Open Collections

THREE CO-RESEARCHERS' EXPERIENCES DURING THEIR FIRST SESSION OF EYE MOVEMENT DESENSITIZATION AND  REPROCESSING  by BRETT PETERSON B.A., The U n i v e r s i t y o f B r i t i s h Columbia, 1989 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES Counselling  Psychology  We accept t h i s t h e s i s ^ a s cpRforming  t o the r e q u i r e d  THE UNIVERSITY OF BRITISH COLUMBIA March 1996 © Brett  Peterson  standard  In  presenting  degree, at freely  this  the  thesis  in  partial  University  of  British  available for  copying  of  department publication  this or of  this  for  his thesis  scholarly  or for  her  Department The University of British Columbia Vancouver, Canada  Date  DE-6  (2/88)  fW  IS  l(o  the  requirements that the  I further agree that  purposes  may  representatives.  financial  permission.  of  Columbia, I agree  reference and study.  thesis by  fulfilment  It  gain shall not  an  permission for  granted  is  understood allowed  advanced  Library shall make  be  be  for  by  the that  without  it  extensive  head  of  my  copying  or  my  written  11  ABSTRACT Eye Movement D e s e n s i t i z a t i o n and Reprocessing Shapiro, 1989a, 1989b, 1995)  i s a r e l a t i v e l y new  (EMDR;  procedure  used p r i m a r i l y f o r t r e a t i n g p o s t t r a u m a t i c s t r e s s d i s o r d e r (PTSD). T h i s study i s the f i r s t  t o s y s t e m a t i c a l l y i n v e s t i g a t e the  moment-to moment experiences of PTSD v i c t i m s d u r i n g t h e i r first  treatment s e s s i o n . U s i n g v a r i a t i o n s of I n t e r p e r s o n a l Process R e c a l l  1994), and C o l a i z z i ' s  (1978) phenomenological  (Elliot,  research  methodology, f i n d i n g s confirmed many of Shapiro's  (1995)  d e s c r i p t i o n s of experience, with nothing of a d i s c o n f i r m i n g nature b e i n g d i s c o v e r e d . Three d i s t i n c t p a t t e r n s of c o - r e s e a r c h e r e x p e r i e n c e were i d e n t i f i e d , w i t h one c o - r e s e a r c h e r r e a c h i n g f u l l  in-session  r e s o l u t i o n of her b a s e l i n e measures. F u r t h e r , t h r e e broad c a t e g o r i e s of experience were discovered  ( P a r t i c i p a n t Experiences and S p e c t a t o r  Experiences  [Cochran,  1990]; and Treatment S p e c i f i c E f f e c t s ) ; each of  which was  f u r t h e r found t o c o n s i s t of f o u r dimensions,  components, of experience. S p e c t a t o r realm was through, memories.  or  Movement from the P a r t i c i p a n t t o  consonant w i t h c o - r e s e a r c h e r s ' working  c o n t e x t u a l i z i n g and making meaning of t r a u m a - r e l a t e d  I l l  TABLE OF CONTENTS ABSTRACT  .  ACKNOWLEDGEMENTS CHAPTER ONE:  v i i  INTRODUCTION TO THE RESEARCH PROBLEM  Purpose o f t h e Study CHAPTER TWO:  i i  . .1 4  LITERATURE REVIEW..  The E f f e c t s o f Trauma  5 5  S h a t t e r e d Assumptions  5  I n t r u s i o n , Hyperarousal and C o n s t r i c t i o n . . . . . . . . . 11 Intrusion.  11  Hyperarousal  14  Constriction  16  C u r r e n t Treatments  f o r Post Traumatic S t r e s s Disorder.18  Imaginal F l o o d i n g  19  C r i t i c i s m o f Imaginal F l o o d i n g Hypnosis  20 22  C r i t i c i s m o f Hypnosis  24  Systematic D e s e n s i t i z a t i o n  25  C r i t i c i s m o f Systematic D e s e n s i t i z a t i o n Eye Movement D e s e n s i t i z a t i o n and R e p r o c e s s i n g  25 26  The O r i g i n a l P r o t o c o l  26  The Revised P r o t o c o l  28  H e a l i n g Mechanisms.  