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EMDR predicament

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barefoot

MyPTSD Pro
I was supposed to start EMDR with a new therapist. We had three info gathering intake sessions in March/April and then I got Coronavirus mid-April and I haven’t yet made a full recovery. So, things have been on pause. I have a quick check-in call (not a session) with the therapist in a couple of weeks.

If I am not feeling well enough/ready to start at that point, she said she would need to close my file and then I would have to get in touch with the service again whenever I was ready, which would then mean going through the original assessments/waiting for a T availability etc again.

So, any thoughts around any of the following:

- My main post-Covid symptom now is fatigue. I don’t have any oomph. Any level of exertion - physical, mental, emotional - wipes me out. I am still napping most days. I feel...depleted. Also feel more emotional than usual - crying very easily at things on tv etc. Those of you who have done EMDR - would being low on energy and not physically 100% make EMDR much harder, do you think? Would I be best to wait until I’m feeling 100% though I have no idea how long that will take. Would starting while feeling depleted be a mistake or will it just mean I’ll probably just feel tired and need to rest after sessions?

- Initially, the T said we could start doing prep stage sessions online via video calls but that their policy was that the actual processing sessions would have to be done in-person. However, they have recently changed their policy and, due to Covid, will not be seeing clients face-to-face until 2021 so now the whole process is being moved to online. Although that is more convenient for me in some ways, I feel a bit concerned about doing EMDR processing with a T who isn’t used to doing it that way - and when they had a policy pre-Covid about not doing it that way because they thought in-person was best. Would be interested to hear of anyone’s experience with doing full EMDR on video calls.

- T is going on maternity leave early October. So, even if I decide to start soon she will be leaving in October. So, I will have a choice of a) whether to start with her and try to get all sessions in before she leaves or b) start with her - perhaps do the prep stage sessions with her - then switch to a new T to complete with or c) start with a new T from the get-go to ensure consistency of same T throughout. Any thoughts/experiences on this? From the three assessment calls I’ve had with her, I quite like this T - she seems nice enough. I am not any more excited about her than that, which is fine... I didn’t choose her, she was just assigned to me and so it’s not like I am super-invested in wanting to work with her specifically. So, it’s not like it will be a major emotional wrench to swap. On the other hand, we have done three pretty full-on info gathering sessions and she knows some recent contexts (eg me being unwell and a friend recently being killed) so, although I know she will do a handover to her colleague and pass on her notes on me, I do feel I would end up repeating stuff to bring the new one up to speak. Not a disaster, I know...it just feels a bit...irritating and tedious to go back over all the background stuff with someone new. And, I suppose it is possible that I won’t like/feel comfortable with the replacement T.

So, any views/suggestions around:
1) Start now or wait til I’m feeling fully recovered - though that could mean waiting months (both for my full recovery and to then go through the system again)
2) Full EMDR process online - good idea or anything to be aware/cautious of?
3) Which T to work with (or both)?

Feels like a big decision - when and how I approach this process - but I have no experience of EMDR so would really value any input.

Thank you!
 
@barefoot, my experience with EMDR kind of happened in two separate stages, so I’m not sure how helpful this will be, but here’s my input:

First and foremost, the prep phase is most important, as it is essential to being able to process safely. Therefore, I do not recommend switching Ts midway through the process unless absolutely necessary - if you are working on complex trauma like me, you may be forced to switch therapists if things like retirement, etc. happen; however, if you have specific goals that are intended to be short-term (the typical 12 sessions or so), then the same T throughout is almost critical. I’m assuming an issue of trust is involved, and if so, I would recommend waiting if you can.

Secondly, EMDR is not recommended when the client is not stable, although for me it is a form of stabilization because it allows me to process my feelings and speak about them. The processing continues long after the session is over, which is why the prep phase, is so important; it gives you tools to cope between sessions. It’s also common for people to feel exhausted afterward and sleep, which to my knowledge, is where most of the processing occurs. Chronic fatigue can be normal for some like me, but symptoms can be exacerbated and difficult to manage during the days following sessions. Pacing is extremely important, and if your fatigue worsens during the prep phase for any reason, I would not suggest moving to processing unless and until the fatigue becomes manageable and/or a part of your “new normal“

In short, EMDR is not right for everyone, although it can look like an appropriate treatment for your situation on the surface, you may start and realize that it is not effective for you. Consistency is extremely important as both the T and client need to exchange honest feedback, positive or negative, in order to determine the pace of treatment. Any experienced EMDR clinician should share whether or not treatment should be discontinued or modified in any way, and physical stamina should be considered when discussing such feedback.

I know that the wait is unknown if you choose to postpone treatment, so I’m going to throw out another suggestion as an alternative. Do you have access to a practitioner who specializes in somatic experiencing? If so, he or she can incorporate your fatigue into sessions in hopes of resolving trauma without any adverse effects. I’d be happy to work through this decision with you, so feel free to reach out!
 
@barefoot Are you sure what you are feeling is from covid and not something else? That is usually no more than a 6 week recovery for severe cases that were hospitalized. I am wondering if something else is going on.
 
I’m doing emdr over a screen and last week over the phone when the WiFi cut out. My therapist knows me really well and I think that is why it’s working well this way. I have a modified version because I get overwhelmed by traditional emdr.

