Tuesday, May 15, 2012


Submitted without comment:

"Humanism is a rational philosophy informed by science, inspired by art, and motivated by compassion. Affirming the dignity of each human being, it supports liberty and opportunity consonant with social and planetary responsibility. Free of theism and other supernatural beliefs, humanism thus derives the goals of life from human need and interest rather than from theological or ideological abstractions, and asserts that humanity must take responsibility for its own destiny." The Humanist magazine

Monday, April 23, 2012

Cognitive Interweaves

EMDR in the Treatment of Adults Abused As ChildrenI recently read Laurel Parnell's book "EMDR in the Treatment of Adults Abused as Children." Parnell provided a nice overview of using EMDR with clients with complex and early trauma histories. What was quite helpful for me was the transcripts she included of reprocessing sessions with her clients. During my own Part I and II training, the point that cognitive interweaves were to be used sparingly was stressed. As such, I have been quite hesitant to employ many interweaves. I change domains often enough, asking for a body sensation or emotions when the client appears stuck. But reading Parnell's book helped me to recognize looping and stuck points more clearly. Reflecting back on several sessions, I can identify times when new content was continuing to arise without the SUD's decreasing any. The content appeared to cycle on memories reinforcing the negative cognition. No harm was done by allowing the processing to take its course, but I imagine the processing could have been accelerated by introducing effective interweaves.

Wednesday, April 4, 2012

Pressuring a Child

I had an interesting question come to mind while working with a client this week. We are using EMDR to desensitize the memories associated with her negative cognition "I'm a bad person." The target involves the memory of being sexually abused at 9 years-old. We have used many ego state interweaves to maintain an optimal level of processing--since she often dissociates when overwhelmed. She also has trouble accessing much of the emotions involved despite her eagerness. We began by having her adult self communicate caring and love to the 9 year-old in the memory. She has also begun to be able to switch into the child's perspective for short periods without dissociating. Her adult self is attempting to encourage the child to allow the memory to progress by providing reassurance and comfort. But it made me wonder whether we are applying extra pressure to an already traumatized 9 year-old girl? Or is that pressure necessary to help unburden the child with the trauma? I wonder if the answer lies in between these dialectic views.

Saturday, March 31, 2012

Exposure to Voices?

It has been a busy couple of weeks and I have much to write about in the near future. Today I want to mention a book I recently read by Edna Foa, a top researcher of prolonged exposure, entitled "Stop Obsessing." Foa describes the basic premises of exposure therapy for the treatment of different types of OCD. What struck me was one of the examples used in the book. A client was experiencing an obsessive thought r that God was going to kill her. As an exposure treatment, a tape was made with a man's voice telling her "I will kill you" which she listened to repeatedly. This treatment reduced her subjective distress.
What differentiates an obsessive thought from a "voice" that people hear inside their heads? Many clients describe the incredible distress they experience from the messages their voices articulate. I often hear clients tell me that they hear voices repeating messages such as "you're bad/ugly/a failure/worthless..." or telling them to "kill yourself/ kill your children..." Could Prolonged Exposure therapy be used to desensitize the distressing messages from a person's voices? In researching further for this post, I was unable to find much research on this question. Romme & Escher appear to be conducting some fascinating research on voice-hearing that goes beyond the confines of a schizophrenia diagnosis. Several other studies (1, 2, 3) appear to be asking unconventional questions.  Also, Paul Miller is researching the use of EMDR with hallucinations. Much more research needs to be done before I would consider using exposure therapy or EMDR on hallucinations, but it sounds like an exciting area of research.

Monday, March 12, 2012

Great Washington Post Article

An important article in the Washington Post on the overuse of atypical antipsychotics: 

"Until the past decade these 11 drugs, most approved in the 1990s, had been reserved for the approximately 3 percent of Americans with the most disabling mental illnesses, chiefly schizophrenia and bipolar disorder; more recently a few have been approved to treat severe depression.

But these days atypical antipsychotics — the most popular are Seroquel, Zyprexa and Abilify — are being prescribed by psychiatrists and primary-care doctors to treat a panoply of conditions for which they have not been approved, including anxiety, attention-deficit disorder, sleep difficulties, behavioral problems in toddlers and dementia. These new drugs account for more than 90 percent of the market and have eclipsed an older generation of antipsychotics. Two recent reports have found that youths in foster care, some less than a year old, are taking more psychotropic drugs than other children, including those with the severest forms of mental illness.
In 2010 antipsychotic drugs racked up more than $16 billion in sales, according to IMS Health, a firm that tracks drug trends for the health-care industry. For the past three years they have ranked near or at the top of the best-selling classes of drugs, outstripping antidepressants and sometimes cholesterol medicines." 
Please read the entire article

Sunday, March 4, 2012

Voices from Trauma

"Go walk in traffic," one client's voices regularly command. I was recently talking with a colleague about the experience of hearing voices that other people cannot hear. She talked about a movement to understand the phenomenology of voice-hearing--understanding the person's own experience. They will ask the client when they began hearing voices, whether its a man or woman's voice, young/old, a voice they recognize, what is being said, when...? Members of this movement ask voice-hearers "what has happened to you?" with the perspective that hallucinations are often the result of trauma.  In contrast, many conventional therapists/psychiatrists will automatically assume a biochemical imbalance is the only source of the hallucinations, requiring "medication compliance."

I would hesitate to assume that all hallucinations originate from trauma. On the other hand, hallucinations are clearly a part of complex PTSD presentations in some cases. If all hallucinations were simply biochemical manifestations of purely genetic origin, why would intelligible speech be so commonly heard? Why wouldn't there be more random noises--birds, random words, or tones, etc? Instead, coherent, complex sentences are often heard which also often interacts with the environment. It makes me wonder, in the cases of trauma, whether coherent voices represent negative cognitions which could be conceptualized as being held in another ego-state or dissociated state. 

Sunday, February 26, 2012

Cognitive Interweaves

A client and I were reprocessing a memory of his sexual abuse. After a number of successive sets of eye movements, he reported continuing to feel "sad and alone." I asked the client to identify someone who has been supportive in his life. We then continued processing with the thought of that person, with good results. Once in a while, a client becomes stuck during EMDR reprocessing. Francine Shapiro explains, "these clients often enter into cognitive and emotional loops that are not amenable to the simpler EMDR interventions." A cognitive interweave can be used in EMDR to restart processing. It involves the therapist identifying information that assists the client in connecting a more positive neuro-network with the abuse neuro-network. 
Robin Shapiro has pioneered a technique she has named the Two Hand Interweave. "Shapiro uses the Two Hand Interweave when a client is stuck between two varying positions, ambivalent about choices, NC/PC, (Negative Cognition/Positive Cognition) past/present view of self or others, and other adaptations." I have only limited experience with this technique so far, but it reminds me of the two handed reflection in Motivational Interviewing, which I use abundantly. 
As an aside: I wonder if bilateral stimulation could be used at any point during the Contemplative Stage of Change with Motivational Interviewing in assisting clients resolve their ambivalence about a specific change.