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Limitations of EMDR Therapy Standard Protocols
Sandra Paulsen and Katie O’Shea observed the limitations of standard EMDR therapy protocols when applied to early injuries, specifically:
1) there is no explicit memory in the first years of life, only implicit memory, so the standard procedure of targeting a memory of trauma could not apply;
2) if a client were able to access early experience in EMDR therapy, it could easily be overwhelming, without adequate preparation;
3) early experience, when accessed, also accesses the client’s felt sense from that early time, with all the limits of self and inner structure that went along with pre-natal, infant, and early childhood developmental stages;
4) because of the paramount importance of relationship and caregiver attachment in infancy, the processing of early experience required modification to ensure the client had the felt sense of the therapist’s compassionate and attentive presence; and,
5) because very early experience is ephemeral and does not consciously register as pictures or videos (as later memories may do), the process needed to explicitly accommodate the subtlety of some early processing. For all these reasons, a four step protocol was developed.
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The Four Steps of the Early Trauma Approach
Early Trauma reprocessing includes the following steps to provide remedies to the limitations of standard EMDR therapy approaches previously described. (Please note that there is substantially more involved in the treatment than is described in this brief summary.)
1) Cultivating structured containment of all experience yet to be “learned from or sorted through,” to leave a clear “emotional desktop” for the work to take place;
2) Developing a felt sense of safety as a starting point for the work, which is achieved by tapping into and strengthening a naturally occurring (but sometimes hidden) “safe state” in the body. Both steps 1 and 2 may require client practice;
3) The most mysterious step-—resetting the affective circuits–involves clearing the emotional pathways that develop in each of us early on during our development in the womb, but which may be congested from maladaptive early learning and inhibitions about whether emotions are okay and safe. Once the circuits are clear, they can function as they were intended, to conduct emotional information between the brain and the body. This step may work directly on subcortical affective circuits, according to Jaak Panksepp, researcher and author of the groundbreaking book, Affective Neuroscience. For individuals with complex trauma histories and/or emotional dysregulation and imbalance, there may need to be additional preparation, most commonly ego state work; further education about healthy emotion, brain functioning and/or trauma; and sometimes somatic work; and,
4) Clearing the early trauma, which happens by processing small time periods, beginning with a time before conception (necessary owing to generational, cellular memory), then moving on to conception, gestation in the womb, birth, and on through the first few years of life. These time periods are variable with the client, depending how “gnarled” the roots of the tree appear to have become by growing around early obstacles. The clearing may be of somatic/implicit memory or of explicit memory, or mental constructs related to the time periods. For each time period, if it doesn’t resolve spontaneously, there is an imaginal good outcome of “what you needed, the way you needed it to be.”
As already mentioned, there is much more to the Early Trauma Approach, but for many individuals, the careful application of these steps produces a critical emotional shift with subsequent increase in emotional stability, comfort, and peaceable relation to one’s emotions and the self.
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The Mechanics of the Early Trauma Approach
The experience of the infant is almost entirely a felt sense; there is not much cognitive happening at the beginning. Therefore, when the therapy taps into those early felt senses, it often occurs without as much access to the more conscious and cognitively informed resources usually available to adults. Because of its central role in early life, this felt sense is an ideal entry point for attending to early, emotionally overwhelming experience so that it can be reprocessed and cleared.
As we are relying upon the most primitive information available to reprocess early experience, the standard EMDR therapy modality of eye movements or taps conducted with equipment may be too scary, too technical, and too alienating for some. Therefore, the reprocessing is facilitated by tapping on the client’s ankles, while the client sits in a comfortable, reclined position. Because the processing may occur over a period of hours, people often want to take off their shoes. This certainly makes it easier to tap on the ankles, and is mentioned here because people sometimes wish they’d worn different socks!
Early trauma reprocessing is designed to come in from the beginning, ‘under the floor-boards’, so to speak, so it is typically quite gentle and tolerable. Grounding is needed much less than in standard EMDR therapy procedures. People learn a lot about their own story in this lovely and very powerful procedure.
