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2nd Summit of Complex Trauma, Dissociative Symptoms & EMDR Therapy

2nd Summit of Complex Trauma, Dissociative Symptoms & EMDR Therapy

Module 1

Toward an Embodied Self: Attachment, Dissociative Symptoms and EMDR
Presenter: Ulrich Lanius,  PhD
EMDR is a powerful integrative psychotherapeutic intervention. However, in the case of disrupted attachment and significant dissociative symptoms EMDR can be destabilizing if used early on in treatment. That is, fragmentation of self and dissociative symptoms commonly interfere with information processing, thus barring the integration and resolution of the traumatic experience through EMDR. Dissociation interferes with clients’ sense of their own body, their ability to experience emotion, their capacity for emotional regulation and their sense of self. Addressing dissociative symptoms prior to proceeding with EMDR treatment is essential for positive treatment outcomes.
Using a neurobiologically informed approach, specific somatic and ego-state interventions and their use during different stages of EMDR treatment are discussed. In addition, the workshop will discuss the adjunctive use of opioid antagonists in the treatment of dissociative symptoms with a particular focus on EMDR. Specific focus is on different ego-state and body therapy interventions to increase awareness of the self and one’s body. Body therapy and somatic interventions are distinguished from other psychotherapeutic interventions in that they are expressed in markedly slowed-down time, in order to give clients ample time to experience the felt sense of their bodies. Similarly ego-state work can be utilized to assist with EMDR target selection, titrate information processing, as well as provide clients’ with internal resources that aid in enhanced information processing.
Attendees will gain knowledge about possible underlying neurobiological processes and how they inform the use of somatic, ego-state and adjunctive pharmacological interventions. The workshop will teach specific somatic interventions intended to stabilize clients, create safety, help the client stay connected or get reconnected and therefore minimize dissociative symptoms and their effect. Further, the participants will learn about ego-state interventions to assist with stabilization - including identifying internal conflicts, dealing with perpetrator introjects, develop resources, as well as identifying EMDR targets, titrate traumatic material and assist in resolving blocked processing. Further, attendees will learn about the adjunctive use of opioid antagonists to reduce dissociative symptoms. Participants will learn how to effectively integrate different somatic and ego-state interventions in the treatment of attachment and trauma related syndromes and dissociative symptoms, as well as how to enhance information processing during the EMDR treatment.

1.  Describe specific somatic interventions for stabilization, to titrate
     information processing and to enhance EMDR processing.
.       Using stabilization exercises to gauge readiness for EMDR processing 
·       Focus on the body
·       Somatic interweaves
·       Somatic tracking
·       Breath
·       Somatic Resourcing
·       Discharging/Sequencing
·       Pendulating
·       Bottom-up processing
·       Intentional Movement
·       Crossing the midline activities 
.       Smell
2. The use of ego-state interventions for stabilization, EMDR target
    selection, identification and resolution of internal conflicts, titration of
    information processing, as well as provide clients’ with internal resources.
·       Gauging readiness for EMDR processing with ego-state work
·       Inner child work
·       Dissociative table
·       Healing circle
·       Identifying internal conflicts
·       Using ego-state work to identify targets
·       Using ego-state work to sequence accessing of parts of self
·       Perpetrator introjects
·       Resource states
.       Pets as helper states
3. The adjunctive use of opioid antagonists to reduce dissociative
     symptoms with a specific focus on stabilization and EMDR processing.
·       Neurobiology of endogenous opiates and relationship to attachment,
        trauma and dissociation
·       Learned helplessness and dissociation
·       PTSD, dissociation & opioid antagonists
·       Regular dose naltrexone
·       Low dose naltrexone
·       High dose naltrexone
·       Opioid antagonists for stabilization
.       Opioid antagonists for EMDR processing

About Ulrich Lanius:
Ulrich F. Lanius, Ph.D. is a Registered Psychologist in West Vancouver, BC with a practice in Clinical and Neuropsychology. He has a particular interest in brain-behavior relationships and the effects of acquired brain injury, as well as those of attachment, trauma and dissociation. Dr. Lanius specializes in the treatment of trauma, dissociation and attachment related problems. Working from a client-centered perspective, he integrates EMDR with body therapy and ego-state interventions, as well as neurotherapy. Dr. Lanius has presented both in North America, as well as internationally and he has authored a recent book, as well as articles and book chapters on both the treatment and the neurobiology of dissociation.

