Treating dissociative disorders with EMDR: the gradual approach

Following numerous initial warnings about the dangers of using EMDR with people suffering from dissociative disorders, a number of proposals have been put forward to adapt EMDR procedures to this specific population. Bearing these earlier warnings in mind, many clinicians continue to believe that EMDR offers interventions limited to the treatment of traumatic memories in high-functioning dissociative patients, and only following a prolonged preparatory phase involving other therapeutic modalities. In this conceptualisation, the use of EMDR is very limited, and it is considered that many survivors of severe trauma cannot benefit from EMDR or, if they can, only at a much more advanced stage of the therapeutic process.

This training will use clinical case studies and video clips to illustrate EMDR interventions with dissociative patients based on the ‘progressive approach’ (González and Mosquera, 202). Using this model, the seminar will demonstrate how EMDR therapists can safely utilise a full range of EMDR interventions with dissociative patients from the preparation phase onwards. The objective of this seminar is to provide a comprehensive model for the application of EMDR therapy in the treatment of dissociative disorders, adapting the model to address the types of dysfunctionally stored information found in people who have suffered the worst forms of trauma and who present with dissociative phobias. EMDR therapists will learn to integrate new interventions into their clinical work during the different phases of treatment. In particular, they will learn to apply specific clinical interventions based on ‘progressive protocols’ for severely traumatised patients, including dissociative identity disorder and somatoform dissociation.

Objectives

• To identify and understand the symptoms experienced by people who have suffered complex trauma or neglect in the past: participants will watch videos and reflect on clinical cases to identify both the obvious and the more subtle signs of complex trauma

• To deepen understanding of the effects of complex trauma and neglect from the perspective of EMDR and the TAI model. An expanded TAI model will be proposed to address the nature of information stored dysfunctionally in people experiencing structural dissociation.

• Learn to recognise and respond to the specific clinical challenges of the different phases of EMDR therapy for highly dissociative patients.

• Learn to identify visible and hidden dissociative symptoms, and how to take them into account in case conceptualisation. The principles of case conceptualisation and strategies for developing a comprehensive treatment plan will be explained, as well as their foundations in relation to dissociative structures and associated symptoms. Clinical examples will be shown on video.

• Learn to identify and understand dissociative phobias based on the Theory of Structural Dissociation of Personality (TDSP, Van der Hart, Nijenhuis and Steele, 2006/2010) and its relevance to the EMDR process.

• Learn how to apply the framework for working with dissociative phobias to help you plan a step-by-step approach to traumatic content and dissociative phobias. Analyse clinical cases and video demonstrations to illustrate the procedures designed to identify and overcome these phobias

• Acquire a set of modified EMDR procedures to work safely with EMDR with dissociative patients. Examine and develop new skills in specific EMDR procedures through clinical cases and videos

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