30  P r e v i o u s Research  32  i n t o EMDR  Controlled Studies  33  Case S t u d i e s  37  C r i t i c i s m o f EMDR Research  40  iv  E t h i c a l Considerations.  41  D e s c r i p t i v e Accounts  42  o f EMDR  S i n g l e Memory P r o c e s s i n g E f f e c t s  43  Multimemory A s s o c i a t i v e P r o c e s s i n g E f f e c t s . . 4 5 CHAPTER THREE:  METHOD.  48  Rational  48  Phenomenological  Research  I n t e r p e r s o n a l Process R e c a l l Overview o f t h e Research Method S e l e c t i o n o f Co-Researchers  48 49 50 51  Selection Criteria  51  Demographic Information  52  Procedure  52  The EMDR In-Session Interview  53  The C l a r i f i c a t i o n Interview  53  A n a l y s i s o f t h e Data CHAPTER FOUR:  .55  RESULTS  57  C a t e g o r i e s o f Experience....  57  P a r t i c i p a n t Experiences.  57  S p e c t a t o r Experiences  58  Treatment S p e c i f i c E f f e c t s  60  Dimensions o f Cp-Researcher Experience P a r t i c i p a n t Experiences  61 61  P a s s i v e Endurance o f Trauma  61  Narrowness o f P e r s p e c t i v e  62  Immediacy o f F o c a l Image  62  I n t e n s i t y o f Emotion  63  V  S p e c t a t o r Experiences.  63  A c t i v e A l t e r a t i o n o f Experience  63  Broadening o f P e r s p e c t i v e  64  D i s t a n c i n g o f t h e F o c a l Image  65  V a r i e t y o f Emotional Experience Treatment  ....65  Specific Effects  66  Momentary C o g n i t i v e Impairment  66  Heightened P h y s i c a l Sensations  66  Change i n Energy L e v e l .  67  Meta Awareness o f t h e Process  67  Co-Researchers' Experiences Co-Researcher  "A"  EMDR Expediences o f Co-Researcher  68 "A"  69  S e q u e n t i a l Experiences by Category  72  Summary o f Experiences by Category  73  Co-Researcher  " B"  EMDR Experiences o f Co-Researcher  75 "B"  76  S e q u e n t i a l Experiences by Category  ....77  Summary o f Experiences by Category  81  Co-Researcher  "C" .  EMDR Experiences o f Co-Researcher  CHAPTER FIVE:  68  83 "C"  84  S e q u e n t i a l Experiences by Category  86  Summary o f Experiences by Category  90  DISCUSSION  92  Review.  92  I m p l i c a t i o n s f o r Theory  94  Implications f o r Counselling  98  vi I m p l i c a t i o n s f o r Research. L i m i t a t i o n s o f t h e Study  99 100  Number o f Subjects  100  L i m i t a t i o n s o f V e r b a l Communication  101  Researcher B i a s and I n f l u e n c e  102  Therapist Style  102  Medication  103  Summary  .103  REFERENCES APPENDIX A:  105 Consent Form  116  vii  ACKNOWLEDGEMENTS First, the  I would l i k e t o express my deep a p p r e c i a t i o n t o  t h r e e c o - r e s e a r c h e r s who p a r t i c i p a t e d i n t h i s study.  T h e i r courage i s both moving and admirable; and w i t h o u t them, t h i s r e s e a r c h would not have been p o s s i b l e . To Dr. Gary Ladd, f o r l e n d i n g h i s time and e x p e r t i s e ; t o Dr. Du-Fay Der, f o r coming on board a t t h e l a s t minute; t o Dr. M a r s h a l l Wilensky, f o r p a r t i c i p a t i n g and i m p a r t i n g a s m a l l p o r t i o n o f h i s EMDR knowledge over s e v e r a l lunch hours; and f i n a l l y , t o Dr. L a r r y Cochran, f o r h i s c l a r i t y ,  wisdom and  p e r s i s t e n t encouragement t o aim h i g h e r , I o f f e r my s i n c e r e s t , heart-felt  appreciation.  