When EMDR is Not Enough: Part II - Ego State Therapy
Summary
TLDRClinical psychologist Sandra Paulson introduces the integration of ego-state therapy with EMDR for treating complex trauma and dissociation. She emphasizes the importance of understanding a client's self-system structure and the role of protective ego-states that may hinder EMDR processing. Paulson advises on screening for dissociation and offers resources, including books and workshops, to enhance therapists' approaches to complex PTSD cases.
Takeaways
- 👩⚕️ Sandra Paulson is a clinical psychologist with 25 years of experience in EMDR and complex trauma treatment.
- 🔒 EMDR is highly effective for treating PTSD, but complex PTSD and dissociative disorders require a different approach due to structural aspects of the self system.
- 👀 It's crucial for therapists to screen for dissociation and assess it properly using tools like the MID or DEEs2, which are screening but not diagnostic instruments.
- 🚫 Therapists unaware of a client's dissociation may inadvertently cause distress or ineffective therapy, potentially leading to overwhelming feelings or therapy loops.
- 🛡️ Protective parts of the self system may interfere with EMDR processing, acting to shield the client from perceived dangers, even if the threat is not current.
- 💪 Some protective parts see themselves as fierce defenders, while others may embody 'perpetrator introjects' or 'parent introjects', acting like external figures to the client.
- 🤔 Therapists must discern whether the 'bad stuff' is still happening or if it's a past event, as this affects the protective parts' behavior.
- 📚 Sandra's book 'Looking Through The Eyes of Trauma and Dissociation' provides a perpetrator introject checklist and more on working with introjects.
- 🤝 Therapists need to work with the self system using ego-state therapy to prevent crises and unraveling of survival strategies.
- 🔄 Ego-state therapy is essential for complex cases to align the self system and prevent protective parts from hindering EMDR processing.
- 🌐 Sandra offers workshops for clinicians on these topics through sranklgroup.com and provides more information on her website, www.banbridgepsychology.com.
Q & A
Who is Sandra Paulson?
-Sandra Paulson is a clinical psychologist with over 25 years of experience working with EMDR and complex trauma.
What is the main topic of Sandra Paulson's video?
-The main topic of the video is the use of ego-state therapy in conjunction with EMDR to work with complex trauma and dissociation.
Why is it important for therapists to be aware of the client's self system structure in complex trauma cases?
-It is important because standard EMDR may not be effective or could even be harmful if it does not take into account the structural aspects of the client's self system, which can include dissociative parts.
What is the potential consequence if a therapist fails to screen for dissociation?
-The potential consequences include the client feeling overwhelmed, the therapy being ineffectual, or the EMDR process getting stuck or 'looping' due to the interference of the client's self system structure.
What is the MID?
-The MID (Million Dollar Questionnaire) is a screening instrument used to assess dissociation, but it is not a diagnostic tool.
What is an 'inject' in the context of dissociation?
-An 'inject' refers to parts of the self that may resemble or act like an external person, often perceived as perpetrators or parents, and can interfere with the EMDR process due to protective mechanisms.
Why might protective parts of the self resist the EMDR process?
-Protective parts of the self might resist EMDR because they believe it is dangerous or could lead to the revelation of secrets, which they perceive as a threat to the client's safety.
What is the role of the therapist in addressing the concerns of protective parts of the self during EMDR therapy?
-The therapist must work with the self system using ego-state therapy to ensure that protective parts are understood and engaged, preventing potential crises and maintaining the client's survival strategies.
What resources does Sandra Paulson recommend for further understanding of ego-state therapy and dissociation in EMDR?
-Sandra Paulson recommends her book 'Looking Through The Eyes of Trauma and Dissociation: An Illustrated Guide for EMDR Clinicians and Their Clients' and chapters she contributed to in 'The Neurobiology and Treatment of Traumatic Dissociation: Toward an Embodied Self'.
How can clinicians access Sandra Paulson's workshop on ego-state therapy and EMDR?
-Clinicians can access Sandra Paulson's workshop through sranklgroup.com or by visiting her website at www.banbridgepsychology.com.
