Excerpt from Finding the Energy to Heal

CHAPTER 1:
USING EMDR TO HEAL STRESS SYMPTOMS

Martha: Incapacitating Insomnia

Martha's voice told me more than Martha's words. In our first phone encounter, she sounded weary and hopeless, her tone filled with despair and anxiety. When I showed her into my office, she began her story hesitantly, her voice almost a whisper, her eyes not meeting mine. “You're my last hope,” she said softly.

Five years ago, Martha began developing a series of health problems.  She had just been promoted to a new job as director of a home health care agency. Although she enjoyed helping to meet the growing need for good homecare in an aging society, Martha's new position was immediately beset by difficulties. Her staff was downsized so that she was responsible for many more administrative duties. She was also required to travel to supervise a number of caseworkers in her region.

In addition, her own supervisor, who had recently joined the company, proved both incompetent and abusive. Her boss treated employees unfairly, giving preference to African-American coworkers and creating an atmosphere of reverse racism.  She never acknowledged Martha's achievements, offering instead biting criticism that was devastating to her.

Martha struggled for the first six months of her new job with a range of symptoms, including numb hands, stomach pain, insomnia, and depression. Finally, she sought medical attention and was prescribed Prozac, an antidepressant. This intervention only seemed to worsen Martha's stress, since she experienced side effects from the medication that included nausea, irritability, and sleeplessness. She alternately tried Zoloft and amitriptyline. Neither provided relief from feelings of depression or help with her continuing insomnia.

Becoming more desperate, Martha consulted an acupuncturist and herbalist. Kava, valerian root, and Chinese herbs helped her to relax but still did not ease the insomnia. Over the next four years, Martha consulted a variety of medical doctors, specialists, and clinics. Thyroid and heart problems were ruled out. A low dosage of estrogen was prescribed by a gynecologist who theorized that her difficulties might be perimenopausal. Diagnosticians at two well-known sleep clinics pronounced Martha depressed and prescribed more antidepressants along with the use of a light box. None of these suggestions significantly reduced the insomnia or other symptoms.

Martha told me at our first session that she had had a brief trial with hypnosis years ago and found it intriguing.  During her first hypnotic trance, she had seen a very dark room that was completely empty. At the time, she wasn't ready to explore this image. In fact, she had found the inner room terrifying and had not returned either to the therapist or to hypnosis.

Three months before seeing me, after struggling five years with her health problems, Martha had decided to quit her job. Her company had offered her the option of medical leave followed by early retirement. Though she felt some relief of stress, her persistent insomnia remained incapacitating. She decided this was the symptom that most impaired her health and targeted it as the one she wanted to resolve first. She also let me know she could only afford a few sessions.

During our second meeting, I presented all of the relevant therapy approaches to treat insomnia, along with their potential benefits and risks. As I explained the EMDR method, I told her that EMDR had the possibility of helping to rapidly resolve the stress and anxiety related to her sleep problems. If her sleep cycle restabilized, I thought she might then have the energy to approach some of her other difficulties. Although Martha wanted to try hypnosis because she found her previous experience to be so powerful, I pointed out that the mixed reactions she had described to hypnosis seemed to parallel her responses to all of the medical interventions she had tried thus far. I believed it would be better to begin with something new to her; if within a few sessions no significant movement had occurred, we could return to the idea of using hypnosis and imagery or other interventions.

Martha agreed to this plan somewhat reluctantly, but admitted, “I've got to trust you. I haven't trusted anything else so far. And that's probably why nothing has worked.”

In Martha's first EMDR session we began with positive target image.   I asked her if she could find a time in her life when she recalled having no trouble sleeping, a time when sleep was easy and restful. Martha immediately recalled her freshman year in college when she could always sleep. She said, “I long for that ability now. It was a womb-like experience.”

Her positive target image was walking in the door to her studio apartment. The thought that accompanied this image was, “Within 10 minutes, I'll be asleep.”  I asked her to focus on that image as well as the accompanying thoughts and feelings during the eye movements. (The symbol // = the instructions “stay with that” or “focus on that” followed by 20-50 side-to-side eye movements.)

M: I saw your hand as a magic wand and thought this might have potential for me. //

M: This time I got a picture of a blackboard. You were beginning to erase whatever was on the board.

MP: Can you tell what I was erasing?

M:  I think you are erasing accumulated bad experiences of my being unable to let go and go to sleep. //

M: I saw the same image of the blackboard . . . I felt calming in my arms and stomach. Then I had an image of a pipe filled with too much gunk and you were cleaning the insides of that. Then you continued to erase those bad experiences off the board. //

M:  I feel calm in my stomach; my arms are heavy.