Highly dissociative people are only appropriate for this method if they have already established considerable groundwork in therapy and the self-system is likely to allow the work. I am experienced in working with dissociative clients and addressing concerns protective parts may have. If you are dissociative and, after the initial evaluation, it seems appropriate (safe) for us to work together using the early trauma approach, it will require that you have an ongoing therapeutic relationship to receive you after leaving the intensive work, assuming you won’t be working with me in Seattle in conventional (weekly-to-week) therapy. It will be necessary for you to grant written permission for me to collaborate with your primary therapist before and/or after your work together.
Why an Intensive, Concentrated Treatment?
Although early trauma reprocessing can occur piecemeal, from week to week, hour by hour, this is terribly inefficient and not particularly cost-effective, as the early trauma healing work can take many months when done on a weekly basis. The ideal way to experience this type of reprocessing is in extended, face-to-face sessions. Because the work is subtle, deep, and more felt than thought about in a conscious way, extended sessions allow the work to unfold viscerally and deeply. It’s akin to being on a commercial flight from Seattle to San Francisco versus a flight from Seattle to Tokyo: yes, you get somewhere in both cases, but if you’re on the long-haul flight, you’re up in the air longer, you move more quickly, and your fuel efficiency is significantly better.
It is not easy to predict whether a client will need one, two, or more intensive treatments to clear the entirety of early disturbances and replace it with a felt sense of well-being. This goal is typically possible, but not necessarily easy to schedule or predict. Most people who have participated in intensives require two to three days, or in many instances, a number more days, to clear the first few years. The time required is variable, based upon how many traumatic experiences there were, how much neglect there was, and how maladaptive the learning outcomes were from those experiences. (Note that it’s not you as an adult who decides all of what was traumatic in those early times. Your brain and nervous system began doing that for you long before you were even consciously aware that wounding was taking place.)
Diagnostic assessment involves looking at the following: 1) your present safety and stability; 2) your capacity for experiencing emotion and body sensation; 3) any internal conflicts that may complicate or block trauma resolution; 3) medical concerns; 4) substance use; and 5) any evidence of structural dissociation, which would require additional assessment and preparation prior to embarking on trauma resolution work of any kind. Biographical assessment covers areas of your history such as work, education, military service, nutrition and self-care, basic family history, spiritual and cultural experience, and so on. Then you’ll be primed and ready for the work to begin at your first in-person meeting.
Preparation for Intensive, Concentrated Treatment
First, there needs to be agreement between you and me that this approach is appropriate for you, your story, and your needs. This format of treatment isn’t for everyone. Sometimes the time devoted in session to collecting history can be curtailed if you are able to provide a written narrative to include key areas of functioning: where you were born and raised; how far you have progressed in your education; specific ‘sticking points’ or ‘hot spots’ related to your family relationships; medical and psychological treatment history; work history; and, related matters. Regardless, there may be some areas that it will be necessary to look at together, in person, owing to the sensitivity of some subject matter.
If you are local, you may consider scheduling one or two sessions to accomplish the preparation steps of the early trauma approach, because then the time set aside for intensives can be most effectively used for clearing early traumatic experience. Those preparation steps are described above, but typically include: 1) container imagery, 2) establishing a safe state or other resources, 3) resetting the affective circuits.
For some people, more complex maneuvering is involved in preparation, including getting the self-system ‘on board’ with the treatment, as well as introducing information about the function of emotions (and the fight, flight, and freeze responses) and how they operate in all mammals for survival and safety. We will also make certain that you can look at emotions from a distance and not just feel taken over by them willy-nilly. This is an important piece in ensuring successful reprocessing.
In some instances, additional assessment and evaluation may be indicated before embarking on the journey of intensive early trauma work, to better ensure your safety and strength in the face of reviewing, releasing, and repairing your old, unhealed emotional wounds.
During and After Early Trauma Clearing
On the first day of the intensive, you and I will ensure that all the necessary preparatory steps have either already been undertaken, or else you’ll begin there in the work together.