Outlines
🧠 EMDR and Complex Trauma: Addressing Dissociation
Sandra Paulson, a clinical psychologist with extensive experience in EMDR and complex trauma, introduces her video series focusing on the integration of ego-state therapy with EMDR for treating complex trauma and dissociation. She emphasizes the importance of understanding the self-system structure in clients with complex PTSD and dissociative disorders, which differ from standard PTSD. Standard EMDR is effective for PTSD, but complex cases may require additional considerations due to the self-system's structure. Paulson warns against proceeding with EMDR without proper screening for dissociation, as it may lead to client overwhelm or ineffective therapy. She discusses the role of protective parts of the self that may hinder EMDR processing, such as fierce defenders or 'injects' that resemble external perpetrators or parents, which can be protective but disoriented about the current safety. The goal is to work with these parts to prevent therapeutic crises.
🛡️ The Protective Role of Ego-States in EMDR Therapy
In the second paragraph, Paulson delves deeper into the concept of protective ego-states that can interfere with EMDR therapy. These ego-states, which may believe they are the external perpetrator or parent, act out of a misguided sense of protection, sometimes even leading to self-harm or suicide attempts if they perceive a threat to the client's secrets or safety. Therapists are cautioned against pushing for secrets and are encouraged to engage with these protective ego-states using ego-state therapy to ensure the therapy's success and prevent crises. Paulson references her book, 'Looking Through The Eyes of Trauma and Dissociation,' and other works where she elaborates on the management of perpetrator ego-states. She also mentions her two-day workshop for clinicians and provides her website for further information.
Mindmap
Keywords
💡EMDR
💡Complex Trauma
💡Dissociation
💡Egate Therapy
💡Self System
💡PTSD
💡Protective Parts
💡Injects
💡Therapy Looping
💡Suicidal Crisis
💡Survival Strategies
Highlights
Introduction of Sandra Paulson, a clinical psychologist with 25 years of experience in EMDR and complex trauma.
Discussion on the use of ego-state therapy in conjunction with EMDR for complex trauma and dissociation.
Standard EMDR is effective for treating PTSD but requires adjustments for complex PTSD and dissociative disorders.
Importance of recognizing and screening for dissociation in clients, as it can affect EMDR therapy outcomes.
Risk of EMDR causing client overwhelm or being ineffectual if dissociation is not properly assessed.
Explanation of how the structure of a client's self system can interfere with EMDR processing.
Identification of protective parts of the self that may hinder EMDR therapy.
Description of fierce defenders, a type of protective part of the self that can resist EMDR.
Introduction of 'injected' parts of the self that resemble external figures and can impede therapy.
The role of protective parts in preventing harmful memories from surfacing during EMDR.
Importance of therapists not pushing for secrets and working with the self system using ego-state therapy.
The origin of protective parts of the self and their initial necessity for survival.
Therapists need to assess whether the 'bad stuff' is still happening to adjust therapy accordingly.
Mention of the 'Perpetrator Inject Checklist' in Paulson's book for working with injected parts.
Reference to Paulson's book 'Looking Through The Eyes of Trauma and Dissociation' for further guidance.
Invitation to Sandra Paulson's two-day workshop for clinicians through sranklgroup.com.
Information on how to find more resources and workshops on Paulson's website.