Module 2

Adapting EMDR Therapy for Dissociative Symptoms: The Progressive Approach
Presenter: Anabel Gonzalez, MD, PhD
Working with EMDR in severely traumatized people goes beyond protocols and procedures. The conceptual framework is extended by including elements from the Structural Dissociation of the Personality and Attachment Theory. Understanding of specific characteristics of complex trauma and dissociation should be combined with a careful work on therapeutic attunement for an effective EMDR treatment of dissociative symptoms.
In this workshop a comprehensive model for EMDR therapy in patients with dissociative symptoms (the Progressive Approach) will be explained. Different interventions with EMDR in severely traumatized people  will be described, including specific procedures to prepare and stabilize these clients. The interweaving between theoretical developments, protocols and video examples will allow the audience to assimilate information and translate it to their clinical practice.

1. Understand a comprehensive model to approach dissociative clients
    from the EMDR perspective, connecting theoretical developments and
    clinical procedures.
·       The theory of structural dissociation of the personality as an extended
        framework in complex trauma
.       Modifications in EMDR standard protocol in severely traumatized
2. Introduce the concept of dissociative phobias as a core aspect in the
    EMDR therapeutic plan of complex trauma patients.
·       Phobia of attachment: difficulties in establishing a therapeutic
·       Phobia of mental actions
·       Phobia of parts: dealing with the internal conflict
·       Phobia of the attachment with the perpetrator
·       Phobia of trauma
.       Phobias of normal life, healthy risk-taking, change and intimacy
3. Identify difficult situations in EMDR therapy of severely traumatized
    people and describe EMDR procedures for dissociative clients, all along
    the different phases of treatment. 
·       Working with emotional disconnection and lack of awareness
·       The need of establishing a therapeutic perspective: working on
        self-care patterns
·       Processing dissociative phobias
.       The tip of the finger strategy: processing peripheral traumatic
        material as an stabilizing maneuver
4. Discuss how to apply the EMDR procedures described in this workshop
    in the participants´ clinical practice.
·       Integrating specific EMDR procedures in the work with the internal
        system of parts
·       Working with parts from a self-care perspective: repairing attachment
        and IWM (Internal Working Models)
·       Processing dissociative phobias and using the TFS to overcome
        difficulties in increasing communication and empathy among parts
.       Promoting co-consciousness and integration

About Anabel González:
Anabel Gonzalez, MD, PhD,  works as psychiatrist and psychotherapist in the Public Mental Health System and in Private Practice. She coordinates a Trauma and Dissociation Program in the University Hospital of A Coruña, Spain, and has a broad clinical experience with Dissociative Disorders and Complex Trauma. She is trained in diverse psychotherapeutic approaches including systemic family and group therapy, cognitive analytic therapy and several trauma-oriented psychotherapies. She is an EMDR Europe Supervisor, a Facilitator and Vice-President of the EMDR Spanish Association. She gives regular Advanced Trainings with the EMDR Spanish Association, and has presented several workshops and courses about EMDR interventions mainly in complex trauma, dissociation and severe mental disorder. She is a member of ESTD and ISST-D. She is the author of several articles, book chapters and a book about Dissociative Disorders.

Module 3

Advanced Dissociative Table Work:  What to do after you “Set the Table”

Presenter:  Kathleen Martin, LCSW
The most common mistake made while working with complex trauma is going into processing too soon.  The dissociative symptoms must be treated prior to EMDR Standard Protocol Phase 4 processing.  This 3 hour lecture will explore the specifics of working with emotional parts of the personality once the “table has been set”.  Topics to be discussed include readiness for the table, treating dissociative phobias, time orientation, treating persecutory and perpetrator parts, and developing compassion throughout the system.  The expanded readiness checklist for Phase 4 processing in complex trauma cases will also be introduced and taught.

