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26/03/2020
Who AM I and Why am I talking about this?
How I Use EMDR Clinical Psychologist
I¯ve qmed EMDR mi_ce
EMDR ca_mqlpa_p mi_ce a_d facilipapal mi_ce
Online I¯ve walked i_ camilex plaqma melvicem ilimaly cale a_d IAPT am well am i_ _eqladevelaime_pal peamm ilivape ilacpice a_d with the Metropolitan police.
I_ I maved pa Fla_ce a_d lealimed I caqld_¯p walk am a cli_ical imychalagimp phele q_pil my piple wam lecag_imed
Dr Naomi Fisher I mpalped walki_g a_li_e bqp faq_d phap wiphaqp EMDR I felp I wam_¯p affeli_g mqch a gaad melvice.
EMDR Consultant and Facilitator (EMDR-Europe) I started experimenting with preparation techniques and then moved onto using the full 8-phase protocol.
Clinical Psychologist .
naomicfisher@gmail.com
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But Paths are made by
I learnt the things that can walking
go wrong the hard way
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Before the SEssion
This isn¯t the only way or • Make your life easy. Use one platform. I use Zoom.
• Da_¯p mweap phe mmall mpqff Thim im_¯p yaql cli_ic laam fal ma_y clie_pm we wa_¯p be able pa leiladqce phe mame
conditions. We need it to be good enough.
necessarily the best way • You may or may not want to send out guidelines
• Clie_pm ale afpe_ a_xiaqm Be ca_fide_p phap phim ca_ walk a_d phap eve_ if ip¯m plicky fal phem pa gep ca__ecped ip will
be worth it.
There will be many other ways which will work too. • Always have a back up § iha_e _qmbel Skyie ID Whap¯m Aii whapevel walkm
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The First SEssion Risk
• You may need to sort out technical issues. See this as part of the introductory work and establishing the space. • Yaq may _ap be able pa cleape a mafe miace fal ilacemmi_g i_ a ielma_¯m hame
• It may initially feel like more of a home visit. You may meet multiple members of the family and people may wander in • Yaq ca_¯p da ihymical glaq_di_g a_li_e
and out. • Yaq ca_¯p mpai a ielma_ flam leavi_g if yaq ale leally ca_cel_ed abaqp pheil wellbei_g They ca_ cqp phe ca__ecpia_ ap
• Check what device they are using.. Zoom can be used on any device where they can get email so many clients may use any time.
their phones. They need to be able to prop it up. • You can record the sessions easily if you are worried that what you say might be mis-reported. Zoom will not record
• Check pheil bappely wa_¯p lq_ aqp you without your knowledge. Clients may record us without our consent but this can happen in person too.
• Check who else is in the room. • Do your usual risk assessment, and make a plan if necessary. Know what you would do if someone becomes very
dimplemmed a_d yaq caqld_¯p heli phem calm daw_ Thim will be diffele_p fal each ielma_
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Ways to make it safer How Do I do BLS online?
• I encourage dissociative clients not to close their eyes when processing online. With their eyes closed, if the sound goes • They ca_¯p fallaw yaql fi_gelm a_li_e a_d yaq • They can download a free app (e.g. Sleep Restore
or their headphones break, you lose all communication. ca_¯p fallaw pheil eyem Based on EMDR by Mark Grant) and then they
• Enlist a co-therapist if one is available (again, this is for dissociative clients). Have their phone number so you can call or • Tapping together works well, and you can vary can use headphones on their own smartphone.
text them. the speed. You need to add some sort of ending. • Thim walkm bemp if phey ale_¯p alma qmi_g phe
• Ask clients to find their own grounding equipment § a cushion, a squishy or stress ball, something to smell, something to • Butterfly tapping is another alternative. You can smartphone to talk to you.
remind them of where they are. do it yourself and they will copy you. • There are various apps which therapists can
• Yaq ca_ alwaym may _a If yaq da_¯p feel phap EMDR waqld be mafe phe_ da_¯p da ip Ume yaql cli_ical jqdgeme_p • My mantra with online work is Keep it Simple. daw_laad a_d mhale wiph clie_pm I have_¯p qmed
these because tapping has worked fine..
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Therapeutic considerations
• Leave space and time for the transition from in-person.
• The unexpected will happen. Roll with it.
What does it look like? • We may fi_d aqlmelvem phe facqm af a_gel flam clie_pm wha wimh phey did_¯p have pa meep qm a_li_e
• Start with preparation techniques to see how it goes. Install a supportive team. Develop resources. You still need to do
everything you would do in person § start with the safe space, the 8-phase protocol and the three-pronged approach.
• The Flash technique (Philip Manfield im ialpicqlally gaad a_li_e i_ my exielie_ce a_d yaq ca_ qme ip if yaq ale_¯p mqle
about full EMDR.
• Progress to trauma processing when you and they are confident.
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What will be different? What¯s great aboqt working online
• No buffer zone § help your clients create one. • We ca_ affel phelaiy pa ieaile wha ca_¯p accemm ip aphelwime
• Things will go wrong and you may well be interrupted. • It enables us to be very flexible.
• Online work is more intense. § your session might feel longer. • Clients feel more relaxed in their own homes or own environment.
• Give yourself a buffer zone. • Peaile ca_ be alaq_d phe memmia_ wiphaqp bei_g ®i_¯ ip § particularly good for children and young people.
• You might be very surprised at how powerful it can be. • It means we can continue to work and clients can continue to benefit from EMDR.
