Session Transcript

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 that accelerate treatment. I have discussed these methods with numerous therapists 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.

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 bilateral sound rather than using eye movement. This sound pattern appear to assist people in carrying out "inner work" and hypnotic methods such as described in this transcript. 

The reference to energy conforms to some Asian thought on energy, but the therapist does not have to subscribe to any metaphysical beliefs in order to use this in enhancing a positive state. The word "energy" can be used to describe a variety of feelings that people sense when focusing internally. It can also serve as a very general allusion to psychological and emotional processes. The term can be used hypnotically to enhance visualization and body awareness. 

EMDR Issues Including Differences in Protocol Used in this Case

Speaking generally, there is a class of self-help and therapy approaches that emphasize rapid desensitization. These include EMDR, EFT, and some processes used in NLP such as V/KD. (They are described very well by others.) It is widely reported that the improvements made with such methods are quite durable. 

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 definition of EMDR has evolved over time. There are certain principles and practices that form the core of EMDR regardless of the various enhancements or changes to the protocol that have taken place officially or by individual therapists. This transcript is for a sessions that focuses on a kind of desensitization. That is one of the phases of EMDR treatment. 

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 white 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.