Introduction
This session was intended to help a client
reduce cravings for cannabis, which he had been using daily for several years. Details
that might reveal his identity have been omitted or altered.
Additional methods are derived from Tantric yogic imagery and
other imaginal energy work, as well as body awareness work with a Reichian influence.
I have posted this case to illustrate some methods I have come to
trust, to encourage discussion among therapists interested in EMDR or in energy as a
concept in psychotherapy, or in methods which accelerate treatment. I have discussed these
methods with numerous therapist and found much support for the ideas expressed here and
throughout this site.
In order to avoid debating the actual definition or boundaries of
EMDR, I refer to this session as using an EMDR-inspired approach.
Warning: This text is not intended as instructions or
training. It exemplifies the integration of influences I value in psychotherapy. Do
not work with any problem or modality for which you do not have appropriate training,
experience and any necessary certification or licensure. Sessions using body mind
modalities including EMDR can be much more challenging then the case reviewed here.
Understanding this Session Summary
This is a session summary. Actual quotes
are in quotation marks. Otherwise, only enough text is provided so that the reader can
follow the flow and intent of the session.
Numbers used in the text such as 1:00 refer to elapsed time from
the point at which the PLS sound is administered. (Sound is explained below.)
You may find it helpful to review the file in this site on Levels of Consciousness in Psychotherapy and other files on
reprocessing and state management for a better appreciation of this summary. This article
is particularly helpful for EMDR-trained therapists to understand and manage sessions.
Methods Used: EMDR-Inspired Work and
"Energy"
The EMDR-inspired stimulus for this
session is not eye movement. Throughout the session, the client is listening to a Phased
Lateral Stimulus (TM) sound used to substitute for eye movement. The sound is not now
commercially available but can be used in research on request. It uses a proprietary
stereo pattern created with MIDI synthesis. The equipment used to develop the sound
allowed use of numerous parameters and sounds intended to elicit a strong subjective
effect, and based on my own, clients' and therapists' responses to early versions. It is
estimated that over 1,000 sessions had been carried out using PLS sound as of 8/96.
This approach is not necessarily endorsed by the EMDR Institute,
however many EMDR-trained therapists have discussed with me or in print their use of
methods such as those illustrated in this text. The EMDR Institute endorses a commercially
available device available only to EMDR-trained clinicians. To my knowledge, the relative
merits of the two sound effects have not been explored extensively.
EMDR, particularly with use of sound, makes hypnotic methods work
more readily. Therefore, hypnotic effects are achieved with minimal hypnotic language. The
reference to energy conforms to some Asian thought on energy, but the therapist does not
have to subscribe to any metaphysical thinking in order to use this in enhancing a
positive state. Although I find it useful to think and experience in terms of energy, the
reader may prefer to think of energy as a metaphor or model for working with psychological
and emotional processes, and one which can be used hypnotically to enhance visualization
and body awareness.
EMDR Issues Including Differences in
Protocol Used in this Case
Follow up with EMDR clients is widely
reported to indicate the gains in EMDR are quite durable. Note however, that most
information on EMDR is on treating psychological trauma. Also, variations in the protocol
used in this case (the stimulus, and methods used), make it inappropriate to speak with
certainty that EMDR research and results can be used to shape expectations for results in
the work illustrated in this case.
However, the responses of
therapists using related methods, the PLS sound, and other appropriate sound stimuli
suggest that this work has a great deal in common with EMDR. This lends credence to the
idea that EMDR can be thought of in a larger sense as a specific protocol for eliciting
reprocessing which is a subset of a larger domain that could be referred to as
reprocessing. The fact that, in actual practice and research, EMDR is done with
significant variations in protocol also supports this thinking. Similarities between an
analysis of EMDR and other practices helped me develop this thinking.
In the article on reprocessing,
written for the general public, there is further discussion of this and a discussion of
cross-cultural and cross-disciplinary aspects I alluded to above.
The Focus on Chemical Dependence
EMDR is being used by many therapists in
treating substance abuse. It is also known that stress management methods can reduce
relapse risk. Because EMDR sessions often develop a positive feeling state as part of
reprocessing, I have brought in methods to enhance and expedite positive state development
when appropriate from Reichian and Asian influences.
The protocol used was inspired in part by the work of A.J. Popkey
with addictions and EMDR. Note that this case does not exemplify his approach or research.