It is not unusual to feel ‘drained’ after early trauma reprocessing has taken place. Most people don’t want to do much in the evenings after an intensive session. The work is profound and will require time set aside for introspection or just plain rest. Self-care is key in this work, so plan on drinking plenty of water, getting plenty of sleep, inviting yourself to dream, eating good food, maybe taking some anti-oxidants because you’ll be releasing energetic holdings. Fruits and vegetables will be put to good work in reconfiguring your new you. If you’re traveling from a different time zone, ensure you are taking Melatonin or some other supplement (as approved by your primary care physician and/or psychiatrist, as appropriate) to manage the effects of jet lag.
After the work, your nervous system will be “knitting and purling” for a time, and this is usually gentle and comfortable. Occasionally, if we ran out of time in a particularly hurtful ‘baby’ spot, you may feel stuck there. It’s always important, in the midst of our work, to let me know if you need help in person or by phone moving through such a spot.
Please keep in mind that any unusual experiences during the work or in the time right after the work may be related to the work. Think of them as ‘vapors leaking up from an underground vault’. So, for example, if your spouse, partner, or a good friend seems, for whatever reason, suddenly to resemble demon spawn, consider the possibility that something about the early work has a theme of demon spawn in it somewhere. Similarly, if it seems to you that your therapist is suddenly just like the meanest parent ever, please mention this, because, although it may have a basis in present time, then we’ll consider that, often those kinds of feelings and perceptions are part of the client’s story, telling itself without words. We use information in the room and about what is happening between us as clues to that story. We’ll be detectives together, and we’ll hear your story together, however it seems to want to be heard.
The most common unsettling experience after early trauma work is to feel oddly inert or flaccid. This seems to be part of a baby state, as if baby is just sitting, waiting, not mobilized for much action.
I feel very honored and gratified to do this important early trauma work my clients. I very much consider this work a sacred trust. It is my deep privilege to hear the story of ‘baby’ you that may never have been told or heard before, except in symptoms or reenactments. I am here to help you review, release and repair very early experience in a way that provides a felt sense of well-being.
Spend a little time before we meet identifying, if you don’t already know, what your highest resource is, and what your relationship is to the spiritual realm. Then we, together, can support your process in a way that makes sense to you, on your own terms. This is the most helpful way I know to repair very early injuries, hurts, betrayals and disappointments.
Frequently Asked Questions about Early Trauma Clearing with Michael
How can I know if intensive treatment for early trauma and neglect is good fit for me?
1. If you arrived to my website ‘cold’, and are not currently in therapy, then there are some things you need to consider before thinking this is right for you:
- Have you been in therapy for years, with multiple providers, without finding the resolution you’ve hoped for?
- Has a previous therapist used EMDR therapy in your treatment without successful, permanent clearing of disturbance for even a single target memory?
- Do you find yourself wanting to ‘push through’ what feels like strong internal resistance in order to do early, or even later life, trauma work?
- Do you suspect that there’s ‘something going on’ for you inside, but no one’s ever given it a name, or recognized it? Does it seem pervasive or intrusive in your life?
- Do you have a sense or hope that you’d like the early trauma work to happen as if by ‘magic’, as though it might erase years of hurt and pain?
- Do you find yourself thinking that this would be a good alternative to engaging in ongoing therapy–just so you can ‘get it done’ or ‘get through it’?
If you responded ‘yes’ to any–or a number–of these questions, then it is worth considering that weekly, ongoing treatment with a therapist who understands and knows how to treat complex trauma and dissociation may be a better fit in the short term, to clarify what’s actually happening for you and prepare you for early trauma work. You can find such therapists in your area with a background in complex trauma and dissociation via the International Society for the Study of Trauma and Dissociation.
2. It will be necessary for a therapist to refer you to me for early trauma clearing, to ensure that any necessary assessment for dissociative symptoms and more complex preparatory work has been taken care of (see #3 below). You can direct your therapist here on my site to get more information about how to facilitate a referral.
Once a referral has been made by your therapist and I’ve agreed that this seems as though early trauma clearing is viable, we can arrange an initial 20-30 minute phone consult free of charge, during which time I will address any lingering questions I may have and answer your questions, as well. I may follow up with your therapist once we’ve completed our phone consult, and it will be at this point that I can determine whether it’s appropriate to move forward. Hereafter, we can begin to plan treatment and schedule time to meet.
