When EMDR is Not Enough: Part II - Ego State Therapy

Summary

Clinical 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

00:00

🧠 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.

05:03

🛡️ 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.

Keywords

💡EMDR

EMDR, or Eye Movement Desensitization and Reprocessing, is a psychotherapy treatment designed to alleviate distress associated with traumatic memories. In the video, it is discussed as a powerful and time-efficient method for treating PTSD but with noted limitations when dealing with complex PTSD and dissociative disorders.

💡Complex Trauma

Complex trauma refers to the cumulative emotional burden borne by an individual who has experienced prolonged, repeated, and often multiple instances of interpersonal trauma. The video emphasizes the importance of understanding the structural aspects of a client's self system when dealing with complex trauma.

💡Dissociation

Dissociation is a psychological defense mechanism where a person disconnects from their thoughts, feelings, memories, or sense of identity. The script discusses the necessity of screening for dissociation and its impact on the effectiveness of EMDR therapy.

💡Egate Therapy

Egate therapy is a therapeutic approach that works with the self system of clients with complex trauma and dissociation. It is mentioned in the video as a method to work in conjunction with EMDR to address the structural aspects of the self system that standard EMDR might not.

💡Self System

The self system in the context of the video refers to the entire psychological structure of a client, including various parts that may have different roles and functions. It is crucial for understanding how clients with complex trauma and dissociation respond to therapy.

💡PTSD

Post-Traumatic Stress Disorder (PTSD) is a mental health condition triggered by experiencing or witnessing a terrifying event. The video script discusses how standard EMDR is effective for treating PTSD but may not be as effective for complex PTSD.

💡Protective Parts

In the script, protective parts refer to aspects of the self system that have the role of safeguarding the individual, often against perceived threats. These parts can interfere with EMDR therapy by resisting the processing of traumatic memories.

💡Injects

Injects, as mentioned in the video, are parts of the self system that may resemble external figures, such as perpetrators or parents, and can influence the client's behavior and therapy process. They are considered protective but may be misguided about the current safety of the client.

💡Therapy Looping

The term 'looping' in the context of EMDR therapy refers to a situation where the therapeutic process gets stuck and does not progress. The video explains that looping in complex cases is often due to the interference of the self system's structure.

💡Suicidal Crisis

A suicidal crisis is a critical situation where an individual is at imminent risk of taking their own life. The video mentions that certain parts of the self system, particularly injects, may be responsible for suicide attempts as a form of protection.

💡Survival Strategies

Survival strategies refer to the psychological and behavioral mechanisms that an individual develops to cope with and endure traumatic experiences. The video discusses the importance of understanding and working with these strategies in therapy to prevent unraveling them.

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

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