There's a New Kid on the Block

How do you help a client whose time and resources are limited, but really needs help?

You figure out a creative way to help them.

I recently had the opportunity to work with Joelle, who was struggling in her role as a mom and was eager to do some personal work so she could show up for herself and her family the way she needed to. But she was also struggling to find the time, given the many demands in her life, and was having difficulty carving out time for anything extra. So the idea of having to commit to an open-ended timeline of therapy felt too overwhelming and more like a burden than an opportunity for growth. 

So we discussed the prospect of an EMDR Intensive.

What is an EMDR Intensive?

The phrase “EMDR Intensive” refers to extended sessions over a shorter period of time. This term is used to refer from anything from two 90-minute sessions per day for 4 days (Mendez et al, 2018), to an 8-hour session per day over 5 days (Greenwald et al, 2020). Depending on your client’s goals and capacities, and of course, aligning our schedules, anything in that range is considered an EMDR intensive.

How do EMDR Intensives work?

One of the most important factors when providing therapy through an EMDR Intensive format is the importance of leaning into Phase 1 –  History Taking and Treatment Planning. For an Intensive to work well, the therapist and client must be very specific on the goal for treatment from the outset. In traditional more open-ended EMDR psychotherapy, the treatment goals evolve over the course of treatment, which is typical as the treatment evolves and the client grows and changes.  

In an EMDR Intensive, however, your client is coming to you for a brief treatment and for a very specific purpose. So, that treatment plan becomes the ‘golden contract’ to which you, as the therapist, must adhere to, even though you might perceive there to be a greater need. Yes, less is more!

Using an EMDR Intensive as our framework, we began by identifying how Joelle would prefer to think, feel and respond to these typical challenge situations in her family. We had to narrow the focus from the multiple problems and issues in her life to one that was the most meaningful to her and that could give her the greatest sense of personal satisfaction as well as relief from her symptoms. Joelle identified that the most important goal was for her to be more proactive by asserting herself more clearly and to set better boundaries with her family. She described being impatient and often losing her temper with her children in the same way her mother did with her, which of course, generates feelings of guilt and shame about her reactivity.

Setting Up an EMDR Intensive

It is often the case with complex developmental trauma that all clinical themes of responsibility/defectiveness, safety/vulnerability, and power/control/choices, are present. This was certainly the case for Joelle, but at the same time, we needed to identify which theme was at play when she was losing her temper with her children. When she described her experience “as if they were in the same danger as their ancestors,” it was clear to both of us that her need for control over their safety was at the root of her difficulties.   

Delivering the Intensive

Once we established our treatment goal, we identified and reprocessed several nodal events.  We agreed to three consecutive days of 5-hour of sessions over a 72-hour period. The morning of our first day, we began our memory mapping based on recent events. Joelle vividly recalled an event that had just happened at the grocery store when her daughter ran ahead of her and bumped into a white, male stranger. She reported that she grabbed her hand tightly, apologized profusely to the stranger, abandoned her cart, and went back to her car with her daughter where she began to yell at her profusely. Using this experience, we floated it back and identified a foundational memory of her and her family hiding in their home whenever an unexpected visitor knocked on their door. Through targeting this memory, we were able to access channels of associations of similar experiences of fear and uncertainty, which helped Joelle better understand and appreciate how the push of these unresolved memories were impacting her ability to remain present to her current circumstances. 

The true beauty of an EMDR Intensive is in how quickly you can “get to the work.” Building off the work of Bongaerts, Van Minnen, and de Jongh (2017), a therapist can omit Phase 2 if a client is stable enough. Alternatively, a therapist can also begin by doing some brief preparation to help your client acclimate to the process and procedures using bilateral stimulation (BLS).