3. Highly dissociative people (in other words, a diagnosis beyond Complex PTSD) are only appropriate for this method if they have already established considerable groundwork in ongoing therapy and the self-system is likely to allow the work. I am experienced in working with dissociative clients and addressing concerns protective parts may have. If you are dissociative and, after the initial evaluation, I agree that the early trauma approach is appropriate at that time, it will require you to have an ongoing therapeutic relationship to receive you after leaving the intensive work, assuming you aren’t working with me on a weekly, ongoing basis, as well. It will be necessary for you to grant written permission for me to collaborate with your primary therapist before, during, and after early trauma clearing.
How much time does early trauma clearing take?
4. It depends on how much unconscious material is there to work through. Many people need three or four days, some need five, sometimes more. If your budget permits only one or two days, then you may not get as far as you’d like, but you’ll be better off than without any of the early work, because it’s akin to laying a new foundation at the base. It integrates, bottom up.
5. It isn’t possible to rush this process, though I am very focused on how we use our time. It’s simply not possible to skip resourcing or, in many instances, to blow past working through internal conflicts prior to working with baby, and both will be revisited as needed throughout the work. It’s simply impossible to avoid dealing with any internal, protective ‘roadblocks’ that comes up. Those roadblocks are invariably there for good (often historical) reasons, can’t tell time, and are simply doing their job to keep life chugging along. Resourcing and ongoing consent from the self-system, simply put, form the scaffolding that supports the work and makes it possible. Fortunately, there are some efficient ways to address both of those issues, for many people. These are issues that determine the pace of the work and rate of progress.
How much does intensive work cost?
6. For intensive treatment, you will owe $125.00 for each 45 minute “hour” you spend with me face-to-face. We will collaborate on when to take breaks and how long to work. It’s easy to misunderstand this point, with some thinking that the fee is $125.00 per clock hour, but this isn’t the case. The basic unit of time measurement for intensive work with me is 45 minutes, so all fee calculation is based on that unit/rate. The total cost is ultimately determined by how many knots there are in the tapestry that is you and your story.
If the work goes from 9:00am until 12:00pm, and then again from 1:00pm to 4:00pm, on a particular day, then this does not translate to 7 hours x $125.00 equals $875.00. Rather, the cost is determined by the following:
The total number of treatment minutes (which I closely track), not including breaks and lunch, divided by 45 (the basic unit of time per session), multiplied by $125.00 for each 45 minute unit. According to this formula, if we worked from 9:00am to 10:30am, with a 15 minute break, then 10:45am to 12:00pm, that equals 165 minutes. In the afternoon, if we worked from 1:00pm to 3:00pm, took a 15 minute break, then worked from 3:15pm to 4:00pm, that equals another 165 minutes. This equals a total for the day of 330 minutes, divided by 45, equals 7.333 units, multiplied by the rate of $125.00, which leaves us with a grand total of = $916.67 for that particular day.
7. You will pre-pay for the bulk of the work, on the following schedule:
The deposit is due at the time of scheduling to reserve the time for you, based on the number of days you are reserving—unless you have made other arrangements with me for payment of the deposit.
Pre-payment is due two weeks before the intensive, assuming that you will incur, at minimum, $750.00 (six 45 minute sessions) per day in fees:
|# of Days||Deposit||Additional Pre-Payment||Total Paid Upfront|
|1 Day||250.00 USD||500.00 USD||750.00 USD minimum|
|2 Days||500.00 USD||1000.00 USD||1500.00 USD minimum|
|3 Days*||750.00 USD||1500.00 USD||2250.00 USD minimum|
*Please note that, currently, my schedule can accommodate only two consecutive days of intensive work.
8. At the close of the intensive sessions, you will owe any remainder over and above the $750.00 per day already pre-paid. It is typical for people to engage in somewhere between six and nine 45 minute ‘hours’ per day, so you may owe up to $1125.00 for a really ‘full’ day. So, although you prepaid $750.00 for each of, for example, two days ($1500.00), if you actually worked for eight ‘units’ on the first day and nine on the second day, you’d owe an additional $625.00 on the last day. If you have an absolute budget, please notify me of this ahead of time so that you can collaborate to use an appropriate amount of time. If you do not notify me ahead of time, it could have a significant, unforeseen impact on the treatment outcome. If you know that you do not want to participate in longer days, please notify me ahead of time so that I can adjust my schedule to accommodate both your and other clients’ needs.
