Making the Complex Simple: Outline

www.suegenest.ca
[email protected]
Making the Complex Simple:
A Simple and Efficient way to Organize EMDR Files
Sue Genest, MSc. CCC
EMDRIA Conference in Denver, Colorado
September 2014
Outline
• Overview mind mapping
• Benefits of mind mapping & EMDR
• EMDR and mind mapping
– Mind map categories
– 8 phases & 3 pronged protocol & AIP model
– Template
– Case illustrations
• Mapping EMDR Protocols
• Mind Map Program
• Hands on creation of EMDR mind map
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What is a mind map?
• is a diagram used to represent words, ideas,
tasks, or other items linked to a central key
word or idea.
• are tools which help you think and learn
• is a strategy for bringing order and structure to
thinking through mentally mapping words
or/and concepts
Wikipedia http://olc.spsd.sk.ca/DE/PD/instr/strats/mindmap/
Mind Map General
Design Examples
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()
Excerpt from Sue Genest’s thesis research ©
Excerpt from Sue Genest’s thesis research ©
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Basic
Addictions
EMDR
Protocols
Recent Events
Pre Verbal
Benefits of Mind Mapping & EMDR
• Simplifies complex case files and targets
• Large files onto 1 or 2 sheets
• Procedure/structure for
– developing treatment plan
– keeping track of new targets
– re-arranging treatment plan
• Review of 8 phases, 3 pronged protocol, and AIP model
• Provides insight into past memory networks, adaptive
information arising, themes, progress, etc.
Benefits of Mind Mapping & EMDR
• Quick review of client file for
–
–
–
–
re-evaluation
returning client
reviewing treatment plan
report writing
• Clarifies stuck points in the process:
– missing parts of the standard protocol, for example:
• didn’t floatback;
• missed future template
• incomplete targets, e.g. SUDs not 0; no PC installation
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Benefits of Mind Mapping & EMDR
• Clarifies stuck points in the process:
– Dissociation; Ego States
• See over time the inconsistency of SUDs e.g. 0 then 8 then 0 then 9 then…
– Easy review of what is or is not changing
• For example: client is no longer eating fast food, but still over eating…
still change in behavior
• Identifies areas in which to seek consultation
Benefits of Mind Mapping & EMDR
• Sharing maps with clients
– builds rapport (footnote 1)
– helps them understand the EMDR process
– encouraging to see what has been accomplished
• Own self care
– where you need consultation;
– reminds therapist of progress; i.e. targets are clearing which is
especially helpful with complex cases; addictions; etc.
– Points out patterns e.g. similar stuck points with several clients
• Helps grasp protocols e.g. DeTUR protocol
Footnote 1: With DID & complex trauma some clients find looking at an extensive mind
map of their history and targets overwhelming
EMDR & Mind Mapping
• Mind Map Categories
•
•
•
•
– 8 phases & 3 pronged protocol
– AIP Model
– Template
Case Illustrations
Mind Mapping EMDR Protocols
Mind Map Program
Hands on creation of EMDR mind map
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8 Phases of EMDR
• History
• Preparation
• Assessment
• Desensitization
• Installation
• Body Scan
• Closure
• Re-Evaluation
3 Phase Protocol
• Past, Present, Future
or
• First
• Worst
• Most Recent
• Future
AIP Model and Mind Mapping
•
•
•
•
Map memory networks
Map adaptive networks
As you map you can see connections, themes,…
Keep track of adaptive responses in processing
e.g. anger or PC’s arising, etc.