Because this client adapted very well to the work, I used the
opportunity to strongly emphasize positive state development as a substitute for pot as
well as to reprocess the actual feelings of craving. EMDR is usually done with awareness
focused on a combination of traumatic memories and associated feelings (referred to as
targeting), but it has been found that variations on focusing awareness can yield
benefits. Variations include, focusing in imagined future events, or focusing exclusively
on feelings, as illustrated in this summary.
The Therapist
I am a licensed marriage, family and child
therapist, certified EAP, and had been level II trained in EMDR four years prior to this
session. I have been involved in human services, counseling and therapy since 1975, and
have diverse experience with Asian and western body mind practices.
The Case
Note that client demographics are omitted
or altered to preserve confidentiality. When demographics are altered, it is done in a way
that preserves the clinical issues of the case.
This 30 year old Anglo male is employed as
a systems administrator for a small biotechnology firm. He has difficulty with motivation
and weight gain, but functions at a high moderate level.
He began treatment conjointly with his
wife of two years on marital issues related, in part, to his motivation. After two
sessions, which included my concerns about pot use, he and his wife openly discussed their
concerns and the client stated he had decided to give up pot use because he wanted to have
more energy, motivation, and other benefits. During a prior period of abstinence, he felt
better.
The EMDR-Inspired session was preceded by
the assessment and orientation tasks described in EMDR training.
Session Summary
I direct client to focus on the
feelings associated with pot craving. He describes pressure in his chest.
0:00 I instruct client to focus on the
feeling of pressure, and to follow the stereo sound pattern.
1:50 I inquire as to the client's status.
He states he is trying to get into a flow. Recalls last night, craving pot. His feeling of
pressure and craving decreases. "I feel really relaxed about it. I was tense over it
last night."
Expedient relaxation in regards to an
issue is often reported in EMDR treatment. The initial reaction appears to occur more
rapidly with sound in my experience.
3:50 RY: "So what's there now?"
Clt: "A natural flow, like waves. They're running through my whole body." I ask
where the weakest area of feeling is in his body (where there is the least feeling.) He
says it is in his thoughts. He is, "scared he might go off the trail."
(Referring to sobriety.) I ask him to locate the feeling of fear.
The client has quickly felt underlying
fear that I think of as underlying the more obvious feelings.
6:20 His belly feels knotted up. I ask him
to go to the center of the feeling and follow the sound. The sound, "softens or
cushions it." I ask him to stay with that feeling.
He has accessed the location and
physical correlate to the fear, and I instructed him to "target" the feeling.
8:45 "I definitely feel a flow going
through my body." I ask him to rate his level of discomfort with craving on a scale
of one to ten (a SUDS or subjective units of discomfort rating.) He gives, "three or
four." RY: "Well, since it's moving, go ahead and continue. See where you go
from there."
We continue targeting because
reprocessing appears to be under way.
10:40 "My body seems like it's all
one, now. An even flow. Now I'm going back to last night. That feeling isn't so intense
now." (SUDS rating is now, "a three or two.") RY: "Follow the sound
and stay with the feeling to see where it takes you."
Clients typically spontaneously know
where to direct their attention, although the therapist may often elect to direct the
client under certain circumstances.
13:35 I inquire as to his status.
"It's definitely going away...cravings feel a lot more distant.
His attention has returned to the
cravings, as the fear and knot have dissipated. He notices that the original target
(craving) is nearly gone.
15:10 RY: "What do you notice in
their place?" Clt: "A lot of positive thoughts." RY: "Such as?"
"Things I could be doing." RY: "Feels good?" Clt: "Yes."
He now feels no weak areas of feeling
(which we refer to as energy, because of the flowing nature of his predominant feelings.)
I ask him to allow the excess energy he
feels radiating from his body to form, "a well-knit energy wet suit, which conforms
to the perfect shape of your energy body." Clt: "It feels good. I got it in a
circle. Just rolling." I augment his relaxation with mildly hypnotic interaction.
This includes an Asian energy pattern referred to by Mantak Chia as the microcosmic orbit
and which resembles the central meridians in Chinese medicine.
A combination of light hypnotic
language and Asian influenced imaginal energy patterns appears to have expedited
development of a positive state in the foreground of the clients awareness.
22:00 I ask him to go to the next
opportunity to smoke during the day, and to notice any difficulty with letting it go.
"I'm trying to remember this flow in that situation." I ask him to focus on that
feeling of efforting without trying to do anything about the feeling, and to follow the
sound.
Moving to another time likely to induce
craving, we return to disturbing feelings to reprocess.
