Integrating EMDR into Phase-Oriented Treatment for Trauma

Abstract

Originally introduced a century ago by Pierre Janet, phaseoriented treatment has been independently proposed by many authors and is now widely considered by trauma specialists to be the treatment of choice for PTSD and other posttraumatic disorders. Much more recently, introduced by Francine Shapiro in 1989, Eye Movement Desensitization and Reprocessing (EMDR) has also become available for the treatment of PTSD and other trauma-based disorders. EMDR has become widely accepted by clinicians and has received strong support regarding its efficacy from a wide range of empirical studies. However, with a very few exceptions (highlighted in this paper), these two major approaches for treating trauma have developed largely independently. The present paper integrates the major EMDR developments with the different stages of the phase-oriented approach to assess if such an integration is conceptually and clinically useful. The EMDR developments integrated into the phases of trauma treatment include: Shapiro's prototypic protocol for PTSD and the protocols for other trauma-based disorders, safety protocols, Leeds' and Korn's work with Resource Development and Installation, and Kitchur's Strategic Developmental Model for EMDR. The usefulness of integrating phase-oriented treatment and EMDR is then assessed. These approaches were found to strongly complement each other in their clinical strengths and weaknesses, while sharing many underlying theoretical and structural elements.There is robust consensus among trauma specialists that a phase-oriented approach is the treatment of choice for trauma survivors. In phase-oriented treatment, work is divided into more or less discrete sequential phases, each characterized by its own treatment objectives, focal symptoms, and relational challenges. Ideally, when the tasks of one phase are accomplished, treatment can move into the next. This model was first formulated about a century ago by Pierre Janet (1889, 1925) who described three phases: (1) stabilization and symptom reduction;(2) metabolization and integration of traumatic material; and (3) personality reintegration and rehabilitation of the self in relationship and in the world (Brown, Scheflin & Hammond, 1998). Janet's contributions were obscured for many years (Ellenberger, 1970), but modern trauma specialists also independently recommend phase-oriented treatment ap-

Rupture and Repair in the EMDR Client/Clinician Relationship: Now Moments and Moments of Meeting

“…Several authors have addressed the issue of needing additional time to build trust and rapport for more complex cases and for clients with insecure attachment status (Dworkin, 2005;Gelinas, 2003;Korn & Leeds, 2002;Leeds, 2009). van der Kolk (2002) speculated that positive results are possible with EMDR even in the absence of a trusting therapeutic relationship, though in a personal communication to M. Dworkin (2008, July), he agreed that attunement and resonance were crucial factors in the healing of trauma.…”

Phase-Oriented Treatment of Structural Dissociation in Complex Traumatization: Overcoming Trauma-Related Phobias

“…For example, while Van der Hart et al (1993) describe a fast and comprehensive version in a single session, others have described a much more gradual approach (i.e., fractionated synthesis) in which the synthesis is divided in a number of smaller steps, which may encompass several or even many sessions (Fine, 1993;Kluft, 1994a;Van der Hart et al, 1993). Titrated synthesis may also occur with the use of EMDR and ample application of the SUDS scale during the process (e.g., Gelinas, 2003;Twombly, 2000). Actually, use of the SUDS scale is helpful even without EMDR.…”

Dissociative and conversion disorders: defining boundaries

“…stabilizing phase, integration of traumatic material and resolution) is commonly used in patients with trauma-related dissociative conditions. Recently, eye movement desensitization and reprocessing, originally used in PTSD, is also being used in dissociative states [37]. In a recent paper, Middleton [38 ] focused on development of 'self-hood' as the most important goal in therapy in this group of patients.…”