A is for Addiction. E is for EMDR. How Do You Bring them Together?

Hope Payson, LCSW, LADC is a widely respected expert in the treatment of addiction and trauma and an EMDR Consultant. She is highly sought-after trainer, consultant and presenter. The Center is offering her 12 CE training—Treating Addictions with EMDR Therapy: A Path to Reconnection. Check it out while spaces still remain. 

Can I use EMDR therapy with my clients who struggle with addiction? 

It’s a common consultation question and a deceptively straightforward one. It’s tempting to look for a yes or no answer, a specific addiction protocol or model. This question can only be answered in the context of the client’s unique clinical landscape. The most effective way to understand that context is through the case conceptualization process that starts the minute we meet our clients.   

Grounded by the AIP model and clinical understanding, case conceptualization clears the smoke from the landscape and allows us to craft a solid treatment map as nuanced and unique as each one of our clients. And Case Conceptualization is not static. It flows throughout our work, shifting and changing as our clients progress.  

 
Start Strong 

Beginning with these two questions will help you establish your starting point and shape your initial plan: 

What setting am I working in? Is your client in a 28-day abstinence-based program? A long-term outpatient setting? Or a harm reduction outreach approach? Knowing whether you have 30 days or one year to work with someone influences the goals and trajectory of your client’s treatment plan. 

What fires need to be put out and how hot are they? Risk is assessed in all phases of EMDR, but particularly in phases 1 and 2.  All out-of-balance behaviors cause pain, but some can be life-threatening. The risks related to opiate use or seriously restricted eating, for example, are much higher than for occasional binge shopping.   

After you’ve assessed all risks, the initial treatment plan may point to using the three-pronged approach to address the “hottest” presenting issue—the one that most fuels risk. Other compelling traumatic memory networks can wait. Working through past, present, and future, on a theme such as: “I can’t ask for help” can help a client increase the supports they need in place to address other themes and associated memories.  

Moving through the EMDR Phases Safely 

First, you’ll complete a Phase 1 assessment which may include a medical assessment for chemically dependent clients. Then you’ll consider the client’s current presentation and all you know from their history. All clients can be engaged in EMDR therapy, but some will need increased stabilization before moving on to other phases.  

How do I know if my client is ready for Phases 3-7? First off, are there are reservations? Who has them? Is the reluctance coming from me, my clients or from both of us? What will increase readiness and decrease this reservation? The answers to these questions can guide us in making the readiness decision.  

Remember, we are a part of this living breathing process and we need to assess our own fears. If we are reluctant, then consultation can help us sort out whether our concerns are rooted in clinical instincts or our personal experiences. Uncertainty is normal and to be expected. We are human. We care and the thought of witnessing a client suffering with addiction can feed our reluctance. It’s hard work and we all need help sometimes. 

Many Choices for Moving Forward Safely 

What memory networks can we address in Phases 3-7? Would addressing addiction memory networks such as triggers, urges, cravings or relapse memories provide needed stability? Or would it be more helpful to address trauma memory networks at this time? What area can we target to help a client address their unique recovery goals? What themes, memories or presenting issues fuel instability? What interventions can be used to increase support networks and decrease risk? We have choices, which is a good thing.   

If there are concerns about going to the “worst and first” memories, we can work on others until more stability is established. We can address current issues, such as triggers and urges, until the client is ready for deeper work. There is almost always something we can do to move forward. 

How can we decrease the negative impact of addiction? The client’s goals, their safety and stability and our clinical knowledge all factor into the case conceptualization process. Including harm reduction strategies in all phases of EMDR increases a client’s stability and strengthens clinical rapport. It’s also a social justice practice that accepts clients as they are, regardless of their recovery or addiction status. Finally, it accepts that relapse may be a part of the process and includes risk management as an important part of harm reduction. 

A Good Treatment Plan Is Flexible 

Because situations are fluid and human beings change, think of your treatment plans as written in pencil. Why? Consider Phase 8 where each session starts with the opportunity to reevaluate our work globally and specifically. And when a treatment plan is written in pencil, we can adjust it to address any shifting condition. We have eight EMDR phases to guide us in this complicated work. And we can ask questions that lead to us to new insights and understanding throughout the process.  

Asking about EMDR therapy for clients who struggle with addiction is only a starting place. We have eight EMDR phases to guide us in this complicated work. Assessing how to engage in EMDR therapy with our clients, requires many more questions—like the ones we’ve suggested here. And we trust that, over time, you will ask many more questions that lead to new insights about how EMDR therapy can help this vulnerable population.