To my  f a t h e r , past and  present;  f o r h i s g r a c i o u s , unending and l o v e .  support  1  CHAPTER ONE:  INTRODUCTION TO THE RESEARCH PROBLEM  That we should d i e i s i n c o n c e i v a b l e .  That we s h o u l d  suddenly, without warning, be f o r c e d t o touch the dark f a c e of a n n i h i l a t i o n and remember, i n t o l e r a b l e .  For i n such a  case, t o s u r v i v e death i s not t o escape i t ,  but t o awaken an  i n e l u c t a b l e shadow. I b e g i n t h i s i n t r o d u c t i o n t o trauma and i t s treatments w i t h a r e f e r e n c e t o death, as any e n c o u n t e r — e v e n  vicarious-  -with a p r o f o u n d l y t r a u m a t i c event, f o r c e s one t o encounter one's own  a n n i h i l a t i o n , f r e q u e n t l y with severe p s y c h o l o g i c a l  repercussions. Whether the t r a u m a t i c event i s rape, war, d i s a s t e r , o r simply a w i t n e s s i n g t h e r e o f , as  natural  Janoff-Bulman  w r i t e s a l l "traumatic events i n v o l v e perhaps t h e most b a s i c of t h r e a t s , t h a t t o our v e r y s u r v i v a l "  (1992, p. 56).  A c c o r d i n g t o the Comprehensive Textbook  of P s y c h i a t r y  (Andreasen, 1985)  the commonalty between a l l p s y c h o l o g i c a l  trauma i s an experience of " i n t e n s e f e a r , h e l p l e s s n e s s , of c o n t r o l , and t h r e a t of a n n i h i l a t i o n " The word "trauma" was  loss  (p. 921).  o r i g i n a l l y d e r i v e d from Greek  v e r b s meaning " t o p i e r c e , " or "wear out," and was  used t o  denote a "wound," or " o b j e c t damage" (Wernik, 1969).  Freud  (1888) extended t h i s meaning t o i n c l u d e p s y c h o l o g i c a l damage.  "For him, trauma, p a r t i c u l a r l y i n the developmental  phases, was  the core of a l l subsequent psychopathology  such  as h y s t e r i a , melancholy and obsessive-compulsive d i s o r d e r " (Benyakar e t a l . ,  1989,  p. 432).  He b e l i e v e d trauma t o be a  2  consequence of an e x t e n s i v e breach being made i n the psychological "protective s h i e l d " against s t i m u l i  (Freud,  1920) . T h i s "breach"  i s the r e s u l t of a sudden p s y c h o l o g i c a l  a s s a u l t on the s e l f too g r e a t t o i n c o r p o r a t e or (Freud,  1920;  Benyakar e t a l . , 1989)  symptoms of p o s t t r a u m a t i c  and r e s u l t s i n the  s t r e s s d i s o r d e r (PTSD; APA,  and the concomitant " s h a t t e r e d assumptions" 1992)  and  withstand  1994)  (Janoff-Bulman,  l o s s of meaning ( F r a n k l , 1963).  J u s t as i n the Greek myth of Persephone, i n which the p r o t a g o n i s t , abducted from a s t a t e of r e l a t i v e n a i v e t e raped i n the Underworld, h e n c e f o r t h must r e t u r n  and  repeatedly  t o the dark s i t e of her trauma, so too, many v i c t i m s of trauma are " f o r c e d " by t h e i r i n t r u s i v e symptoms t o experience private The  a frequent, u n p r e d i c t a b l e descent  own  "underworld." symptoms of PTSD ( r e c u r r e n t nightmares;  anxiety; hyper-arousal; o r i g i n a l trauma; APA, treat  into their  avoidance of reminders of  1994)  flashbacks the  are n o t o r i o u s l y d i f f i c u l t  (Kleinknecht & Morgan, 1992;  Spector  to  & Huthwaite,  1993) ; w i t h t r a d i t i o n a l trauma treatments such as f l o o d i n g , (Stampfl and L e v i s , 1967); systematic d e s e n s i t i z a t i o n , (Wolpe, 1959,  1990); hypnosis,  Dondershine, 1988;  (Janet, 1919;  Stutman & B l i s s ,  1985); group  (Yalom & Yalom, 1990); and pharmacotherapy, 1986;  S p i e g a l Hunt &  (Bleich et a l .  