EMDR Therapy & Personality Disorders
September 29, 2017
Presented by: Uri Bergmann, PhD
Title: Treating Dissociation in the Spectrum of Personality Disorders
Historically, the treatment of personality disorders has been described as difficult, if not impossible; manifested by a rigid character-armor and defensive resistance. These diagnostic categories include individuals manifesting character pathology, borderline personalities, antisocial and sociopathic tendencies as well as addictive behaviors.
These clients have often been seen as poor candidates for EMDR or even non-responders. They are often mandated for treatment or come at the behest of others. Their histories often include early repeated experiences of abuse, deprivation, abandonment and parental coldness. The hallmarks of personality disorders are rigid, intractable defenses, difficulty relating and empathizing with others as well as acting-out behavior.
This presentation will propose that the symptoms of personality disorders be viewed as aspects of dissociation and will examine the applications of ego state concepts and techniques to all phases of the EMDR protocol in order to facilitate the treatment of these clients. Central to this approach is the conceptualization of self and object representations, self-objects, or schemas as ego-states. Discussion will include how to use a developmental approach to assessment, and will review the identification, mapping and accessing of ego-states as well as how to promote ego-state-specific EMDR targets, facilitating the enhancement of EMDR processing.
1. Participants will be able to discuss and integrate the concepts of dissociation, ego states, and levels of co-consciousness with the phenomena of ego-syntonic traits, self and object representations, self-objects, and schemas.
2. Participants will be able to discuss and describe how to developmentally assess, identify, map and access ego-states of personality disordered clients and how to promote their ego state participation in EMDR preparation and targeting.
3. Participants will be prepared to utilize ego-state-specific EMDR targeting to enhance the processing of these most difficult clients.
September 30, 2017
Presented by: Colin Ross, MD
Title: Trauma, Dissociation and Personality Disorders: Principles for Preparation and Stabilization in EMDR
In this presentation, Dr. Ross will explain the relationships between trauma, dissociation and personality disorders, with an emphasis on borderline personality disorder (BPD). He will describe a slightly modified version of the theory of structural dissociation, according to which BPD can be understood as a type of dissociative disorder. He will briefly review research data on the overlap and relationship between dissociative identity disorder (DID) and BPD. In addition, Dr. Ross will go over a number of other personality disorders, explaining how they can be understood as reactions to trauma: these will include paranoid, schizotypal, narcissistic, histrionic and antisocial personality disorders. He will discuss treatment approaches for preparation and stabilization that follow from this perspective. Although he will not go into the desensitization phases of EMDR, strategies for targeting follow naturally from this perspective.
Participants will be able to:
- Describe a modified version of the theory of structural dissociation.
- Describe the relationships and overlap between borderline personality disorder and dissociative identity disorder.
- Describe the relationships between trauma, dissociation and a range of other personality disorders.
October 6, 2017
Presented by: Dolores Mosquera, MS
Title: The relevance of understanding the different types of Dysfunctional Stored Information in Personality Disorders. How to identify and work with the variety of targets that are related to the most problematic symptoms.
Personality Disorders present great challenges for clinicians. Patients with this diagnosis often present with high risk behaviors, diverse difficulties in self-regulation, impulsivity issues and severe problems in their interpersonal relationships. Some clients with personality disorders, especially those with Borderline Personality Disorder present self-harming behaviors, suicidal ideation and a history of or risk of suicide attempts. Others present poor impulse control and aggressive reactions that can be frightening for themselves and others, including clinicians. Clients with Personality Disorders can generate strong countertransference issues in clinicians, and EMDR can mobilize strong affect in clients. Therefore, it is important for clinicians to be alert to and to be able to recognize defensive responses and affect phobias both in themselves and their personality disorder patients.
On the other hand, sometimes it can be difficult for EMDR trained clinicians to establish the connecting thread between the patient's symptoms (including the frequent difficulties they present in the therapeutic relationship) and the early environments in which they grew up, characterized by a high rate of attachment disruptions and severe traumatic events. In this presentation, Dolores Mosquera will explain how the Adaptive Information Processing Model can help understand the underlying issues of the most problematic symptoms in Personality Disorders, how to go from current symptoms to specific targets for EMDR reprocessing and the different types of dysfunctional information that should be addressed in this population. Dolores will also explain some of the most frequent defensive processes and difficulties that take place in this population during Phases 3-7 of EMDR Therapy and how to address them.
Participants will be able to:
- Describe the different types of Dysfunctional Stored Information to identify a variety of targets in this population.
- Describe at least 5 defensive regulation strategies.
- Describe different problems that arise during Phases 3 to 7 of EMDR Therapy.
- Describe the role of dysfunctional positive affect in Personality Disorders.
October 7, 2017
Presented by: Jim Knipe, PhD
Title: Using modified EMDR Procedures to Treat Issues of “locus of Control Shift” and “Attachment to the Perpetrator” (Ross and Halpern, 2009), Utilizing the CIPOS, Loving Eyes” and “Healing Dialogue” Methods
EMDR-related therapy procedures will be proposed for treatment of dissociative clients who present with intense chronic shame resulting from sexual abuse by caretakers. A treatment model will be presented involving appropriately sequenced procedures of:
- Identification of well-remembered traumas and targeting with standard EMDR
- Identification of initially dissociated traumas, through bridging to the source of intrusive symptoms (e.g.hallucinatory experiences (voices)
- Therapeutic visualization of the younger child part of the personality, as an emotionally safer means of establishing dual attention within the window of tolerance
- Trauma processing, with emotional safety enhanced through frequent installation of present orientation and safety, and
- the use of bilateral-stimulation facilitated internal dialogue to heal emotionally painful ambivalence between initially conflicted personality parts.
Participants will be able to:
- Describe three conceptually separate ways that a difficult childhood environment can negatively influence the development of personality structure
- Describe the “Loving Eyes” procedure, and when that procedure is a preferable alternative to standard EMDR Phase 3
- Describe a Healing Dialogue cognitive interweave, and the appropriate use of that interweave with clients who have defensive shame originating in abuse/neglect by valued caretakers
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