Standard uses of EMDR suggest beginning with a clinical target image.   These include images of the events from the past that created the problem, current situations that trigger distress, and the skills that are needed for change. In Martha's case, a therapy target might be a time when Martha was not sleeping well and felt anxious about it, or a past event that is believed to have triggered the insomnia. However, I start my work a bit differently--by focusing first on the strengths already in place. I call these positive target images.

A positive target image is a sensory image that contains an experience of mastery related to the client's therapy goals. Not necessarily a visual image, it can represent a special event or an interlude of time before the symptoms began or when they were in remission. The positive target is installed using several sets of eye movements in order to provide strengthening at the beginning of therapy and to uncover linking resources that can be helpful for healing.

Here I ask Martha to identify a time in the past when she has experienced an abundant supply of what she wants to have now--deep, restful sleep that comes easily to her. She quickly recalls her freshman year of college when sleep was a delicious, “womb-like” experience. We are able to install this image as a positive target during several sets of eye movements. Martha holds the positive feelings evoked by this image and expands their meaning. My fingers become a “magic wand” and then a hand erasing a blackboard of past negative experiences, which include insomnia.

I wanted to start with the possibility that even though her sleep might have been very poor during the last five years, there might have been some time before that when sleep was not in any way a problem for her. If she had not been able to find a positive target image closely related to her therapy goals, we might have started with another kind of positive image. As you read through this book, you'll learn more about the many types of images that can be used as positive targets.

As we continued to focus on the positive target image, Martha discovered some familiar negative thoughts:

M: I started having thoughts that I'm not doing this right. It's just going to be like everything else I've tried. I know I'm going to be disappointed.

MP: Do you have a sense of what you might want to do with those thoughts? That is, could you use the blackboard image in some way?

M:  I could let you erase them. //

M: We erased the negative thoughts together; we kept erasing the board. //

M: This time I had the image of you as a priest giving me a blessing. It was lovely and sweet. You were giving me grace. The amazing thing is that I was receiving it; I could take it in. I've had a hole in my stomach for so long. I feel relaxed now. My arms and legs are like lead.

EMDR can be very helpful in changing negative ways of thinking. Here Martha's self-critical thoughts intruded as she found herself judging her process as not good enough. When EMDR clients cycle again and again through the same negative thoughts, feelings, sensations, or images in such a way that progress is blocked, they are said to be looping. Fortunately, steps can be taken to remove these barriers so that healing can flow freely again.

One way to break through looping and other negative thought patterns is to use EMDR interweaves. An interweave is a way of adding new information not available. This may be because mindbody pathways have closed in response to trauma and other factors. Usually the interweave is suggested by the therapist at appropriate times when EMDR processing is not moving forward.

The blackboard image Martha discovered early in this session is used as a special type of interweave called a resource interweave.  A resource interweave can consist of an image, symbol, body sensation, thought, inner voice, or any other somatosensory experience that appears to be strengthening. When it is installed during sets of lateral eye movements, the resource interweave should expand and the positive feelings that are evoked should deepen. This resource occurs spontaneously during an EMDR session or in between sessions.  I have found that the most effective resource interweaves are those that appear spontaneously in the rich stream of feelings and sensory associations shared by my clients during and immediately after sets of eye movements. My role is to identify these resources and to utilize them as interweaves when appropriate.

I used Martha's image of me erasing blackboard as a resource interweave to remind her that she could make choices about letting critical thoughts interrupt her positive focus. Throughout the rest of our EMDR work, the blackboard image became a powerful resource to help interrupt self-judgmental cycles so that Martha could take in the positive shifts she was making in a more permanent way.

MP: Because our time is almost up, I'm going to ask you to return to our positive target image of you walking in the front door of your freshman apartment. Tell me what happens when you bring up that image now.

M: I'm moving this to the bedroom I sleep in now. I can only do it a little bit but I think if I practice, it will get stronger.

We decided Martha would practice bringing up the image of entering her freshman apartment to reinforce our meeting and to prepare her mind for the experience of sleeping restfully. If any negative thoughts came up, she would use the image of erasing them from the blackboard.

Two weeks later, Martha reported that she had slept well every night but one. I suggested that we take one more trial with a positive target image so that she could continue to feel even more confident about this change.6  We started with the task of forming a positive target image of the last two weeks:

M: When I look at the last two weeks there is a definite shift. I feel really blessed, and there are tears of hope. //

M: I feel more relaxed. My hands feel warm and I'm feeling full. These are nice

feelings. //

M: I have a heavy feeling in my hands and arms . . . I'm also feeling very sad. I don't know why but it's OK. //

M: I felt my arms get even heavier. I'm not sure how I feel. I want to believe that this exercise will somehow clear me . . .  //

M: It feels like everything from my chest is draining into my arms. The release through my fingers and chest is lighter. Feels good. //

M: I feel lighter. It literally feels like this gunk in my chest is just coming down and then out. It's comforting to know that. . . . Now I'm judging myself. I'm thinking this isn't good enough. I'm starting to get off the track and I know it, but I can't stop myself.