E p s t e i n , 1989;) being g e n e r a l l y regarded  partially effective  (Janoff-Bulman, 1992;  therapy,  as  Shapiro,  only 1995).  3  Hence, with t h e advent o f Eye Movement D e s e n s i t i z a t i o n and Reprocessing  (Shapiro, 1989a; 1989b; 1995), comes new  hope f o r v i c t i m s o f PTSD. normally  Proponents have claimed  that the  treatment r e s i s t a n t symptoms from a s i n g l e - e v e n t  trauma can be e r a d i c a t e d i n one t o t h r e e s e s s i o n s o f EMDR (Shapiro, 1989a; 1989b; 1995).  F u r t h e r , some have d e c l a r e d  i t e f f e c t i v e i n t h e treatment o f a v a r i e t y o f o t h e r diagnoses as w e l l (Shapiro, 1995; S i n c e i t s i n c e p t i o n i n 1989,  Marquis, 1991). r e s e a r c h i n t o EMDR has  e s c a l a t e d t o the p o i n t where "there are a t p r e s e n t more p o s i t i v e c o n t r o l l e d s t u d i e s on EMDR than on any o t h e r method used i n t h e treatment o f p s y c h o l o g i c a l trauma"  (Shapiro,  1995,  f o c u s i n g on  p. x ) .  Yet no in-depth d e s c r i p t i v e study  the phenomenology o f EMDR has been undertaken; and i s , hence, t a c i t l y suggested by the "gap"  i n the l i t e r a t u r e .  Such a study might p r o v i d e r e l e v a n t i n f o r m a t i o n t o r e s e a r c h e r s , t h e r a p i s t s and f u t u r e c l i e n t s , and h e l p e l u c i d a t e t h e "EMDR experience,"  and the meaning i n d i v i d u a l s  ascribe to i t . PURPOSE OF THE STUDY I t was n o t t h e i n t e n t o f t h e author o f t h i s study t o a f f i r m o r deny the claims o f EMDR treatment e f f i c a c y ; an undertaking  such  would r e q u i r e a c o n t r o l l e d experiment beyond  the scope o f a Master's t h e s i s .  Rather, as some o f t h e  e x t a n t EMDR l i t e r a t u r e claims use o f t h e technique l e a d s t o profound experiences  often  o f i n s i g h t ; memory r e t r i e v a l ;  the emergence o f a f f e c t i v e l y o r s e m a n t i c a l l y r e l a t e d  4  a s s o c i a t i o n s ; and dramatic  and s w i f t a l l e v i a t i o n o f symptoms  ( K l e i n k n e c h t & Morgan, 1992;  McCann, 1992; Shapiro,  1995), i t was hoped a close-up f i r s t s e s s i o n experiences  1989a,  investigation of subjects'  o f EMDR would h e l p shed l i g h t on  these phenomena (should they o c c u r ) , and on what, e x a c t l y , occurs  f o r s u b j e c t s d u r i n g t h e i r EMDR e x p e r i e n c e ( s ) .  5  CHAPTER TWO: LITERATURE REVIEW The E f f e c t s o f Trauma S h a t t e r e d Assumptions When i t occurs t o a man t h a t Nature does n o t r e g a r d him as important,  and t h a t she f e e l s she would  not maim t h e u n i v e r s e by d i s p o s i n g o f him, he a t f i r s t wishes t o throw b r i c k s a t t h e temple, and he hates deeply t h e f a c t t h a t t h e r e a r e no b r i c k s and no temples. — S t e p h e n Crane, "The Open Boat"  E v i l has come though I expected I looked f o r l i g h t  good;  but t h e r e came darkness.  . . .  When I stop t o t h i n k , I am f i l l e d w i t h h o r r o r , and my whole body i s convulsed. —Job  In Stephen Crane's s h o r t s t o r y , "The Open Boat"  (1960),  a s h i p has sunk i n t h e open sea, l e a v i n g o n l y f o u r s u r v i v o r s i n a t i n y dinghy.  Exhausted and t e r r i f i e d ,  they a r e t o s s e d  m e r c i l e s s l y by an endless p r o c e s s i o n o f " s n a r l i n g " waves, which t h r e a t e n , with each t h r u s t , t o c a p s i z e and devour them, w h i l e a s h a r k — e q u a l l y hungry f o r t h e i r d e a t h — c i r c l e s repeatedly. T h e i r sudden r e a l i z a t i o n of t h e randomness and meaninglessness o f t h e i r s i t u a t i o n , and Nature's indifference to i t , i s intolerable.  profound  That t h e r e s h o u l d be no  6  God,  no benevolent C r e a t o r t o save them a t such a moment, or  a t l e a s t p r o v i d e some meaning t o t h e i r p l i g h t , i s overwhelming,  and, i n t h e i r eyes, i n e x c u s a b l e .  They, i n f r u s t r a t i o n and anger, want t o complain and appeal t h e i r case t o a h i g h e r a u t h o r i t y ; and, b a r r i n g a f a v o r a b l e r u l i n g , "throw b r i c k s " a t the Temple o f J u s t i c e ; but a r e even more d i s t r a u g h t and demoralized upon r e a l i z i n g t h a t " t h e r e are no b r i c k s and no temples."  So, attempting  t o r e s t o r e order, and assuage t h e i r a n x i e t y , they p e r s o n i f y and blame F a t e ; as i f ,  by t h r e a t e n i n g or p l e a d i n g w i t h her,  they might r e g a i n some c o n t r o l over t h e i r l i v e s , and a f f e c t the outcome of t h e i r drama.  still  In v a r i o u s ways they are  t r y i n g t o f i n d order and meaning i n , and make sense o f , t h a t which i s i n h e r e n t l y random, b i z a r r e and meaningless. S i m i l a r l y , the B i b l e ' s Job, renown as a "blameless and u p r i g h t " man, d e s p i t e the why  "the g r e a t e s t man  i n a l l the E a s t , " cannot,  r a t i o n a l i z a t i o n s of h i s v i s i t o r s ,  understand  the God he l o v e s and r e s p e c t s , and b e f o r e whom he  has  behaved most p i o u s l y , has v i s i t e d upon him the s l a u g h t e r of h i s c h i l d r e n , the l o s s of h i s l i v e s t o c k and shepherds,  and  smote him w i t h "running sores from head t o f o o t . " He c o u l d w e l l be i n the same boat w i t h Crane's c h a r a c t e r s . For a l l are i n the process of e x p e r i e n c i n g one of the most profound e f f e c t s of trauma: one's b a s i c assumptions  A s h a t t e r i n g of  about the s e l f and world.  7  A c c o r d i n g t o Janoff-Bulman  (1992), such i n d i v i d u a l s , i n  the presence or aftermath of trauma, " s h a t t e r i n g " or l o s s of t h r e e b a s i c  may  s u f f e r the  assumptions:  1.  The world i s benevolent and good; and those who  it,  " b a s i c a l l y k i n d , h e l p f u l and c a r i n g "  a f f e c t i n g us w i l l t u r n out w e l l .  (p. 6 ) .  inhabit  Events  Though we understand  p r i n c i p a l of bad t h i n g s o c c u r r i n g i n the world, we  the  expect  they w i l l not happen t o us.  2.  