Monday, April 24, 2017

The Magic of EMDR: How Sarah Gained a Newfound Understanding

I’ve been using EMDR for many years now.  An initial skeptic, I’m now a firm believer of its capabilities.  I’ve been impressed by this treatment's effectiveness in uncovering deep wounds and unconscious self-blame time and time again. Often, difficult life experiences or trauma can leave us with an unreasonable sense of responsibility as well as self-doubt. Part of EMDR’s effectiveness is not only in examining those faulty assumptions, but in understanding the body's states and emotions that accompany them. Usually, these are unconscious states with high reactivity and a stuck pattern. EMDR can reduce this reactivity so that new patterns and new self-assessments can occur.
Image Credit: North Boulder Counseling

Recently, I saw Sarah. She was referred after having tried several different treatment approaches. For the last couple of years, she found herself unable to drive to new locations. If she was familiar with a location, she was fine, but panic ensued if it was someplace new. Even thinking about it felt overwhelming. She found herself avoiding activities and making excuses for not attending outings with friends, work get togethers, and invitations to unknown places. Her life was becoming more and more restricted.   
After we did a history, we uncovered several upsetting incidents related to driving. We chose a couple to target. The one I thought would be most traumatic, an angry husband fed up with her fear and purposely driving into oncoming traffic, was not on the top of her list. Instead, it was something that seemed much more innocuous-- getting lost in a subdivision.  It was this experience that held all the energy and caused panic. Most of us know the frustration that comes with getting lost in a labyrinth of winding streets, but for Sarah, it brought on a panic attack: narrowed vision, heart palpitations, shallow breathing, and trembling.
As we prepared the EMDR protocol, I asked Sarah to imagine this scene, being aware of her body and any negative thoughts. The feeling that emerged was “I’m not competent,” as well as shame and anger at herself for not being able to manage a seemingly simple situation. As we continued with the eye movements, something shifted, and a new thought emerged. This can happen, where a more salient thought bubbles up. This new thought was not about her competence, but instead her invisibility. When she called her husband for help, he was annoyed and refused to come to her aid since she couldn’t tell him where she was. It was a replay of earlier childhood experiences where she had been denied help.  
As the oldest of five, she had excessive responsibilities. Her parents were neglectful and put her in charge of her siblings, expected her to make dinners and babysit. On the few occasions she asked for help, she was told she could handle it. So, even though fearful, she stopped asking and developed a belief that her needs were illegitimate. When her husband refused to help her when she was lost, she had the same sense of being invisible. Being denied help when she was distressed and fearful exacerbated a sense of helplessness and self-blame. She needed reassurance and guidance, precisely what was absent in her childhood.
As we continued with more eye movements, her distress began to recede, and at one point, she could see herself upset but not immobile. Instead, she imagined going up and down the streets until she found the right location. At this point in the processing, she imagined a way to proceed and was no longer stuck in frozen fear, but had new energy and confidence.  
While initially not very believable, she settled on, “My needs matter and I can expect help when I need it.” Sarah rarely asked for help. Instead, she was the one who extended help.  If she was distressed, she found ways to distract herself that didn’t involve other people. Yet this new idea of her worthiness to be seen and cared about was gaining strength. After a few more sets of eye movement, her face began to soften and a smile emerged. “It still feels weird, but I like it.” Sarah had had so few life experiences of being able to rely on others, it was hard to believe it was possible. She was pleased by this idea, and could now see the legitimately of her needs and allow for more self-care and reliance on others.  

It’s hard to understand in advance what hidden experiences might impact our current functioning. Sarah herself was surprised that her early experiences of being denied help were behind her current driving aversions. She knew something was off, and had been diligently seeking help, but logically understanding that her fears were unfounded was not making things better. I believe the magic of EMDR comes from being able to tap into the unconscious patterns that stay locked in our nervous system and being able to unlock their power so that more adaptive patterns can emerge. For Sarah, her fear of driving to new locations has all but disappeared.