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Case study (ALL IDENTIFYING DETAILS HAVE BEEN CHANGED) Assessment and Risk
• Mary, woman in her mid-30s. • Mary reported no dissociation and had no history of childhood trauma. She had a supportive family whom she was in
• Was planning training for her multi-_apia_al camia_y a_ pheil ialicy a_ mexqal ammaqlpm whe_ mhe mpalped havi_g flamhbackm ®a close contact with. She was able to draw a safe place (on an island), and we installed that successfully..
heavy feeli_g a_ my chemp¯ She wam i_ a lale whele jq_ial emilayeem blaqghp pheil ca_cel_m pa hel i_clqdi_g phame alaq_d • She was able to find a confidential space to do the processing (in a room at work) and her life was stable.
sexual harassment and assault.
• Had had experiences which she had not considered previously assault § but which included being locked in a room for several days • She was highly motivated to engage.
by an ex-partner. When organising the training she had a sudden realisation that she had been assaulted and raped. • Oql i_pel_ep ca__ecpia_ wam gaad e_aqgh alphaqgh mamepimem we caqld_¯p qme videa a_d had pa walk jqmp wiph aqdia
• Naw felp phap mhe waqld_¯p be able pa walk a_d keip phi_ki_g af phe ammaqlpm
• Lived in central Africa, and had no access to EMDR locally. • I therefore felt comfortable with going forwards and using EMDR online with her.
• Demclibed helmelf am ®vely alpimpic¯ a_d laved pa dlaw
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A Triangular Team Starting EMDR processing
• We installed a supportive team. She chose three women. An assertive woman she had known from work, another • We used a time line to make a map of the work we would be doing. She reported several traumatic periods in her adult
_qlpqli_g calleagqe hel maphel ®wha makem me feel I have all phe pime i_ phe walld¯ life, including a relationship which was abusive (and during which she was sexually assaulted).
• Spontaneously she visualised the three women standing in a triangle. • We agreed to start by processing the most distressing memory.
• During the installation she said that the triangle was a shield, and having those women on her side meant that she could • I was led by her in choosing which memory to start with.
pake aff hel almaql She maid mhe had a feeli_g af iawel a_d e_elgy i_ hel ha_dm a_d phap mhe caqld lifp aff phe ®claw_ • She chose to process the memory of supporting a junior employee after he had been sexually assaulted. Image was
af dimaiiai_pme_p¯ mhe felp mhe wale a_d lep ip ga seeing his face when he came to tell her what had happened. We used tapping.
• NC wam ®I am iawellemm¯ PC wam ®I did my bemp¯ Umed paiii_g pa ilacemm Dqli_g phe ilacemmi_g phe PC cha_ged pa ®I
wam a gaad flie_d¯ SUDS came daw_ pa |ela flam pe_
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I Want my Glow back Processing the backpack
• The next week she came back with a story board that she had drawn about all the events in her life which she felt were • Next session she came back with a new picture, of her backpack. It was huge and heavy, and it had all her traumatic
important. experiences inside it.
• She drew herself going through her life, gradually collecting traumatic expereinces into a backpack, which got bigger in each • We ilacemmed phe backiack NC wam ®I am blake_¯ PC wam ®I ca_ iqp phim daw_¯ SUDS wele
picture.
• She also drew a glow inside herself which she felt was diminishing as her life continued. • We took several sessions to process the backpack and she drew it again every time, slightly differently.
• I asked her to go through the story board and we did some BLS on each page § a bit like a frame by frame but using her • Things poked out of the backpack, her feelings and sensations, and we processed them as they came.
drawings. We turned each page and then I tapped whilst she either just looked at the page or told me the story of that part of • During the processing the backpack grew bigger and then started to shrink. She ended with the image of a small
her life. suitcase and said that she felt that this was what she needed to carry with her for now. SUDS were 0.
• Ap phe e_d mhe maid ®My glaw wam whe_ I had all pheme dleamm I wa_ped pa leach Fallawi_g phe dleamm mea_m leppi_g ga af • Bqbblem mpalped pa mqllaq_d phe mmall mqipcame wiph phe wald ®Live¯ i_ phem We i_mpalled phap
aphel phi_gm¯
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Ending outcome
• She went back to edit the training document which had triggered her in the first place, and found that it was no longer •PTSD: IES-R: Assessment: 34, First session: 29, Final session: 0.
phleape_i_g a_d did_¯p qimep hel The flamhbackm had ga_e •Depression: PHQ-9: First session: 6, Final session: 1
• She felt she had discovered that the answers to the questions she had about her life went way back, but that she had
the power to live her dreams in her every day life. •Anxiety: GAD-7: First session: 1, Final session: 0.
• She said she had reconnected with who she was and what was important to her.
• She felt we had unpacked things she had been carrying for years.
• She was able to continue working but also made a plan that in ten years time she wanted to be doing something
different and working for herself.
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Powerful therapeutic work is possible online
• You can create a therapeutic environment online, and it may even feel more powerful than your clinic room.
• Ip will be diffele_p bqp phim im_¯p alwaym a bad phi_g
• This is a time of great uncertainly and anxiety for everyone. Thank you and good luck
• In the short term, our work is likely to be helping our clients stabilise and manage their anxiety. We can use preparation
and stabilisation techniques.
• We can then progress to doing full EMDR online.
• If we face our anxieties, we can help our clients face theirs.
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