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.