The w o r l d i s meaningful.  We  can assure our ample  r e c e i p t of good t h i n g s by our j u s t behaviour: o n l y t o those who  behave badly.  Our fundamental  One gets what one deserves.  assumption  not simply b e l i e f s about why  about meaning i n v o l v e s  events happen i n our  world, but, more s p e c i f i c a l l y , why t o p a r t i c u l a r people.  We  Bad happens  these events happen  seek t o understand  the  " d i s t r i b u t i o n " of good and bad outcomes, and i n the s e r v i c e of meaning we r e c o g n i z e or impose seemingly n a t u r a l c o n t i n g e n c i e s between people and t h e i r outcomes (p. 8 ) .  We  are deeply d i s t u r b e d by the p o s s i b i l i t y  n e g a t i v e events c o u l d occur randomly t o us We p r e f e r t o b e l i e v e t h a t she who wonton; he who  is i l l  was  that  (Lerner, 1970).  raped was  d e s e r v i n g or  d i d not take c a r e of h i m s e l f ; she  who  8  was i n an automobile a c c i d e n t should have been more aware; and t h a t i f we take t h e necessary p r e c a u t i o n s , we w i l l be s a f e from these e v i l s  and l i v e h e a l t h i l y u n t i l  concept i n which we never r e a l l y  3.  Self-Worth.  assumptions capable.  The t h i r d  b e l i e v e ; Becker,  o f the b a s i c  1974) .  pre-trauma  i s t h a t we a r e i n h e r e n t l y good, moral and  T h e r e f o r e , we b e l i e v e , we a r e worthy o f t h e  rewards which we b e l i e v e w i l l come t o us. circular: are  our death (a  We g e t rewarded  Our r e a s o n i n g i s  and l i v e p r o s p e r o u s l y because  we  good; and we must be good because our p r o s p e r i t y proves  it.  In  sum, t h e assumptions  a r e as f o l l o w s :  My world i s benevolent.  Even i n such a good world  n e g a t i v e events happen, even i f r e l a t i v e l y infrequently.  Yet when they occur they a r e n o t random,  but r a t h e r a r e m e a n i n g f u l l y d i s t r i b u t e d .  They happen  t o people who deserve them, e i t h e r because o f who they are  o r what they d i d or f a i l e d t o do.  competent, c a r e f u l person.  I am a good,  Bad t h i n g s c o u l d n ' t happen  t o me (p. 19).  When such core assumptions,  developed d u r i n g i n f a n c y  and c h i l d h o o d (Ainsworth, 1979; Bowlby, 1969; M a r r i s , 1982) are  " s h a t t e r e d " by the "shock" o f trauma, t h e v i c t i m i s l e f t  9  f e e l i n g , among other t h i n g s , v u l n e r a b l e , confused  h e l p l e s s and  (Janoff-Bulman, 1992; Herman, 1992); and through  various defensive  means, s e t s about t o r e c o n s t r u c t t h e s e l f  amid t h e r u b b l e — t o  make sense out o f t h e s e n s e l e s s ;  meaning  out o f t h e meaningless. V i c t o r Frankl  (1963), who s u f f e r e d g r e a t l y w h i l e a  p r i s o n e r o f war a t Auschwitz, emphasized t h e importance o f f i n d i n g o r c r e a t i n g meaning i n t h e f a c e o f trauma. According  t o F r a n k l , one can withstand almost any degree o f  s u f f e r i n g i f meaning can be a s c r i b e d t o i t , and he w r i t e s t h a t " s u f f e r i n g ceases t o be s u f f e r i n g i n some way a t t h e moment i t f i n d s a meaning. . . " (p. 179). So important i s i t t o us as human beings t o a s c r i b e meaning t o events (put them i n emotional and i n t e l l e c t u a l p e r s p e c t i v e )  t h a t , as  Benyakar, Kutz, Dasberg and Stern  "certain  (1989) w r i t e ,  people w i l l choose t o g i v e up t h e i r l i v e s r a t h e r than . . . [surrender]  . . . t h e i r ideas and b e l i e f s , which, f o r them,  i s incompatible  with existence"  However, as S p i e g e l  (p. 438).  (1988) w r i t e s , t h e very essence o f  trauma i s t h a t " i t i s i n some sense meaningless," and t h i s i n t o l e r a b l e senselessness v i c t i m s on a search  o r absence o f meaning " s e t s  f o r some framework i n which t o g i v e t h e  otherwise meaningless experience some sense o f importance i n their l i f e "  (p. 21), a task which can prove  profoundly  difficult. I f i t i s t r u e , as i n t e r p e r s o n a l and o b j e c t r e l a t i o n s t h e o r i s t s c l a i m , t h a t "we a r e our o t h e r s "  10  (Cashdan, 1988,  p. 4 7 ) — t h a t  i s , who  we  believe ourselves  be i s the r e s u l t of our having i n c o r p o r a t e d  and  "metabolized" r e l a t i o n a l experiences and v a l u e s , f o l l o w s t h a t an encounter with, malicious self.  and  to  then i t  incorporation of,  the  "other" would l e a d t o a profound d i s o r i e n t a t i o n of  Hence a s h a t t e r i n g of our assumptive world i s  mirrored  by a sense of s h a t t e r i n g , or fragmentation of  the  T h i s n o t i o n of a f r a c t u r e d or d i v i d e d s e l f i s not  new  self.  t o psychology.  From a t l e a s t as f a r back as Freud  Janet, the predominant metaphors used t o psychopathology and fragmentation.  and  describe  i t ' s symptoms are those of  Terms such as " r e p r e s s i o n , " " d e n i a l , "  "compartmentalization,  11  "splitting," "dissociation,"  " d i s i n t e g r a t i o n , "schizophrenic,"  "schizoid," "multiple  p e r s o n a l i t y , " a l l imply a s s o c i a t i o n s between h e a l t h wholeness, i l l n e s s and  fragmentation.  Further,  and  the g o a l  of  many forms of psychotherapy has t r a d i t i o n a l l y been conceptualized  as the r e - i n t e g r a t i o n of t h a t which  has  become d i s i n t e g r a t e d . That we  equate h e a l t h with wholeness, and  t h e r e o f w i t h fragmentation, i s r e f l e c t e d i n our According  a lack language.  t o Metzner (1986), the E n g l i s h words "whole"  "wholesome,  11  as w e l l as " h o l i s t i c " and  " h o l y , " have t h e i r  o r i g i n s i n Old E n g l i s h h a l . which meant " h e a l t h y , " as w e l l as "complete."  and  "sound"  He w r i t e s t h a t "wholeness, i n the  sense of i n t e g r a t i o n , overlaps  considerably  w i t h the  concept  11  of h e a l t h " (p. 89). Middle  F u r t h e r , our modern " c r a z y " comes from  E n g l i s h crasen, meaning "to break":  " I n s a n i t y and  p s y c h o s i s , t h e r e f o r e , are r e l a t e d i n common language thought t o the n o t i o n of p s y c h i c fragmentation" Hence, when one  i s "crazy",  and  (p. 91).  ( s u f f e r i n g mental d i s t r e s s ) one  i s "broken" or fragmented; and c o n v e r s e l y , when one  is  h e a l t h y — e m o t i o n a l l y and s p i r i t u a l l y — o n e i s whole, or as the modern v e r n a c u l a r might put i t , I n t r u s i o n . Hyperarousal The  "together."  