• Map relevant past experiences that create and
perpetuate maladaptive patterns of response /
“unmetabolized components of memory”
F. Shapiro & D. Laliotis, Clinical Social Work Journal (2011) 39:191-200. Published online October 12, 2010, p.193
Age 3yrs
Dad hits mom
Intimacy with partner
Sexual Assault
20yrs old
Body: pain,
shaking
Guilt
Anger
Family holidays
Partner
Intimacy
I’m damaged
Diagram by Sue Genest ©
Aggressive men
News stories
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Car Accident
Diagram by Sue Genest ©
Drunk
driver's
face
It's my
fault
Floatback
memories
Death
files: I'm
Gonna
Die
Noise of
Crash
Body Pain
& shaking
Insurance
trauma
Best
friends
suicide
Dog dies
age 10
Grandma
dies age 3
Map various components of an incident from the
history taking or as you begin to process
Husband Dies
Diagram by Sue Genest ©
Death
files
Doing
CPR; still
dies
Judgement of
in-laws
Sound of
ambulance
Hospital
Parents
Deaths
Children's
reactions
I'm not
good
enough
Its my
fault
Map chronology of recent event and associative links
Mind Map Categories
• Goals (SMART)
• Resources e.g. calm place, container,…
– Stabilization and Self Soothing; Life skills; Coping skills
– Strengths, Positive experiences, support systems,…
Targets / Unprocessed memories
– Top ten worst, History,…
– PIC, NC, PC, VOC, SUDs,…
– Floatback, Re-Evaluation;
– 1st, worst, most recent, future
Triggers
Themes, repetitive cognitions
Developmental milestones
Symptoms & positive outcomes
Connections b/w memories
Progress indicators
•
•
•
•
•
•
•
History:
Possible
Targets
Tx Targets
Pic
NC / PC
SUDs / VOC
Emotions
Body
Top 10
Worst
3 pronged
protocol
Triggers
Goals
Mind
Mapping
Calm
Place;
Container
Resources
Diagram by Sue Genest ©
Support
systems
PC's
NC's
Themes
Developmental
Milestones
Progress
Indicators
Self
Soothing
Life Skills;
Coping Skills
Strengths
Top 10
Best
Symptoms /
Outcomes
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SESSION 2
Resources:
Calm place
Container
Protective / Nurturing Figures
Strengths
Self Aware
Motivated
Intelligent
Perseverance
Attachment / bonding
Kind; compassionate
Best
Grandmother
Graduation
Marriage
Children
Client Initials
Diagram by Sue Genest ©
Outcomes
Calmer
Assertive
Triggers resolved
No impulsive eating
Depression resolved
SESSION 1-2
Intro. to EMDR;
History / Possible
Targets
Symptoms
Anxious
Over eating
Can't say No
Depressed
Worst
Parents
Uncle
Boss
Themes
SESSION 3
SESSION 4
Original Target Name
PIC; NC; Emotions; SUDs 9
Re Evaluation
Floatback
SUDs 2 - 0
VOC 7
Floatback: Utero
PIC Alone in darkness
NC I'm unlovable
PC I'm lovable
SUDs 5 - 0
VOC 2 - 7
Body: Clear
SESSION 5
ReEvaluation
Floatback SUDs 0
Worst SUDs 0
Original Target
PIC, NC, PC
Emotions
SUDs 5- 0
VOC 7
Body: Clear
Worst:
PIC; NC; PC
SUDs 5 - 0
VOC 2 - 7
Body: Clear
Future Template
Case Illustrations
Blue for initially named targets
Calm Place: Ocean
Cue: peaceful
Container: blue jar
Strengths/Resources:
Son
Humor
Perseverance
Resourceful
Best friend
Resilient
Intelligent
Purple for targets that arose duringTx
1) Drunk drivers face
SUDs 10
NC It's my fault
Best Friends Death
SUDs 9
Floatback to grandmothers
death Age 3
NC I did something wrong
SUDs 5-0
PC I was just a kid Voc 7
Original & Worst
NC I can't handle this
SUDs 6-0 &
PC I can handle this; VOC 7
Normal grief
Floatback to age 5yrs
3yr old Sister lost
NC Its my fault SUDs 10
SUDs 0
PC It's not my fault
VOC 7
Car accident
Diagram by
Sue Genest ©
Original & Worst
SUDs 7 - 0
PC It's not my fault
VOC 7
Future driving... with BLS in car
Insurance Call
Trauma
SUDs 10
NC I'm in danger
SUDs 0 PC I'm safe
now and can work
through this VOC 7
Body clear
Future... all insurance
dealings
2) Noise of crash
SUDs 10
Symptoms Relieved:
PTSD
Flashbacks
Nightmares
Jumpiness
Unable to drive
Anxiety driving
Sleeplessness
Floatback to 1st Age 3
Dad yelling at mom
NC: I'm unsafe
PC I'm safe now
SUDs 8 - 0 VOC 7
Outcome
Calm
Sleeping well
Driving without anxiety
Healthy Grief process
Ex Husband Abuse (Worst)
NC I'm powerless
SUDs 8 - 0 PC
I'm powerful VOC 7
Original
NC I'm going to die
Session I SUDs 10
Session II SUDs 2
Session III SUDs 0
PC I'm safe now
VOC 7
Body Clear
Future loud noises;
car screetches; ...
