, click below to book an initial free 15-minute consultation. 

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‘I am grounded in joy; I am not grounded in the trauma anymore’

Tarana Burke
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Does love need to be tormented to be ‘true love’?

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We can’t ignore the fact that we live in a ‘no gain no pain’ society and this has influenced many aspects of our ordinary lives. So it is not surprising that the same rule applies to love. We often get persuaded into believing that in order to access true love, there needs to be torment and tears. 

Think of films and books, where the most mind-blowing and captivating love stories are the ones where at least one of them suffers and chases; or when the partners are so ‘passionately’ in love that they fight and make up (insert your imagination here) all the time. 

But what happened to that kind of love that makes one feel safe and nurtured? That kind of love that makes one thrive and develop as a deserving human being? Of course, to maintain love we have to work hard and commit ourselves, but this does not mean that we have to sweat and cry blood; or plague ourselves at night, tossing and turning in nightmarish scenarios of abandonment and despair. 

At a societal level, we know that we get affected by media and mainstream narratives, but I think that we need to pay closer attention to the personal level as well. Usually, people who subconsciously look for difficult relationships are the same ones who have barely ever experienced safe and unconditional love. Maybe their first relationships with friends and partners were very turbulent and chaotic. Or they witnessed their parents fight and argue, or they had to chase their own parents or caregivers in order to get their needs of safety and nurturing met. 

Can we change things? Can we actually review our love imprinting and build relationships, be they romantic or platonic, based on mutual respect and encouragement to become better people? I believe we can. Sometimes realising that we fall into the same patterns (for example, becoming infatuated with someone who is emotionally unavailable) can be a good enough realisation that helps us to stay clear from similar occurrences. Some other times, we might need profound, repairing and healing therapeutic work in order to challenge deeply rooted beliefs that suggest that we are unlovable or not deserving space in people’s lives and minds. 

Photo by Jonas Vincent on Unsplash

So I believe that love does NOT have to be tormented. A loving relationship is an essential space for us to grow, heal and thrive. If we feel stuck, drained, fatigued and distraught when we are around specific people, we ought to review our position and take ourselves out of these difficult scenarios. It is an arduous task, but it is nothing less important than eating the right food or getting good quality sleep. It is about self-care and survival. 

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I am not wrong, my past is

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More often than not, in my practice I come across people who are haunted by their past traumas, for example difficult relationships with their parents, abuse or bullying. Especially during our first meetings, I encourage clients to start making connections between their present thoughts, feelings and behaviours and their formative years of life. This is what I call joining the dots in a psychologically informed way. 

For example, a client might struggle to form lasting relationships because they fear they will eventually be abandoned. So they either establish superficial connections with others; or they become quite attached to the very people that are bound to reject them, which in turn confirms their belief of being unlovable.

Therefore, as soon as they recognise their ways of operating in the present by making links to their past, clients develop new insights which render their current struggles less random and thus possible to tackle. However, it is at this stage that clients might start considering themselves as damaged goods and become hopeless, as they believe they will never be able to evolve. Or even worse, they feel that their predicaments are due to the fact that there is something irreparably wrong with them. They become cynical and this can stall their progress.

What I will never stop putting across to clients is that gaining insight is the very first important step towards healing. This represents a vital opportunity to appreciate that WHAT they went through is wrong, instead of thinking that THEY are wrong.

We as human beings have no fault for how badly or unjustly or uncaringly we were treated. However, we are accountable to take those steps that will allow us to heal by changing our behaviours, and to surround ourselves with nurturing people that can provide us with what we fundamentally need and deserve. 

In other words, we are not wrong, our traumatic past is.

Like in most cases, self-compassion is the key because, after all, if we don’t learn to truly acknowledge our worth, how can we expect that others will do that for us?

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What’s so good about anger?

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‘Have you ever considered that feeling anger might be a good thing?’ 

