Over the years, people who’ve trained with me have remarked on the reinforcing phrases I use to summarize what I teach. These are phrases they say have really helped them in their EMDR therapy practice. They have dubbed them “Deanyisms.” If they help you, great! If you want to share them or use the art, you’re welcome to. All I ask is that you give credit—Deany Laliotis LICSW © 2018—and link to this website.
For most clients, coming in for symptom relief is their primary motivation. However, the symptoms are often the tip of an iceberg of more deeply rooted issues based in childhood, and not everyone is ready or motivated to approach that territory.
Similarly to the notion that there is work before the work, asking for permission is the prelude to that work. Just because we understand what is needed doesn’t mean we can assume that it’s okay to proceed. It’s often useful to generate curiosity about why the client is struggling and enlist them in exploring the emotional territory.
We often get stuck in our work because the client is not on board with what needs to change. Similarly to the notion that we must always ask permission to proceed, part of the challenge is in helping the client make a conscious decision about what they want to get out of therapy, and, more importantly, that they are willing to explore other ways of getting their needs met that are more adaptive to their lives now, versus engaging in reenactments of the past, hoping for a different outcome.
Part of what clients are not prepared to face is the imperfection of their parents at best, and the way in which they were hurt and abandoned by them at worst. It is not uncommon for adult clients to defend what their parents did or didn’t do, claiming, “they did the best they could.” While that may be true, it doesn’t adequately address the lasting confusion about whose responsibility it was for the “badness” that occurred. It’s always about designating appropriate responsibility for what happened. Children are never responsible for their abuse.
Adults traumatized as children were so busy surviving their childhood, they missed out on important developmental milestones. So, for example, when the client is working on a memory where they learned not to speak up for themselves, the resolution of that memory doesn’t automatically yield to a skill set that includes identifying a need, articulating it to an “other,” and navigating the relational demand of negotiating how those needs can get met.
While the EMDR standard protocol is robust and effective, clinicians frequently get over focused on “doing it right” versus responding to the clinical demands of the situation. While it’s not an either/or proposition, it is common for therapists to get “triggered” by the protocol at the expense of assessing what is needed clinically. The protocol is there as a guide to establish a framework for the work to take place. We teach modifications to the standard protocol in order to help clinicians better respond to what is needed. It’s about how to think about what we’re doing and why; not just to follow a script in order to get it right.
It’s not just about what happened…it’s also about what happened next.
As trauma therapists, we look to identify and process the negative experiences that have had a lasting impact on self and psyche. While that is important, it’s not sufficient. We must also address the collateral damage that is incurred as a byproduct of these experiences. So, for example, if a child is left alone too long and too often, their adaptation to this traumatic situation is to give up on the need for connection, so, in adult life they become avoidant of attachment. So the question to the therapist is, “What did the client learn to do in response to their situation in order to cope?”
When children are left to their own devices in order to survive their situations, they develop adaptations to meet their emotional needs in order to cope. Often, however, these adaptations are habitually applied in adult life, long after the situation has changed, and are frequently overdeveloped, if not obsolete. The clinical challenge is to separate the positive intention of the adaptation from the strategy by validating the need and uncoupling it from the strategy itself. This creates the opportunity to generate more appropriate and flexible adaptations that better meet the client’s needs, both in and out of therapy.
It’s not who they are, it’s about what happened to them.
For clients who were severely traumatized as young children, they hadn’t developed a sufficient sense of self to mitigate the badness in their everyday life. Unfortunately, the negativity of their formative experiences blends with their developing identity as a person, and they are emotionally unable to differentiate what happened to them from their integrity as a person. One of the first steps in the treatment of developmental trauma is to assess the client’s capacity to understand and appreciate this important distinction, so they can begin to observe their reactions, rather than to be blended with the negativity of their experiences.
- November 13 - November 14