How does payment work, and will insurance pay for it?
9. Pay As You Go. Many people find the cost challenging, needing to save for some months or more to be prepared to pay for the work prior to undertaking the work. Sorry, but I cannot carry balances or do ‘IOUs’ over the course of the work, so it’s important to schedule ONLY once you are ready financially for such a large commitment.
10. Payment for intensive treatment may be made via the following methods:
- Personal or bank check, or money order
- ACH bank transfer through Chase QuickPay
- Direct credit card payment with Visa, Mastercard, American Express, and Discover
- FSA and HSA cards (I am considered a ‘health care’ designated merchant by his credit card processor)
If I have not received payment by the specified due dates (unless other arrangements have been made), the time you have reserved will be released in favor of others’ scheduling needs.
11. Insurance: Insurance is unlikely to pay for this treatment. I do not accept private insurance, but I can make available to you a receipt for you to submit to your insurance company if you request it.
What is the cancellation policy for intensive treatment?
11. Due to the amount of time being held for you when you schedule an intensive as part of your healing, the cancellation policy, for any reason, is as follows.
• Cancellation after paying deposit : No return on initial deposit, but the payment may be applied to future work if you reschedule.
• Cancellation after additional pre-payment is paid, and more than one week prior to doing intensive sessions: 50% of additional pre-payment will be returned. No return on initial deposit.
• Cancellation for any reason after additional pre-payment is paid and less than one week prior to intensive sessions: None of pre-payment will be returned. No return on initial deposit.
• Cancellation after intensive has begun. None of pre-payment will be returned. No return on initial deposit.
What steps need to take place prior to intensive treatment?
12. Your initial deposit saves the dates you have arranged with me.
13. You’ll need to register ahead of time, and those forms will be available to complete once we have agreed to an initial intake session. All of the registration forms will be made available via the secure portal, aside from the form required for me to speak freely with your current therapist (if applicable). I will guide you through that piece directly.
14. I generally schedule an initial appointment in person or by phone/secure video link in order to conduct a ‘proper’ assessment. History taking may occur remotely either through the secure portal or in person, depending on your situation. The most important reason for the initial assessment is to make certain that an intensive approach to treatment is appropriate for you, your story, and your needs. It isn’t for everyone.
15. For some people–especially those who have not previously had their symptoms thoroughly evaluated–additional assessment and preparation may be indicated before launching into intensive early trauma work, to ensure your safety and strength in the face of reviewing, releasing, and repairing trauma.
16. If you are nearby and using the intensive for the purposes of treating early trauma, you may opt for one or two sessions to begin/complete the preparation steps for early trauma clearing. Then, the time set aside for the intensive itself can be most effectively used for clearing early traumatic experience. Those preparation steps are described above, but typically include: 1) resourcing/containment, 2) installing a ‘safe state’ or other resources, and 3) resetting the affective circuits (if applicable).
17. For some people, more complex maneuvering may be involved, including getting the self-system on board (see information about Ego State Therapy elsewhere on this site for more information about this), and familiarizing them with the function of emotions (and the fight, flight, and freeze/collapse responses) and how they operate in all mammals for survival and safety. Additionally, I may employ Sensorimotor Psychotherapy for resourcing/containment work prior to hearing baby’s story. It’s rarely easy to know how much fancy footwork may be required in these instances, or how long it might take. Making certain that the self-system is consenting to the work is non-negotiable. (It’s simply unavoidable–but many find an increased sense of calm merely as a result of addressing long-standing, entrenched internal conflicts.) We’ll also make sure you can look at emotions from a distance and not just feel hijacked by them willy-nilly. That’s a critical piece to ensure success in this–or any–reprocessing work.
18. Before finalizing air travel, if you are traveling from a notable distance, please be certain to confirm that you are in fact on my schedule during the window of time that you understand yourself to be.
19. A deposit to save the dates and prepayment of the minimum likely treatment time are required, and cancellation policies apply. See above for further information about both.