This is what I asked Anthony (fictitious name) during a difficult session.

I could sense that there was unexpressed antagonism within him and I felt under attack and defensive. So I plucked the courage and I commented: ‘There is some irritation coming from you. Is that a valid assessment?’ After denying experiencing anything worth noting, Anthony admitted that he had been feeling angry at me because I was not helping him enough. Then he broke down in tears. I took a deep breath and I asked him to do the same. I sat with him through it all and I made sure that he could see that I was feeling sorry and concerned. 

So, I asked that question: ‘Have you ever considered that feeling anger might be a good thing?’ Anthony met this question with a baffled look and said indignantly: ‘what’s so good about anger? I hate it, it makes me feel horrible and pushes people away!’ 

This is when I assisted Anthony appreciate that:

There is a difference between feeling anger and expressing it

There are at least two different ways of expressing anger, which tend to be diametrically opposite: to build and connect; or to destroy and disconnect.

I went on explaining that witnessing unexpressed anger in his body language made me feel like I wanted to pull away and disengage – this was the disconnecting action of anger. So yes, I agreed with him that this could be a problem when it came to maintaining meaningful relationships. I also felt some destructive undertones when he angrily asked: ‘what’s so good about anger?’ It did not feel like his question was coming from a curious and open place and yet again, I experienced the urge to recoil. 

However, very importantly, I finally felt deeply connected and empathetic when Anthony admitted how he had been feeling towards me and my shortcomings. It motivated me to get closer and hear his feedback better and fully, because I could sense his emotional pain.

We ultimately convened that: anger is neither a positive or negative feeling. It is just a feeling that, even though can be unpleasant and undesirable, can inform us that something’s not quite right. This will drive us to do something to change the status quo.

hands people friends communication
Photo by Pixabay on Pexels.com

This difficult interaction led us to a very important breakthrough in our therapy, as Anthony grasped that it was possible for him to feel anger safely and express it constructively, so that we could explore what was hiding behind it: a strong sense of loneliness and sadness.     

DISCLAIMER: Although lessons learned from the treatment of actual patients are included in the patient stories on this website and blog, the historical events and facts represented have been changed to protect the identities of any real patients and to protect their confidentiality

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Is forgiving giving in?

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Some time ago I was talking to a very distraught client, whom I shall call Laura. 

Laura had received irrefutable proof that her husband had been having an affair and that the woman he was having an affair with was pregnant with his baby. 

After the initial shock, Laura started putting two and two together and realised that there had been some clues in her husband’s behaviour that had suggested that something was not quite right. She could recollect having challenged him over his being at work longer than he needed or that he was not so present when it came to looking after their twin boys. However, he was always very quick in providing good enough reasons for his absence and shortcomings. 

When we met for our session, I was struck by Laura’s view of the situation. Yes, she was perturbed by the whole state of affairs, but was already pondering how to ‘channel’ her anger and disappointment towards something that would be more aligned with her values. Laura explained that she realised that her ‘little story’ was embedded in a bigger picture with a much larger story and that perhaps she could turn this experience around and make the world a better place for her sons. Her mind jumped into different scenarios, including volunteering in an association that dealt with unwanted pregnancies (as it seemed that the husband’s other woman was not interested in keeping the child).

This was the moment when Laura mentioned the word forgiveness and burst into tears. These were not warm or moved tears, but tears of disbelief as she could not fathom how she could consider forgiveness when her parents’ teachings were completely different. Laura told me that her critical mother would blame her for being a fool and her late loving father would advise her to cut ties with her husband. In fact, even some of her closest friends were suggesting that she leave and build a new life with her children. Laura explained that her tears were tinted with shame at the idea of being judged as a ‘loser’ or a ‘weak woman’ for forgiving her unfaithful husband. She was concerned about becoming a cliche.

