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7 Course of Treatment and Assessment of Progress
Unlike CBT, which focuses primarily on exposure to situations and body sensations
through therapist-assisted exposure, the primary focus of EMDR treatment is in-session
processing of etiological events, triggers, and new behaviors. Targeting individual memo-
ries often leads to insights, and the revealing of other triggers and events for subsequent
processing. In all, 12 sessions of EMDR focused on processing of etiological memories and
triggers and 3 on development and enhancement of future behaviors. All in vivo exposure
was self-initiated by the client and done without therapist assistance.
The history-taking phase was conducted in the first three sessions. During the second phase
of EMDR treatment (
client preparation
), a therapeutic alliance is strengthened between the
client and the clinician, a task that is consistent with any psychotherapeutic process. The find-
ings of Goldstein et al. (2000; see also Shapiro, 2001) underscore the need to allocate ade-
quate time to establish a therapeutic alliance and prepare the client. Consequently, alliance
building and three sessions of psychoeducation on anxiety symptoms, including self-control
techniques, were conducted before reprocessing began. The EMDR process and effects were
explained to Adriana, and she was provided with a
safe place
exercise, which asked her to
bring up an image of a place that elicited a positive feeling of well-being (e.g., walking on her
bare feet on the green grass at her uncle’s farm, feeling the softness and the freshness of the
grass under her feet). While concentrating on this image, she felt lightness on her whole body
and associated it to the word
nature
. The image, emotions, and physical sensations were then
increased through simultaneous pairing with bilateral stimulation (see Shapiro, 2001). This
exercise is a very nonthreatening way to introduce EMDR to the client. Adriana would then
be able to use this exercise to regain her emotional calmness if disturbing material was
re-experienced during therapy or between sessions.
During the first history-taking and preparation sessions, Adriana had gained awareness
of the issues or situations that contributed to this disorder and was able to identify the rel-
evant triggers. This information was key in formulating the treatment plan, which involved
a very specific method of addressing these issues. Allowing six sessions for history-taking
and preparation fostered a sense of coparticipation in Adriana and became central to the
psychoeducation, which set the stage for subsequent reprocessing. Explanations to Adriana
regarding the standard EMDR protocol (Shapiro, 2001) that targets etiological events that
are experiential contributors to the disorder, recent triggers, and future templates became
part of the psychoeducation process.
During the third phase of EMDR treatment (
assessment
), the client and the clinician
identify the target to be processed in that session and choose the image that represents the
worst part of the traumatic event, along with a statement that expresses a current negative
belief about herself (e.g., “I am in danger”). Then the therapist encourages the client to find
a related positive statement that she would like to believe instead (e.g., “I am safe now”).
The validity of cognition scale (VOC; 1 =
feels completely false
to 7 =
feels completely
true
; Shapiro, 1989, 2001) is used to obtain a rating of how true the positive statement feels.
The client also identifies the negative emotions (e.g., fear, anger) linked to the memory and
to the negative statement “I am in danger.” The intensity of these emotions is measured
using the SUD scale and the accompanying bodily sensations (e.g., tension, spasms) are
identified.
Fernandez, Faretta / Panic Disorder and EMDR Treatment
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