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appendix c emdr therapy scripts resource development steps affect management and behavior change shapiro 2013 pp 70 71 1 resource client identifies the needed resource or affect management skill examples ...

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                         Appendix C
                         EMDR Therapy Scripts
                             RESOURCE DEVELOPMENT STEPS—AFFECT MANAGEMENT  
                                                     AND BEHAVIOR CHANGE
                         (Shapiro, 2013, pp. 70–71)
                           1. Resource
                               Client  identifies  the  needed  resource  or  affect  management  skill. 
                              Examples: calm place, container, breathing technique, courage, focus, 
                              and so on.
                           2. Image
                               Client images a time, activity, or place (real or imagined) when that 
                              resource had been successfully used.
                           3. Emotions and sensations
                               Client focuses on image and feelings and identifies location of positive 
                              sensations associated with the resource.
                           4. Enhancement
                               Clinician verbally enhances the resource with guided imagery stressing 
                              its positive behavior, feelings, and sensations.
                           5. Bilateral stimulation
                               Once enhanced, add several brief sets of bilateral stimulation (BLS 6–8 
                              slow passes).
                               “Bring up your resource and those pleasant feelings.” (BLS 6–8 slow 
                               passes.)
                                                                                                                383
           Copyright Springer Publishing Company. All Rights Reserved.            
           From: An EMDR Therapy Primer, Second Edition                           
           DOI: 10.1891/9780826194558.ap03 
       384  Appendix C 
         Repeat several times if process has enhanced client’s positive feelings 
       and sensations. If not positive, consider returning to step 1 and identify 
       another resource.
         6. Cue word
          Have client identify a word or phrase that represents the resource. Use 
         that word/phrase to verbally enhance the pleasant feelings and sensa-
         tions. Once fully accessed, further enhance by using a short set (BLS 6–8 
         slow passes). If positive, repeat several times. If negative, return to step 1  
         and consider an alternative coping skill.
         7. In order to avoid premature linkage with trauma material, no BLS is 
         used from this point on.
         8. Self-cuing
          Instruct client to repeat procedure on her own, bringing up the image of 
         the resource and its positive emotions and sensations.
         9. Cuing with disturbance
          Have the client think of a recent, mild disturbance then instruct her to 
         imagine how using her resource would have helped in managing the 
         situation. Guide client through the process until she is able to experi-
         ence positive emotions and sensations.
        10. Self-cuing with disturbance
          Without any help from the clinician, have the client think of another 
         mild, recent disturbing event, imagining using the resource and experi-
         encing positive emotions and sensations.
        11. Keep a TICES Log
          A TICES log is used to evaluate the effectiveness of the calm (safe) place 
         or any other stress management strategy being used by the client.
                  CONTAINER EXERCISE
       At the end of an incomplete session, the client is encouraged to “contain” 
       whatever aspects of their trauma that still linger. This entails the client plac-
       ing their residual trauma in a container of their choice.
         Containers may be as simple as a box, a jar, or vase or as complex as a safe 
       that is thrown into the bottom of the ocean, key box buried in their backyard, 
       or having it bound by bubble wrap and duct tape and placed in the closet.
         Some clients may wish to place a sign on the container stating, “Do 
       not open until next session” to lessen their contact with the thoughts of 
       the trauma between sessions. Others, who are unable to visualize with any 
       success, may wish to write whatever they are upset about on a piece of 
       paper and place it in a box or put it into a drawer. And still others may wish 
                                                                      Appendix C      385
                   to leave residue of the nearly reprocessed trauma in the therapist’s office. 
                   The container visualization may be reinforced and strengthened with slow, 
                   short sets of BLS. For a more comprehensive example of this container exer-
                   cise see Murray (2011).
                       Dr. Shapiro (2001) suggests using vertical eye movements when closing 
                   an incomplete session because of the calming effect they appear to produce.
                                             BREATHING SHIFT
                   (Shapiro, 2006a, p. 46; 2013a, pp. 72–73)
                   Here is a scripted version of the breathing shift:
                   Clinician:  Bring up a positive memory . . . a memory that is a good or happy 
                   memory.
                   Client:  Okay.
                   Clinician:  Just notice where your breath starts and then place your hands 
                   over it.
                   Client:  Okay.
                   Clinician:  (Pause) Just notice how it feels. Good. (Pause) Bring up a memory 
                   with a low level of disturbance. (Pause) Notice how your breath changes. 
                   (Pause)  Place  your  hand  over  the  location  where  you  feel  the  change. 
                   (Pause) Now place your hand where you had it before and deliberately 
                   change your breathing pattern accordingly.
                       If this technique does not cause the disturbance to dissipate, try some-
                   thing else (e.g., spiral technique).
                                            SPIRAL TECHNIQUE
                   (Shapiro, 2006a, p. 46; 2013, p. 73)
                   A scripted version of the spiral technique follows:
                   Clinician:  Bring up a disturbing memory and concentrate on body sen-
                   sations that emerge. This is an imaginal exercise, so there are no right or 
                   wrong responses.
                   Client:  Okay.
                   Clinician:  When you think of the original event (or incident), on a scale from 
                   0 to 10, where 0 is neutral or no disturbance and 10 is the worst disturbance 
                   you can imagine, how disturbing is the event (or incident) to you now?
                   Client:  Nine.
       386  Appendix C 
       Clinician:  Where do you feel it in your body?
       Client:  In my stomach.
       Clinician:  Concentrate on what you are feeling in your body. Imagine that 
       the feelings are energy. If the energy is going in a spiral, what direction is it 
       going? Clockwise? Or counterclockwise?
       Client:  Clockwise.
       Clinician:  Good. Focus on the feelings and change the direction of the spiral 
       to counterclockwise. Just notice what happens as you do.
       Client:  Okay.
       Clinician:  What happens?
       Client:  The sensations seem to be lessening.
         If this technique is working, the client’s sensations may dissipate and 
       the Subjective Units of Disturbance (SUD) level may drop. If it does not 
       work, try something else (e.g., breathing shift).
                 LIGHTSTREAM TECHNIQUE
       (Shapiro, 2013, p. 72)
       A stress management strategy the clinician can use with the client is the 
       Lightstream Technique. Utilizing this technique, the clinician asks the client 
       to concentrate on an upsetting body sensation and helps the client identify 
       the shape, size, color, temperature, texture, and sound, by asking, “If it had 
       _____ (fill in the blank), what would it be?
         Example: Sam is talking about his mother and is getting more and more 
       upset. He keeps getting cramps in his chest as he continues to talk. The 
       therapist instructs Sam to focus on the cramps in his stomach. The clini-
       cian says, “If it had a shape, what would it be? (Pause) If it had a size, what 
       would it be? (Pause) If it had a color, what would it be? (Pause) If it had 
       a temperature, what would it be? (Pause) If it had a texture, what would 
       it be? [Pause] If it had a sound, what would it be?” (Pause) What is your 
       favorite color you associate with healing?” (Shapiro, 2012)
         The clinician then says, “Imagine that this favorite colored light is com-
       ing in through the top of your head and directing itself at the shape identi-
       fied above in your body. Let’s pretend that the source of this light is the 
       cosmos, so the more you use, the more you have available. The light directs 
       itself at the shape and resonates, vibrates in and around it. And, as it does, 
       what happens to the shape, size, or color?”
         If the client reports that the shape is changing in any way, the clinician 
       will repeat a version of the underlined portion below of this technique and 
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