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Goals:
Rarely Anxious
Calm and Okay about son
Assertive vs. Angry
Feel good about self
Home Practice: Calm & Confident
Watching sports
Gardening
1st Session: Container: Black Bin
Calm Place: Fishing; Cue: "blue" when relaxed
Childhood
illness
Mother
overbearing
Strengths:
Affectionate, loving
Committed father, husband
Perseverance
Intelligent
Resourceful
Responsible
Compassionate
Billy
Diagram by Sue Genest ©
Bullied at
school
HISTORY
2nd Session;
Ongoing
Best things in Life:
Partner
Son
Education
Travelling
Promotion at work
Parenting
guilt
Mothers
anger
Death
Grandmother
3rd Session
Triggers:
Sons problems
Strong women
Lg trucks behind
me in traffic
Social
anxiety
Themes:
Take care of others 1st
Can't say my truth
Don't fit in
Threat to my life
Not good enough
Damaged
Car
accident
6th Session:
Parenting
Pic: Son's scared face
Emotion: profound sadness; shame; guilt
SUDs 7
NC: I'm a failure
Social Anxiety
Pic Hiding in a corner with head down
SUDs 10
NC "I'm not good enough"
Floatback
Car accident age 18yrs;
Bullied Grd.4;
Grandmothers death age 5yrs
Floatback: 4yrs old (also Worst)
Pic Mother's angry face
Emotions: fear, NC: "I'm a bad person"
PC "I'm good person"
SUDs 8; Voc 3
Body: chest; throat
(PreVerbal - Imaginal nurturing)
SUDs 3
4th Session
12 - 13th Session:
Original Social Anxiety: SUDs 5
PC "I'm good enough"
Ends SUDs 0; VOC 7; Body Clear
14th Session : Future Template
Trucks in traffic; Various Social situations
15th Session
7th Session
ReEvaluation Age 2yrs SUDs 9-4
(bring in protective/nurturing figure)
5th Session
NC "I'm gonna die"
PC "I'm ok"
SUDs 4; Ends SUDs 0; Voc 7
ReEval. Worst SUDs 0 Voc 7
Earliest: Childhood Illness Age 2yrs
Pic: Alone in hospital room in dark
Emotions: Intense fear; loneliness
NC: "I'm gonna die"
PC "I'm safe now" Voc 4 SUDs 8
Re-evaluation Floatback SUDs 2
End Session: SUDs 0; Voc 7; Body Clear
11th Session: Worst: Car accident 18yrs
Check In with day to day social triggers
and relationship with son
No disturbance; calm
8th Session
Re-Evaluate Floatback SUDs 0
Re-evaluate Original Parenting SUDs 4
NC "I'm a failure"
PC "I'm a loving parent"
Emotions: sadness; guilt; shame
Body: Chest; throat
Ends SUDs 0; Voc 7; body clear
16th Session
ReEvaluation Age 2yrs SUDs 4 - 2
(grandmothers death arises & clears;
PC arises "Its not my fault")
ReEval. all targets SUDs 0
PC's Voc 7 and strong
CLOSURE
9th Session
OUTCOMES:
ReEvaluation Age 2yrs SUDs 3 - 2
(Bullying clears & PC arises "I am worthwhile")
Partner notices more calm
10th Session
Able to listen to son's problems
without anxiety
Future: Son has any life difficulty;
Movie free of disturbance
ReEvaluation Age 2yrs SUDs 3 - 0
VOC 7 Body: Clear
Approached boss with needs
Joined staff in lunch room
Mind Mapping EMDR Protocols
• Working through procedural steps
8 Phase Std Protocol
Diagram by Sue Genest ©
Phase 1
History & Tx
planning
When Phase
1 & 2 are
complete
move to
Phase 3
Phase 2
Preparation
Phase 3
Assessment
Partial set up
Current
target based
on Tx plan in
order to do
floatback
PIC
NC
Emotion
SUDs
Body
Floatback
to earliest
memory
Phase 4
Desensitization
Phase 5
Installation
Phase 6 Body
Scan
First Memory
PIC; NC; PC; VOC; Emotions; SUDs; Body
Desensitize to SUDs 0
Install PC to VOC 7
Body: clear scan
Phase 7
Closure
Phase 8 ReEvaluation
Closure at
the end of
each session
Re-Evaluate
at beginning of
each session
Incomplete
session
instructions
in manual
Worst Memory
PIC; NC; PC; VOC; Emotions; SUDs; Body
Desensitize to SUDs 0
Install PC to VOC 7
Body: clear scan
Current Situation
PIC; NC; PC; VOC; Emotions; SUDs; Body
Desensitize to SUDs 0
Install PC to VOC 7
Body: clear scan
Future Template
Run movie eyes closed till no disturbance
Run movie eyes open
(People, places, things, time,...)
