Arguably the most important step in EMDR treatment is the preparation phase. Since the EMDR process involves recalling disturbing memories, feelings and sensations, it is of utmost importance for clients to have tools to manage those and stay within their “window of tolerance.” Window of tolerance, a term coined by Dr. Dan Siegel, is now commonly used to understand and describe the body’s autonomic nervous system response to stress and trauma. The “window” is the state of our nervous system that is neither under (hypo) or over (hyper) aroused, but in the state of “rest and digest.” For most clients, the preparation phase will take from 1-4 sessions. For others with more complex histories of trauma/adverse experiences, it can be much longer. The following are some tools an EMDR trained clinician will teach a client to manage their stress response and allow them to comfortably go about life as normal during the treatment.
In this exercise, the clinician will ask the client to think of a place, either real or imagined, where the client feels completely safe and calm. The clinician will ask the client to fully engage the senses and imagine the scene, including temperature, smells, sounds and other sensations. Once the safe/calm space is identified, the clinician will ask the client to notice how their body feels when thinking about this space. For this to be an effective tool when distressed, the client should feel no discomfort when bringing the image to mind and should notice a mental and physical shift that will clear the client’s mind of distressing thoughts, decrease heart rate, slow the client’s breathing and relax the body. The clinician will then have the client practice shifting “states” by thinking of something mildly disturbing and noticing how their body reacts, followed by imagining their space and noticing the mental and physical shift. The more the client uses this in and outside of session, the effect is strengthened and becomes easier to access when needed.
This tool is used at the end of session to provide a mental holding space for whatever content is being processed to be placed until next session. It is also helpful when the client’s thoughts outside of session are such that they are too distressing for a client to manage at any given moment. The clinician will ask the client to imagine a container that is large enough to contain whatever the client needs to put inside and also comfortable enough so that whatever is placed inside will stay inside. The container should have a two-way system, in which big thoughts and feelings can be placed at once and small amounts can be accessed at a time. A client may choose a barrel with a spout at the bottom, or a jewelry box with a spinning mechanism to select one item at a time. Clients tend to get creative with this one! Just like the safe/calm space, the clinician will have the client practice using this tool in a similar way, noticing the physical and mental shift when placing thoughts and feelings inside. Clients will continue to “process” the material being targeted outside of session and it is essential that the client have this container to avoid undue distress in between sessions. Whatever the client chooses to place there will inevitably be retrieved and processed in session under the direction and care of the clinician.
There is no one size fits all resource. For whatever reason, a client may not find these two tools to be effective. There is no right or wrong here. The clinician and client can get creative and tailor the tools to fit each individual. Deep breathing exercises like Yogic Breathing, yoga stretching, aromatherapy and music can be just as effective. What is most important in EMDR treatment success is finding a clinician who will meet the client where they are and is willing to experiment with different tools and strategies to make the treatment process not only effective, but manageable.
If you are interested in learning more about EMDR or would like to schedule an appointment, reach out through the contact page or call our office.
This article was written by Tonya Nowlin, MA, LPC. To learn more about Tonya please visit her bio.