26:00 I instruct the client to imagine
that on the inhale he can pull energy into his bones, which soak up the energy to a point
of saturation. I ask him to let me know when the bones are full.
After about four minutes of
reprocessing future imagined cravings, I add a method to enhance the positive state which
was temporarily in the background. It is a somewhat abbreviated version of "bone
breathing," discussed by Mantak Chia as a "nie kung" (meaning something
like imagery work) technique from Asia. This client has reduced cravings fairly quickly
and so I focus on positive state enhancement, self regulation, and imagining future
successful behavior.
27:45 "I'm seeing my body as being
like a big glass and it's just filling up. I feel like there's energy all through my
body." I ask the client to become aware of a point in the lower back and behind each
knee and have the energy absorbed there as a way of storing additional energy. I suggest
that in the future, when he feels upset or a craving, that he can send excess emotional
energy in his head and heart into these points to balance his feelings.
I introduce an additional technique for
positive state enhancement. It may also help as a self regulatory method to cope with
distress or craving. It is based on Asian points also described by Mantak Chia for this
purpose.
29:30 I ask client to imagine his life as
a timeline into the future. I have him allow the positive feelings he has now to flow
forward through the timeline to each desire for pot that would occur. I hypnotically
describe the energy being like a flow, opening blockages, reprocessing each point of
craving. I say that it energizes his old age, extending life, creating room for self-care
throughout his life...a leisurely feeling of taking time to run or other self-care he
would care to indulge in.
The client has suspended judgment, so
the imagining of future successful behavior is laced with extreme suggestions of health
and successful behavior.
36:30 "It's kinda weird because I put
myself in that next craving situation and it seems far off, not strong. RY: "You can
imagine what you'd do instead." Clt: "A positive thought, no, more of a feeling,
came over and took it over. Seems like the longer I listen to this, the more comfortable I
am with the energy, like it was always a normal thing. But with my fingers being the
strongest outlet." I ask him to channel that excess energy into his energy wet suit,
which conforms to his energy body, returning energy to deeper organs which circulate it
back out and into the flow.
The energy wet suit is an image which
corresponds to an energy flow posited by Chines medicine. According to the book
Acupuncture Imaging, this flow is not commonly discussed in TCM (traditional Chinese
medicine.) In the West, it is not widely known that TCM is a consolidation of Chinese
medicine developed in the fifties under Mao. It does not comprise the whole of Chinese
medicine, which is quite diverse and, of course, is thousands of years old.
42:00 "The sound disappeared."
(It faded out at the end of the tape.) He is very surprised that nearly forty five minutes
has elapsed. We discuss the session. He described a cycle that occurred during the
sessions in which he felt craving and getting to a point of not needing to use pot,
"like it was a waste of time." He says that at first it was hard to relax into
the process, but that after a few minutes he became absorbed, saying, "After you get
to the focus of it, everything comes to be one." He now feels drained, but good, and
says that he can still see the energy, which he will use as a tool for dealing with
craving.
EMDR-inspired work is often as long as
ninety minutes, but the limited focus of this session, and the apparently light level of
addiction has allowed the session to move quickly and include a large proportion of time
spent on positive state development.
Clients commonly feel drained after EMDR,
and report time distortion when positive state development is a significant portion of the
session. The cycle of repeated targeting of craving the client described became more
expedient with each occurrence. This is common. The level of spontaneous direction and
reprocessing was unusually high in this session.
It is interesting that, in spite of an
apparent rapid move into state, the client said he had initial difficulty relaxing into
the process. This implies that an innate sense of direction in reprocessing was elicited,
resulting in a struggle to experience it. The client had not experienced reprocessing
before, yet knew where he wanted to go when he started listening to the PLS sound. For
example, he had said that he was having trouble "remembering" the energy in a
craving scenario early in the session.
Follow up
Follow up with clients exposed to this
type of protocol provided by myself and other clinicians has yielded promising results. In
my experience, clients who do not maintain free of their drug of choice have begun using
almost immediately, using some type of rationalization (as extreme as, "I wanted to
test the treatment.") It has been suggested that the therapist focus on the deeper
"characterological" attachment to the drug that is more powerful than the
consciously experienced craving, as well as any trauma history.
Some clients have spontaneously stopped
using after other issues (trauma and depression, for example) were treated using EMDR. In
other cases, other issues have improved after targeting the addiction.
This client was maintaining free of
cannabis at the time of the last contact two months following this session.
© Robert Yourell, 1996 |