Failed At Emdr Again - Where Now?

[Abstract]

Maggie, yes, I can see why DBT would be helpful for your friend but it is used by people all the time who are neither self injuring, are working and are not suicidal. I hope you re think about DBT as I do think it could help you.

Maybe start with this site http://www.dbtselfhelp.com/. It isn't properly operational at present but will still give you an idea. You can do a DBT course and still continue with normal therapy and in fact it is recommended to do so. I am still unclear about what your t is and isn't but I will leave all that to you!

 

[Hashi]

We were supposed to be installing a safe place using EMDR. Last time we tried I struggled, so I went prepared with pics of my safe place I'd chosen, sounds etc, confident it would work. But... ... We came to the conclusion I can't focus on my internal world and pay attention to external stimuli

I think the safe place approach is problematic for many people. Partly because not everyone can come up with a truly safe-feeling place. Partly because of the way it's often used - asking us to focus cognitively on something while under emotional stress/distress. Personally, I prefer other ways to manage safety.

I always thought I had good coping strategies, but it seems I don't have enough. Done a lot of work on grounding and staying in the present, but not enough

Is it OK to ask what sort of things you do for grounding and staying in the present? Which are the most effective for you?

Maybe tho I need someone more experienced to help. We have discussed sensorimotor therapy in the past, that may help esp with body memories...

Do you mean sensorimotor therapy with the same therapist?

Is it an option to continue seeing this therapist who you trust, at the same time as having a somatic therapy? I realise that might not be practical for financial or other reasons, but I wondered.

I looked up sensorimotor therapy and it sounds similar to what I understand as body psychotherapy and Focussing. Having done both, I'd say that if you have a trauma history you need serious skills at coping and stabilising to do them. They can be very effective, especially if you experience a lot of somatisation, but that goes hand in hand with unleashing some powerful energies and memories that the body has been holding.

I also found that some parts of my body were at war with each other or with other parts of me (like my mind). In particular, one part of my body was furious and unforgiving towards my mind for a decision that I made and acted on. I (my mind) felt unfairly judged and attacked and was angry in return. This makes sense to me now, that all this would be going on under the surface, but I hadn't expected it and it was terrible. This stuff can be really raw.

I'm a big fan of somatic therapy, but I'd approach it with a great deal of care. I'd look for a therapist experienced in trauma who is big on safety and stability. In fact, I wonder if a good somatic therapist who is very strong in that area and can work with you on it, would be a very helpful thing for you. Maybe to focus initially on safety and stability alone, learning how to contain what your body is expressing before trying to process it.

If you're dissociating then you don't feel safe enough. That's the bottom line, and in my view all you should be focussing on right now is safety, coping skills and containment - to a high level. I think DBT skills can help with that, and I think it goes beyond DBT skills. I think it goes far beyond a safe place.

Would you like to say more about the dissociation and how you experience it?

 

[Maggiemay]

Thanks Abstract, I can mention it when I see psych.

Trauma service won't touch me as I'm "too complex". I was referred a year ago. I had 8 sessions under complex needs service but couldn't offer me more. They were going to put me on the waiting list for mentalisation therapy but too long. I saw T through talking therapies, which was 20 sessions of cbt supposedly. Now seeing her privately at reduced rate...

 

[Maggiemay]

Hashi -

I was able to think of safe place as was prepared as knew what we would be doing in advance, but struggled when we introduced bilateral stimulation.

To ground myself I do a lot of naming what I see/counting/picking out colours/reminding myself where I am and how old I am/breathing exercises.

I'd rather stay with current T as I trust her, but don't think she's trained. It would have to be through NHS if possible as I can't afford it - only pay T £10 a session.

I somatsise A LOT: non-epileptic seizures, blacking out, acid reflux, sinus tachycardia, fibromyalgia, sciatica, IBS etc... It's my biggest difficulty alongside the dissociation but they're very linked as body expressing what I can't express verbally. Am worried about any therapy that may leave me re-traumatised after my experiences last year linked to flashbacks that were horrific.

Wow! The being at war is me to a T! I read a book about body memories last year that was very helpful and off with T to workshop on the body and trauma in July. The being at war also links to my different fragments.

I guess you're right, but I spend my life fighting and refusing to be beaten that it's not until recently I've realised just how serious this all is. I definately need help feeling safe

*deleted*

 

[Maggiemay]

I suffer from depersonalization - feeling that my body is not my own; physical numbness and being out of sync, effecting my movement/severe all over pain leaving me literally frozen and unable to move ; not recognising myself in the mirror; watch myself as if on film (I'm usually in the corner looking at myself or from above); total disconnection between mind and body causing somatisation.

I also suffer from derealism - I can black out; loose large chunks of time; warped perceptions - I can't hear/sensory overload when any sound or bright lights fells like I'm being touched and hurts like hell; my vision will become very hazy and out of focus, or stationary objects will move/things will feel nearer/further away (worst = going through car park when it feels like the cars are moving towards you); I do a lot of blank staring - used to freak family out when I lived at home as they couldn't get me out of it.

I have a lot of panic attacks and flashbacks, and although I know I don't have did as no amnesia, I have a very fragmented personality.