When do we start and end each day?
20. Full days will typically begin at 9:00am, and end between 4:00pm and 5:00pm. Start/end times, though, may be negotiable if I have nothing else scheduled for the day. For information about travel to the office, please direct your browser to my ‘Location & Contact’ page.
What about travel logistics if I'm coming from far away?
21. Seattle is a fabulous city, full of art, music, sport, great food, and everything else under the sun (and the clouds and rain—it is Seattle, after all). If you’re visiting from out of town for your intensive and have never been to Seattle before, it can be a bit of an adventure to navigate. There is one airport, Seattle-Tacoma—known as ‘SeaTac’—to the south of Seattle. My office is very easily accessible via public transportation (both Light Rail and bus), and this mode of transport is highly recommended. Car rental can be a viable option, and there is even on-site parking here and here, for a fee. Another alternative is taxi cabs or rideshare services, but passenger beware: It can get a bit pricey. For more information on public transit in the Seattle Metro area, direct your web browser to http://metro.kingcounty.gov.
Where should I stay?
22. Hotels, motels, B&Bs, we have it all in Seattle. I recommend the following as helpful resources for booking (and with which I am not associated in any way, beyond liking them on a personal level):
Bed and Breakfast dot com
TripAdvisor dot com
Please note that my office is located at 2401 ½ 10th Avenue E, Suite B, Seattle, Washington 98102. Be kind to yourself by using this information as a guide in deciding how close to (or far away from) the work you’d like to be, and how far you’d like to commute, each day.
While I'm at the office there, working with you, where should I eat?
23. Ah, the Downtown and Belltown areas are wonderful, interesting, colorful, lively (and even quiet, depending on where you are)…and my office is located right in between both of them. Tastes vary, so the best way to scout for something tasty is to click/press here to consult the oracle known as Yelp!.
I'm not familiar with the area. What else is there to do nearby?
24. Maybe a better question is, ‘What isn’t there to do nearby?’ There are all sorts of things to do in Seattle–and lots of resources for finding them–and so I suggest starting either right Downtown or in Belltown, as my office location is literally on the boundary separating them. There’s always something interesting going on around here.
Is there anything more I should know about the intensive work itself?
25. On the first day of the intensive, we’ll ensure that all the necessary preparatory steps have either already been undertaken, or we’ll begin there in the work together.
26. It is not unusual to feel ‘drained’ after early trauma reprocessing has taken place. Most people don’t want to do much in the evenings after an intensive session. The work is profound and deserves some time set aside for introspection and just plain rest. Self-care is key in this work, so plan on drinking plenty of water, getting plenty of sleep, inviting yourself to dream, eat nutritious food, maybe take some anti-oxidants because you’ll be releasing energetic holdings. Fruits and vegetables will be put to good work in supporting the healing process. If you’re traveling from a different time zone, ensure you are taking Melatonin or some other supplement (approved by your primary care physician, as appropriate) to manage the effects of jet lag.
27. After the work, your nervous system will be continuing to digest things for a time, and this is usually gentle and comfortable. Occasionally, if we ran out of time in a particularly hurtful ‘baby’ spot, you may feel stuck there. Please please please let me know if you need help in person or by phone moving through one of these spots.
28. Please keep in mind that any unusual experiences during the work or in the time right after the work may be related to the work. Think of them as ‘vapors leaking up from an underground vault’. So, for example, if your spouse, partner, or a good friend seems, for whatever reason, suddenly to resemble demon spawn, consider the possibility that something about the early work has a theme of demon spawn in it somewhere. Similarly, if it seems to you that I am suddenly just like the meanest parent ever, please mention this me, because, although it may have a basis in present time (and my dogs might agree with you, depending on which chew-thing I’ve liberated from them that day), we’ll consider that, often those kinds of feelings and perceptions are part of the client’s story, telling itself without words. We use information in the room and about what is happening between us as clues to that story. We’ll be detectives together, and we’ll hear your story together, however it seems to want to be heard.
29. The most common unsettling experience after the ET work is to feel oddly inert or flaccid for a time. This seems to be part of a baby state, as if baby is just sitting, waiting, not mobilized for much action.