Transcripts
[Music]
hi I'm Sandra Paulson a clinical
psychologist who's been working with
EMDR and complex trauma for a quarter
century and as promised this is my first
uh brief video and the topic of this
video will be the um use of egate
therapy to work with complex trauma and
dissociation in conjunction with EMDR
now there's a great deal to say on this
subject and I've said a lot of it in
um book chapters and books and
workshops but here I want to communicate
to clients directly as well as to EMDR
therapists who may not be familiar with
my
work that for complex
cases there are some very important
things that we need to take into account
about how the client's self system is
structured standard EMDR is extremely
effective and powerful and time
efficient for treating
PTSD however complex PTSD and
dissociative disorders are characterized
by their often being structural aspect
aspects to the client's self system that
need to be taken into account if the
therapist doesn't believe in
dissociation or doesn't know that a
particular client is dissociative
because after all they don't come in
with a tattoo on their head that says
did or quite
dissociative then the the therapist may
make the mistake of failing to screen
for dissociation failing to assess
properly for dissociation using the mid
Paul Dell's mid or some other
appropriate device like the
skidd the dees2 is a screening
instrument but it's not a diagnostic
instrument so the therapist May with the
best intentions proceed to do EMDR and
the EMDR might either cause the client
to feel overwhelmed because it has
access more than the client has a
capacity to tolerate or the therapy may
just be ineffectual and EMDR might as we
say Loop
meaning it's like Wheels spinning stuck
in the mud circling the airport not
going
anywhere
and when it's looping that means that
whatever would come up next in the
processing the EMDR processing isn't for
some reason and with complex cases
that's usually because the structure of
the client self system is interfer feing
as if the EMDR is tripping over a
dissociative
curb usual not always but usually that's
because there are parts of the self
whose job it is to protect and they are
doing that in
Spades there are a couple different
kinds of protective parts of self one is
parts of the self that Envision
themselves as being
protective and they can be fierce
Defenders of the
client by and when I use the word client
I mean the entire client I don't use the
word client to refer to the front part
of a client and many therapists do and I
think that's an error because the client
is the whole system of
parts
so the front part may say yeah sure
let's do EMDR while there are other
parts back behind saying no way Jose are
we going to do
MDR or as one client once said to me I
don't know what this means but when I
was little I had imaginary friend and I
haven't heard from her in years but
she's there in my head now sitting on
the curb at the car accident scene
saying no way I'm going to go through
that car accident again so that
illustrates how a protective part of
self may think it's dangerous because
there's confusion about whether the
danger is now or not the other type of
protective part that really happens very
often is it it's called it's got a fancy
word it's it's called an
inject injects of perpetrators or
parents which may or may not be the same
thing are parts of self that are almost
holographic likenesses of an external
person to the client it seems like they
are the external person and by that I
mean both the inject part of the client
and other parts of the client including
the front part of the client may not
always May believe that that is actually
the outside parent or outside
perpetrator but it's not it's part of
the client who's disoriented and who
believes that the MDR should not happen
usually because there's a fear that some
secret will come out or that it'll be
dangerous now those parts of self are
there also for protection in a way they
may seem malignant sometimes
they're responsible for suicide attempts
which to them may be a homicide attempt
but if they think the front part of the
client should die for example for
telling Secrets this is why it's really
important for therapists to not push for
secrets and why therapists need to get
injects on board and work with the self
system using egate therapy in order to
prevent a suicidal crisis or to prevent
an an unraveling of the the survival Ral
strategies that the self system has in
place
so those parts of self that stop EMDR
are doing their level best to make sure
nothing bad happens because when they
first came into existence and here's the
trick see when they first came into
existence it was because it was
necessary for survival the smile child
small child had to get with the program
and look at their own circumstances
through their perpetrator's eyes in
order to get with the program and do
what had to be done for
survival and for in that understanding
of course even a Troublesome inject is
protective just a little disoriented
about what year it is whether the bad
stuff's happening now the therapist has
to know if the bad stuff's still
happening or
not um sometimes geographic location is
a world away from the bad stuff happened
so these are all things that make a
difference there's
um more to say on the subject of working
with inject quite a bit more and it's
covered in uh perpetrator inject
checklist in my book Looking Through The
Eyes of trauma and dissociation an
illustrated guide for EMDR clinicians
and their
clients uh 2009 available on Amazon I've
also covered it in two chapters well
various chapters one with Marilyn Luber
um Carl
forgash uh chapters I wrote with Joan
gston in the book The neurobiology and
treatment of traumatic dissociation
toward an embodied self in the edited
book with my
colleagues uh o
lanus and myself and Frank Corgan are
the co-editors of that so uh there's a
lot more to say about egate therap I
also have a two-day workshop for
clinicians available through srankl
group.com if you forget that go to my
website and you find the link there my
website is
www Banbridge psychology.com b a i n b r
i d g psychology.com thanks for
listening there's more of these brief
videos coming up
[Music]
[Music]
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