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