I’m concerned that you are crying and tired. It sounds like me when I’m having depression. Please get evaluated for your symptoms.

When your suds is high, emdr will knock you down hard. My head will feel stuffed up for a day or two. Headache and tired. I take off work. I do feel strong a few days later.
 
Would I be best to wait until I’m feeling 100% though I have no idea how long that will take.
My last bad flu it took me about 2 years to recover physically from the infection itself, and I’m at about the 18mo mark on recovering from side effects (broken bones from corticosteroids, muscle atrophy, dislocations subsequent to muscle atrophy, etc. Oh joy, oh rapture ;)), with probably another 18mo or so to go. In an ideal world I’d have been inpatient for another 6-8 weeks, and then 3-6mo of skilled nursing care, and 12 months of physio... but that’s “just” what my treatment team ordered, not what my insurance would pay for... so things are on a much slooooooower timeframe :wtf: Stupid flu.

The fatigue really is the worst part of it, once you’re no longer likely.

My very strong suggestion, is if the fatigue is at the point of circumscribing your life? To upgrade your care, if at all possible. Either by having specialists come to you, or in a facility where the ones you need the most are employed, and others can -hopefully- meet you there, as part of their rounds. Not all practitioners do this, of course, but it’s prooooobably more likely if they’re NHS, than private, that they’d have clinical hours to fulfill in a local hospital or acute care center?

Clearly... that’s not always possible. The NHS is so freaking variable depending on the area you live, and it’s all been turned upside down by Covid. But I had to be about 3 years out before I could really appreciate how much faster/easier things might have been if I hadn’t been so focused on surviving day by day, but could have had the resources to hand that I needed.

Just another avenue to consider. Something of a middle road between being well enough to attack your life -vs- sick enough to have to cancel everything until you’re well enough to get back on waitlists.
 
Thanks for sharing all that info @ButterflyBean

I do not recommend switching Ts midway through the process unless absolutely necessary

Yeah...I figured this probably wasn't ideal. It's just a bit annoying having already done three detailed intake to then not do anything further with her. But I guess switching to a different therapist at this point is probably preferable to doing more with this T and then switching further down the line?


the typical 12 sessions or so

I think I will either have 12 or 20.


Secondly, EMDR is not recommended when the client is not stable, although for me it is a form of stabilization because it allows me to process my feelings and speak about them.

Yes, that makes sense. I don't think I feel I am unstable. Just that I feel a bit depleted and am not firing on all cylinders, if you know what I mean?

if your fatigue worsens during the prep phase for any reason, I would not suggest moving to processing unless and until the fatigue becomes manageable and/or a part of your “new normal“

I'm not sure if it will be clear that this is happening seeing as I am so fatigued in the first place but some days are worse than others?

Do you have access to a practitioner who specializes in somatic experiencing?

A good idea but unfortunately not. There aren't any in my area plus I can't afford to take on a private therapist at the moment – the EMDR T is on the NHS. As far as I know, somatic experiencing isn't offered here on the NHS.


Are you sure what you are feeling is from covid and not something else? That is usually no more than a 6 week recovery for severe cases that were hospitalized.

No. There are actually thousands of people experiencing the 'long tail' of Covid – 'Covid Long Haulers'. There has been much more press coverage about this in recent weeks here in the UK. These patients – including me – are still on a long, slow path to full recovery and experiencing an array of symptoms many weeks and months later. And the majority of them originally had 'mild' Coronavirus ('mild' meaning they weren't admitted to hospital) Many doctors are now saying there will have to be more focus on longer term effects/treatment and predicting an increase in Chronic Fatigue Syndrome/M.E. type chronic illnesses. I have developed two lung infections so far following the Coronavirus itself, which hasn't helped, of course!


I’m doing emdr over a screen and last week over the phone when the WiFi cut out.

This is interesting to hear that you are doing it all online. Though you did start in person, so I wonder if that helped make it successful over screen? Do you mind sharing more about the adjustments your T has made to the EMDR process for you? No worries if you'd rather not!

I’m concerned that you are crying and tired. It sounds like me when I’m having depression. Please get evaluated for your symptoms.

No, not depressed. Tired because I've been physically unwell for several weeks and fatigue is the main on-going symptom I'm experiencing at the moment. So, I'm having to be very mindful of pacing myself, managing my energy levels etc. And crying for the same reason, I think. Just feeling very depleted. Plus, a friend was recently killed in a terrorist attack here. So, things are just hard at the moment because there's been a lot of not great things going on. But I don't feel depressed.


if the fatigue is at the point of circumscribing your life? To upgrade your care, if at all possible. Either by having specialists come to you, or in a facility where the ones you need the most are employed, and others can - hopefully - meet you there, as part of their rounds.

Are you meaning go and stay in a hospital and/or have medical practitioners come to care for me at home? I don't need anything that extreme and wouldn't be able to get anything like that even if I thought I did! I'm doing ok – I'm just balancing things at the moment and managing my energy the best I can, restructuring my time etc. So, while I'm limited in what I can do at the moment and I feel quite fed up about it at times, I'm managing ok.
 
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