MP:  Do you have a sense of what you might use to help with those judgments?

M:  Right, you're reminding me that I can erase it from the blackboard. //

M: Your hand erased that thought. It was nice. . . . I'm laughing now because bodywork has been so frightening for me. It's lovely I can do it now. My body has been carrying a lot. I'm grateful for my body, for faith in my mind and body that I can let go of all this. //

M: It's very calming to feel all that gratitude. I'm surprised at my sense of faith. Your hands are like a benediction and a blessing. . . .  Is that OK? //

M: My hands are very heavy now. I had an image of you cleaning my lungs, my chest cavity. . . . //

M: I feel calm and goodness and heavy. I'm lighter in my chest. I feel pretty damn good.

Martha's story also gives us a chance to examine the role EMDR can play in helping people find and use the resources of relationship. In most kinds of therapy, relationship issues that occur between client and therapist are referred to as transference and countertransference.7 In the first EMDR session, Martha perceived me as the instrument of change. It was I who waved a magic wand, then erased the blackboard and removed her past negative experiences, which included insomnia. I was transformed into a healer, cleaning “gunk” from her body. Later, I became a priest, using my hands to offer her blessings, benedictions, and spiritual cleansing.

 Unlike other therapies, EMDR does not involve giving suggestions, manipulating, or interpreting reactions toward the therapist. These transferential responses are fully accepted and allowed to move with the eye movements, just like other inner data. Most reactions toward the therapist that surface during EMDR are then naturally assimilated by clients in healthy, organic ways.

Martha seemed a bit uncomfortable with her images that involved me. She asked in the second session, “Is this OK?” Rather than responding, I simply invited her to stay with her images of me and to incorporate them into the rest of the inner connections she was making. One of the strengths of EMDR is its clear focus on the client's experience. When feelings, whether positive or negative, come up about the therapist, they become another link in a complex chain of associations that lead clients to a new sense of self and others.

Martha's initial sense of me as healer and priest shifted naturally to one of her providing the nurturing.  At the end of our second EMDR session, I asked Martha to go back to the target image of the last two weeks, her sense of the definite shift that occurred, feeling blessed, feeling tears and hope:

MP: What happens when you bring up that image now?

M: I see a little encapsulated egg. . . . It's white and surrounded by light. I feel full of new beginnings, like a rebirth. . . . The egg is very fragile. It needs care. It needs me to coddle it. (Sobbing)  It's like this egg has been given to me so many times and I've brushed it aside. //

As we talked for a few minutes about the egg, Martha told me that she thought it represented a neglected part of her that she had previously brushed aside because she did not know how to help it. Now she felt ready to nurture the egg self and felt confident that, with practice, she would be a good mother.

My sense is that because Martha was allowed to have and use freely her transpersonal images of me as a good parent and a comforting spiritual presence, she was able to incorporate those roles fairly quickly into her own identity. We will explore later on how other kinds of transpersonal reactions, including negative ones, can be used as positive pathways for change through EMDR.

Two weeks after her second EMDR session, Martha reported that her sleep was absolutely fine. She had had no further insomnia and wanted to begin working on other conflicts, including the lack of focus and fatigue that kept her from enjoying her early retirement and her love of art. At this point, we began using EMDR in a more traditional way, identifying clinical target images related to anxiety triggers that originated from past events. After three months, her debilitating insomnia still had not returned. The other health symptoms, including depression, stomach pain, and numbness, had vanished. She is appreciative. Her parting words to me were, “I could be a poster child for EMDR.”

How did two EMDR sessions resolve a five-year bout of insomnia? I attribute the rapid change to several factors. First, EMDR's multi-faceted system enabled Martha to reprocess, or transform, information related to her insomnia at cognitive, physical, emotional, and even spiritual levels very quickly. Second, the use of positive target images strengthened Martha's self confidence and sense of mastery by demonstrating to her that she already had the necessary resources to resolve her symptom.8 Third, from an energy psychology perspective, the positive targets images clarified rapidly the psychological issue that was blocking Martha's mindbody energies for healing. Her own self-criticism was the culprit!  Once we found a resource (i.e. the image of erasing the blackboard) that was more powerful energetically than her judgments, the block was cleared and Martha's healing pathways were open again.

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