That reaction took me by surprise as until a minute earlier I had been internally celebrating her flexible way of thinking when she was considering getting something positive or constructive out of this traumatic experience. I relayed that to Laura and invited her to hold these two positions in mind and appreciate their contrast with each other. We concluded that she was the host of two parts within her: an inflexible part who was born out of her rigid upbringing and a part that she had built over the years, which was much more malleable and adaptable to different circumstances. 

We discussed this conundrum a little longer and agreed that forgiving doesn’t mean giving in. Forgiveness is an act of courage, a step out of an intransigent way of living life and into a liberating sea of opportunities. 

I admire Laura a great deal and I am thankful for her letting me bear witness to her difficult situation. I hope that she will always live by her values and realise how much she has got to offer to her children and the world.

DISCLAIMER: Although lessons learned from the treatment of actual patients are included in the patient stories on this website and blog, the historical events and facts represented have been changed to protect the identities of any real patients and to protect their confidentiality

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A heart-warming video worth watching

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Apart from the beautiful message around body image, I find this video moving for how the passers-by interact with this lovely woman. It makes me reflect on how hard we try to come across as perfect and invincible, but then we cool down when we witness other people’s vulnerability and we empathically reach out to them. Why? I think because others’ vulnerability reminds of ours and this becomes an opportunity for deep connection.

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What’s insomnia and 13 ways to fix it

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Article at a glance

This article will explain why sleep is so important. It will also offer a description of insomnia and of the two most important stages of sleep: deep and REM sleep. 

Lastly, it will offer tips on how to treat your insomnia in the following order

6 Things to avoid before bedtime
4 things to do before bedtime
3 things to do if you wake up in the middle of the night

It’s 3AM, you are lying in bed in the dark and are wide awake. How do you know what time it is? Well, you just checked your bedside table clock or your phone. Now, the only thing that matters to you is: ‘I MUST sleep’. The more you think about your lost sleep, the less sleepy you’ll get, because obsessing over it winds you up so much that your intention of slowing down and letting yourself go seems to be lost. And it might as well be. But why is sleep so important and what can you do to address your sleep problems?

Why is sleep so important?

Sleep is most probably the most vital activity of our day. That’s right, without sleep we cannot function to our full potential and therefore our day-time performance gets negatively affected. But why? Sleep has a restorative effect for our body and minds. It is during night time, when all is dark and nature quiets down, that we are meant to slow down and recharge our batteries. Our muscles relax to a point where they reach immobility and this will enable them to restore and repair themselves. Our minds also operate a sort of defragmenting, which allows us to consolidate our learning and memories so that we can incorporate new information the following day, and add to the pre-existing knowledge. 

So, no wonder we feel achy, confused, anxious and/or depressed after a bad night’s sleep. The lack of sleep, or disturbed sleep, is often referred to as ‘insomnia’

So… what’s insomnia?

photo of person holding alarm clock
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Insomnia can be seen as an umbrella term meaning that you don’t get enough and regular sleep. This can be either perceived by you during the day or it can go unnoticed. Even if it goes unnoticed, at a cellular level your body will register the negative impact of bad sleep and you will not function properly – or at least as optimally as you would like. 

There are two important sleep phases that need to be mentioned here:

  • Deep sleep: this is the most rejuvenative sleep stage and it’s linked to muscle health
  • REM sleep: Rapid Eye Movement sleep is important for both your mind and body and is linked to memory consolidation and creativity. 

When these stages of sleep are regularly negatively affected, you will mostly likely suffer from insomnia.