 

[Hashi]

I think the grounding exercises you describe are the norm and it isn't always suggested to us that we need more. However, I'm going to suggest - very strongly - that you need a lot more than this.

They are all quite reactive - they are in response to starting to dissociate. They aren't preventative - they don't stop you from dissociating before it happens.

That's if I've understood correctly, ie you're not spending all day long actively picking out colours and reminding yourself where you are? If you are spending all day long doing that as a preventative measure, I think there are more effective things you can be doing through the day.

There are grounding exercises that work on keeping you grounded, rather than getting grounded again when you start losing that. For example, imagining as you walk that your feet are 12 inches below the surface of the ground. There are exercises like this at the beginning of the book "Psychic Protection" by William Bloom. I suggest you have a look at those, and find other sources of exercises like this, and do them tons. All through the day.

I would also suggest you use imagery, like your safe place imagery, in a preventative way. That is, you come up with images for staying grounded and safe all the time, and practise those through the day.

I can't point you to a single place that explains this because I haven't found one. The idea of imagery is covered reasonably well in "Invisible Heroes" by Belleruth Naparstek but I can't recommend her actual examples of visualisations which are in the book. William Bloom's Psychic Protection book has better imagery, but it isn't aimed at trauma survivors - it's about protection generally from other people's negative energies - so it needs quite a bit of adapting to the context. Each person has to find imagery that works best for them individually, anyway.

I don't know what to say about how your therapist might fit into all this. I've got to be honest and say I feel concern at her seeming lack of experience with people in situations like yours. At the same time, I do understand financial constraints and I understand about having built up trust.

My first instinct would be to suggest you do everything you can, and even things that might seem impossible, to try to find a way to see a private therapist who would be more appropriate for this.

You mentioned an NHS waiting list that was too long. Are you on it? I think it's worth putting your name on it, however long it is.

I really hate to say this, because I'm concerned about what you say about your therapist's knowledge and experience - but if you are decided on continuing to work with her I think she herself needs to be learning a great deal about client safety beyond the basic techniques and using a safe place. More than a single workshop in July as well.

I'm really concerned about your therapist's judgement, though. I don't understand why she was doing EMDR with you when you have the symptoms you describe. It doesn't sound like you're anywhere near stable enough to be trying it.

 

[Maggiemay]

Wow ! Thanks Soooo much for your input :D

I've never thought of grounding in a proactive rather than a reactive way so that's incredibly helpful :)I'll look into it more and look up your book recommendations :)

Not on the waiting list - I had 8 sessions under complex needs services instead = pointless waste of time!

Sadly, at the mo it's current T or nothing as NS very reluctant to help. I'm waiting on appt with psych, she was going to come and support me but I may go alone so I can discuss stuff but I then risk going mute and not getting my needs met...

I'm waiting for her to look at DES questionnaire tomorrow . Also, I sent her theSDQ20 which focuses on somatic dissociation - it's me to a T!!!

 

[Abstract]

There are many areas that offer DBT courses through the NHS and I think it's worth enquiring about it. It is a post code lottery unfortunately but you never know unless you try and ask. Even though your BPD symptoms are not your main concern the diagnoses could be a means to get at it. Something similar on offer in the UK is Mindfulness based DBT. The NHS is still quite backward about offering it to others even though it is becoming much more available privately and for more situations but with a very large price tag attached. I would see if you could use your diagnoses to get at some good skill building. ;)

It seems to me that if you can supplement your treatment elsewhere and yourself as much as possible then it will help compensate for your t's deficits.

Do you think she would be open to learning more herself in the way Hashi mentioned? Would she be defensive if you suggested it or not do you think?

 

[Maggiemay]

;) I know DBT is available under my PCT (Primary Care Trust ) under the complex needs services so I'll look into it :) Never thought I would be using BPD diagnosis to my advantage - I hate it!!

She's very open to learning New things. Ironically, she did the EMDR training a year ago for me after trauma services rejected me. She's used it successfully on other clients , but I guess I don't neatly fit in a box...

 

[Abstract]

There is always a silver lining to everything! ;) Even a diagnoses you didn't want! It would cost a lot of money doing it on your own.

She should never have been attempting EMDR with you after just training! I am a bit horrified. To know more you might want to read this which is an interview from the woman who created EMDR. Note what she says about complex trauma.
http://consults.blogs.nytimes.com/2012/03/16/expert-answers-on-e-m-d-r/?_php=true&_type=blogs&_r=0

Quote: When someone has had an extremely difficult childhood that includes neglect or abuse, it is important to interview prospective clinicians to find someone who is experienced and well trained in phase-oriented trauma treatment for chronic childhood abuse and the use of E.M.D.R. therapy.

 

[Maggiemay]

LOL! If only BPD had more silver linings! I very rarely admit I have it due to prejudice, often share CPTSD label tho as makes me feel less ashamed. It acknowledges this isn't my fault.
She has good intentions and genuinely wants to help, but don't think she has all the tools i need. Hard tho as I trust her a lot

 

[Pencil]

Trauma service won't touch me as I'm "too complex".

I was rejected by 3 therapists for the same reason. Not a nice feeling, Maggiemay. I relate, for what it's worth.