1. Name the most common mistake made in treating clients with complex trauma and one way
    to avoid this mistake.
·       Growing the phobia to the traumatic material and how to avoid this
·       Decreasing the phobias to the emotional parts of the personality
·       Increase positive affect tolerance
.       Increasing compassion toward emotional parts
2. Construct One Oblique Time Orientation Strategy
3. Understand how to work with perpetrator and self-persecutory parts
4. Define 3 key additions to the Readiness Checklist for trauma processing
    for clients with complex PTSD
.       Compassion;  reduction of dissociative phobias; time orientation;
        communication, cooperation and collaboration among parts of
        the system; reduction in cognitive errors to allow  processing
        to occur; coconsciousness.
About Kathleen Martin:
Kathleen Martin, LCSW is an EMDRIA Approved EMDR Consultant and Trainer.  She specializes in trauma and dissociation in her private practice in Rochester, NY, USA.  She is a consultant and trainer to both individual clinicians and mental health agencies internationally.  She has published an article entitled How to Use Fraser’s Dissociative Table Technique to Access and Work with Emotional Parts of the Personality and has another one in press on the importance and art of time orientation.  She has developed a strategy called Oblique Time Orientation that is detailed in this later article.   She teaches both basic and advanced EMDR courses and workshops internationally and often teaches on topics related to trauma and dissociation.  She has integrated Structural Dissociation Theory and the Polyvagal Theory into her clinical EMDR Psychotherapy practice and teaches master classes to help others do the same. 

Module 4

Integrating Porges' Polyvagal Theory into EMDR practice
Presenter:  Gunilla Klensmeden, MD, PhD

Presentation Description:
According to the Polyvagal Theory (Porges, 2011), a safe childhood environment is crucial for development of a balanced autonomic nervous system (homeostasis). In this workshop participants will learn how to use the polyvagal theory in their EMDR practice.
In the first phase, to understand the impact of dangerous and life-threatening childhood environments on the autonomic nervous system, and in the second phase to learn specific techniques aimed at helping the patient to feel safe in the therapy relationship, and to prepare the patient for reprocessing. In the third phase, participants will learn how to assess autonomic states (face expression, breathing etc.), and in the fourth phase learn ways to identify and handle over-activation (e.g., hyperarousal) of the autonomic nervous system. The techniques taught are specifically developed for complex trauma and personality disorders, but can be used in the treatment of most mental disorders. The overall objective is to customize treatment in order to increase the effectiveness. 

1. Learn the basis of the autonomic nervous system and the polyvagal
·       The core of the polyvagal theory: safety, connectedness, co-regulation
         and self-care
·       The autonomic nervous system: The embryology, anatomy and
        function of the sympathetic and parasympathetic nervous system
.        Introduction to the Polyvagal theory: homeostasis, stress, stress
         vulnerability, heart-rate variability and respiratory sinus arrhythmia,
2. Learn how the polyvagal theory can be used and integrated into EMDR
    therapy. Phase-oriented integration of the polyvagal theory into EMDR
·       Client history: Information specifically about childhood family and
        school environment: safe,unsafe, life-threatening
·       Preparation: Client education about the autonomous nervous system,
        the polyvagal theory and personality development, how to use the
        polyvagal theory to create a safe therapy relationship and overcome
        dysfunctional defense
·       Assessment: identify severity of symptoms, breathing patterns,
        polyvagal and psychiatric status, evaluate need for medication
.       Reprocessing: look for signs of severe stress such as shutdown
        or stress vulnerability or stress responses.

About Gunilla Klensmeden, MD, PhD:

Gunilla Klensmeden, MD, PhD  is an accredited EMDR Europe consultant and an international trainer in Schema Therapy. She is the project manager of an international EMDR study. She currently teaches and supervises about complex trauma at the Nordland Hospital in Norway. She collaborates with researchers and professionals all over the world and is particularly interested in neurophysiology and the polyvagal theory.

Continuing Education
12 Clinical Continuing Education Credits
APA: EMDR Institute, Inc., is approved by the American Psychological Association to offer continuing education for psychologists. EMDR Institute, Inc., maintains responsibility for this program and its contents.
RN: EMDR Institute, Inc is a provider approved by the California Board of Registered Nursing, Provider Number 9755.
BBS: For California the course meets the qualifications for continuing education credit for LMFT, LPCC and LCSW as required by the California Board of Behavioral Sciences. Approval No: PCE270.
SW: EMDR Institute, provider #1206, is an approved provider for SW continuing education by the Assoc of SW Boards (ASWB) www.aswb.org through the Approved Continuing Education (ACE) program. EMDR Institute maintains responsibility for the program. Social workers participating in this course will receive 12/weekend clinical continuing education clock hours.
Please contact the EMDR Institute 831-761-1040 or inst@emdr.com for information about continuing education for social workers. (SW boards outside the state in which the training occurs may or may not accept transferal of units depending upon individual state board policy.)
EMDRIA 12 Credits- Ana Gomez is a general EMDRIA provider #GP1502-02