Ways to treat insomnia 

6 things to avoid before bedtime

  1. Avoid drinking stimulants such as caffeinated coffees and teas before going to sleep, or any other drinks that contain caffeine, after 3PM
  1. Avoid sugary drinks, including carbonated ones or juice as they will make your insulin spike and make you alert before going to bed. 
  1. Avoid processed foods (junk food), such as sweets, crisps, microwaveable meals; same as above, they will make your body excited just before going to bed
  1. Avoid smoking cigarettes as this will increase your dopamine levels and excites your system
  1. Avoid looking at bright screens, such as TV and smartphones for a couple of hours before bedtime. Looking at bright screens will trick your brain into believing that it’s daytime and will make you very alert 
  1. Avoid physical activity before going to bed. This will release hormones that do not agree with relaxation

4 things to do before bedtime

  1. Relax by listening to soothing music or taking a bath
  1. Write on a journal by focusing on things that you are grateful for
  1. Make your room cool and comfortable. Lower temperature in the bedroom has been proven to facilitate and maintain good quality sleep
  1. Do some meditation if that is your thing – this will slow down your breathing and mind

3 things to do if you wake up in the middle of the night

  1. If you can’t get to fall asleep within 30 minutes, let go of that expectation and take some deep breaths
  1. Accept the fact that you might not fall asleep again during that night, get out of bed, do something relaxing (such as reading a book or drinking a hot non-sugary drink) and set the intention to spend a stress-free day and go to bed at a decent time the following day
  1. If you feel anxious or have a sense of doom, once again, don’t just lie in bed: get up and turn on a couple of lights just to orient yourself to time and space. When we wake up in the middle of the night, it can be quite disorienting for us and the darkness might feed into a sense of dread. This is just the legacy left to us by the primitive men so that we are always on the lookout for danger. 
gray cat near brown vase with sunflowers
Photo by Buenosia Carol on Pexels.com

The main message is: sleep is extremely important, but you might happen to lose some. If that happens, accept that this is happening, put in place the tips provided above, and be nice to yourself. 

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What is Post-Traumatic Stress Disorder and 4 ways to know if you have it

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Post-traumatic stress disorder, commonly known as PTSD, can be very debilitating. It presents itself with a number of symptoms that can be distressing for both the person who experiences them and people who are around them.

It usually starts at least a month after a traumatic event takes place.

What’s a Traumatic Event?
Generally, it’s an event in which the traumatised person thought that they, or someone close to them, were going to die or suffer from severe harm. But it can include all sorts of experiences that are perceived by the traumatised person as dangerous.

What are the symptoms of PTSD?
Usually symptoms are grouped in categories:

  • Traumatic memories intrusions: this is when the person experiences flashbacks, in the form of images, feelings or body sensations.
  • Avoidance of any reminders of the traumatic event, even when the link is symbolic. For example, if someone had a car accident, which they found traumatic, they may not want to sit in enclosed spaces resembling the space within the car.
  • Sudden changes in mood and anxiety, which can be triggered very easily. This problem is also known as emotional dysregulation.
  • Being very alert and jumpy, for example when walking in the dark or hearing a sudden noise.
  • More often than not, feeling spaced out and experiencing out-of-body sensations. This phenomenon is also known as dissociation.

5 ways to determine if you have PTSD?

1. Find any written information pertaining to psychological trauma, from reputable websites and books.

3. Talk to your GP, as they will definitely have at least a broad idea of what PTSD is and can direct you to get the right help.

2. Talk to trusted people in your life, such as close friends or family members.

4. Have an introductory chat with a mental health professional, such a psychologist, psychotherapist or counsellor, to discuss your symptoms and whether it would be helpful to embark on therapy.

How can you cure your PTSD?
Bear in mind that one of the biggest factors that will not allow you to heal from PTSD is hiding your emotional struggles from others, because it reinforces your strong sense of shame. It is easy to blame ourselves for what happened to us, but it is not helpful or healthy. This is why trauma-focused psychotherapies, such as Cognitive Behavioural Therapy (CBT) and EMDR (Eye Movement Desensitisation and Reprocessing) are the best ways to address PTSD, because they enable the person to break the spell of their traumatic past so that they can live in the present, without being dragged back to the traumatic experience... and finally move on.

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“Healing takes courage, and we all have courage, even if we have to dig a little to find it.”
Tori Amos