Once you proceed with Phases 3-7, be prepared to marvel at how much change you will see in your clients. We began reprocessing before our afternoon session on Day 1.  Since the memory networks were all primed from our work on mapping and identifying the targets, Joelle’s brain started making connections rapidly. One of the more notable connections she made was overhearing stories of a family member having been pulled from their ancestral home during the war and was never to be seen again. Though she could not remember the details, she recalled her conviction that their family was never safe. She then had the new insight that this ancestral story explained why her family would hide whenever someone unexpectedly came to their door. 

EMDR Intensives allow you to get to the root causes of the issue more quickly and see your client move through the arousal curves so they can start experiencing rapid relief.  

By having several sessions consecutively over the next two days, we had the opportunity to keep the reprocessing moving, without having a period of time between sessions.

The Importance of the Future Template in EMDR Intensives

The third prong of the AIP approach cannot be understated in an EMDR Intensive.  

With the rapid resolution of these foundational memories, it is imperative that we help fill in the developmental deficits using the Future Template.

Joelle had never seen what parenting looked like without anger and fear, which she now realized was based in her family’s history as well as her own. So, we had to build a memory network from the ground up by generating a number of challenging scenarios with her children where her fear would get triggered in the past. Her desire was to remain grounded, speak calmly to her children, and help them understand what was expected. Using the Future Template, we generated two challenge situations of her daughter running into someone she considered non-threatening and then someone who represented a threat to her in the past. Because we had already cleared out the foundational and present-day memories, Joelle was able to step into these future scenarios with ease and embody the more adaptive responses of being able to trust herself to respond appropriately with her children given what the current situated warranted.

As Joelle was able to think, feel and respond differently at home with her children, she started feeling better about herself not just as a mother, but also as a person, as her actions were more in alignment with how she wanted to be as a person in all of her relationships.

Does an EMDR Intensive Offer Long Term Relief?

One of the other questions I often get from clients and colleagues alike is, does an EMDR Intensive offer long-term relief? In a world where we emphasize fast information, instant gratification, and quick relief, it can raise our therapist “red flags” for therapy to be offered in this format.  

Research on the topic of EMDR Intensives is still in its early phases, although studies conducted so far (that I’m aware of) have shown significant treatment gains. Mendez et al (2018) found that the participants in their study maintained their progress two weeks after completion of treatment. Both Bongaerts et al (2017) and Greenwald et al (2020) showed maintained progress at 12 weeks post treatment, and Hurley (2018) showed maintained treatment gains at one-year post-treatment.

My experience with Joelle was that she achieved the same trait changes that we expect from standard applications of EMDR. Joelle describes herself today as a different person. Not only was she able to transform her relationship with her children and start viewing herself differently, but she experienced generalization effects. Joelle found she had more patience with other people in her life and felt less anxious overall. It was truly a wonderful experience for her as a human  and a parent.  

As a therapist who offers EMDR Intensives as part of my clinical services, I am grateful to witness the profound healing and growth that can occur in an EMDR Intensive. If you find this blog helpful, I invite you to share it with your network.

References:

Bongaerts, H. & Van Minnen, A., & de Jongh, A. (2017). Intensive EMDR to treat PTSD patients with severe comorbidity: A case series. Journal of EMDR Practice and Research. 11. 84-95. 10.1891/1933-3196.11.2.84.

Greenwald, R., Camden, A.A., Gamache, N., Lasser, K.A., Chapman, R., & Rattner, B. (2020). Intensive trauma-focused therapy with victims of crime. European Journal of Trauma & Dissociation, 100146.

Hurley E. C. (2018). Effective Treatment of Veterans With PTSD: Comparison Between Intensive Daily and Weekly EMDR Approaches. Frontiers in psychology, 9, 1458. https://doi.org/10.3389/fpsyg.2018.01458

Zepeda Méndez, M., Nijdam, M. J., Ter Heide, F. J. J., van der Aa, N., & Olff, M. (2018). A five-day inpatient EMDR treatment programme for PTSD: pilot study. European journal of psychotraumatology, 9(1), 1425575. https://doi.org/10.1080/20008198.2018.1425575