Associative Network
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• Understanding a protocol e.g. DeTUR
DeTUR
Dr. AJ Popky
(diagram by Sue Genest)
History
Preparation
Resource
State
Positive Tx
Goal
Pos. Goal
State
Phys. Anchor
Installation
Desensitization
Triggers
Current
Distress
Triggers w/
Pos. Goal
State
Barriers to
Recovery
Past
Trauma
Standard
Protocol
Future
Relapse
Future
Closure
Re Evaluation
• Understanding a protocol e.g. DeTUR
DeTUR
Dr. AJ Popky
(diagram by Sue Genest)
I. History
Diagnosis
Trauma Hx
A. Preparation
Screen for dissociation
Resources in Life
Support system e.g. AA,...
1. Resource State
I now have clients recall a time when they experienced feelings of being
resourceful, powerful and in-control and direct them to those to notice the
powerful feelings, and then use eye movements (EM) to strengthen these
powerful feelings. This appears to empower clients and allows the process
to move faster.
The trick here is to have them freeze the experience and only focus on the
positive element before doing eye movements.
a. Positive Tx Goal
(1) Client's attention is directed towards a positive, attractive,
achievable, compelling goal of coping and functioning
The positive treatment goal should be attractive and achievable, one
that has a magnetic pull that they can easily maintain their focus on. I
use their definition of how they would look coping and functioning
successfully in a positive manner.
(1) Pos. Goal State
Phys. Anchor - The next step is to have them associate with their goal.
Give them the experience of how it would feel to successfully achieve
their goal, and then using associative representation, anchor the
experience into their physiology.
Anchoring or Conditioned Response: is a process of being able to
replicate the physiological experience associated with an emotion or state
by linking it to a physical representation (slight finger pressure). I exert
slight pressure on a knuckle as the representation (after obtaining
Inspiration Program
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Specific
Tx Targets
Pic
NC / PC
SUDs / VOC
Emotions
Body
Measurable
Achievable
History:
Possible
Targets
Goals
Calm
Place;
Container
Realistic
Trackable
Top 10
Worst
3 pronged
protocol
Triggers
Mind
Mapping
Resources
Diagram by Sue Genest ©
Support
systems
PC's
NC's
Themes
Developmental
Milestones
Progress
Indicators
Self
Soothing
Life Skills;
Coping Skills
Strengths
Top 10
Best
Symptoms /
Outcomes
11
Goals
Specific
Measurable
Achievable
Realistic
Trackable
History:
Possible
Targets
Tx Targets
Pic
NC / PC
SUDs / VOC
Emotions
Body
Top 10
Worst
3 pronged
protocol
Triggers
Calm
Place;
Container
Goals
Mind
Mapping
Resources
Diagram by Sue Genest ©
Support
systems
PC's
Developmental
Milestones
NC's
Themes
Progress
Indicators
Self
Soothing
Life Skills;
Coping Skills
Strengths
Top 10
Best
Symptoms /
Outcomes
Hands on
Creation of Your own Map
www.suegenest.ca
[email protected]
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