and C o n s t r i c t i o n  s h a t t e r i n g or fragmentation  of s e l f and  one's  assumptive world have t h r e e concomitant mental and p h y s i c a l m a n i f e s t a t i o n s r e c o g n i z e d by The D i a g n o s t i c and  Statistical  Manual of Mental D i s o r d e r s , Fourth E d i t i o n  IV;  (DSM  APA,  1994), which have become the d e f i n i n g c r i t e r i a f o r the d i a g n o s i s of PTSD:  Intrusion, hyperarousal  and  constriction. Intrusion.  U n f o r t u n a t e l y f o r those s u f f e r i n g from  PTSD, the t r a u m a t i c c o g n i t i v e and a f f e c t i v e  information  which the v i c t i m r e f l e x i v e l y attempts t o e x p e l from awareness, does  not remain i n e x i l e .  IV d i a g n o s i s of PTSD experience following:  DSM  one or more of the  (a) " r e c u r r e n t and i n t r u s i v e d i s t r e s s i n g  r e c o l l e c t i o n s of the event, perceptions"; event";  Those meeting a  i n c l u d i n g images, thoughts,  or  (b) " r e c u r r e n t d i s t r e s s i n g dreams of t h e  (c) a r e - e x p e r i e n c i n g of the trauma, as i f i t were  o c c u r r i n g i n the moment ( f l a s h b a c k s ) ; or  (d)  "intense  p s y c h o l o g i c a l d i s t r e s s a t exposure t o . . . c u e s " — b e  they  12  i n t e r n a l or e x t e r n a l — " t h a t symbolize or resemble an a s p e c t of t h e t r a u m a t i c event" (APA, 1994, p. 209). I n t r u s i v e , t r a u m a t i c memories are u n l i k e our normal " n a r r a t i v e " memories—those which can be put i n t o a s t o r y , and understood w i t h i n a s p e c i f i c c o n t e x t .  Rather, they are  o f t e n encoded i n the form of v i v i d s e n s a t i o n s and mental images, which possess a " f r o z e n and wordless q u a l i t y " (Herman, 1992, p. 37; Janet, 1919); and o f t e n break spontaneously i n t o consciousness, "both as f l a s h b a c k s d u r i n g waking s t a t e s and as t r a u m a t i c nightmares d u r i n g s l e e p " (p. 37) . A c c o r d i n g t o van der Kolk (1988), i n s t a t e s o f h i g h sympathetic nervous system a r o u s a l experienced d u r i n g trauma, the normal l i n g u i s t i c encoding of memory may  become  i n a c t i v a t e d and r e p l a c e d by sensory and i c o n i c forms o f memory ( s i m i l a r t o those found i n c h i l d r e n ) which t h e n i n t r u d e i n t o waking and dreaming s t a t e s .  Dreams r e l a t e d t o  trauma o f t e n i n c l u d e exact r e p l i c a t i o n s of the o r i g i n a l t r a u m a t i c event, and can occur o u t s i d e of r a p i d eye movement (REM)  sleep  (Herman, 1992; Ross, B a l l & S u l l i v a n ,  1989).  The i n t r u s i v e r e - e x p e r i e n c i n g of t r a u m a t i c memories Freud  (1958) termed a " r e p e t i t i o n compulsion," which he  c o n c e p t u a l i z e d as an attempt t o master t h a t which e x p e r i e n c e d as overwhelming and overpowering. Janet  was  Similarly,  (1919) b e l i e v e d t h a t because the trauma v i c t i m  e x p e r i e n c e d a p r o t r a c t e d sense of trauma-induced  13  h e l p l e s s n e s s , a sense of what we would now e f f i c a c y i s seen as the a n t i d o t e One  call  (Seligman,  self-  1975).  former Vietnam veteran d e s c r i b e d h i s i n t r u s i v e  experience  this  way:  At l e a s t twice a week f o r . . . y e a r s I  had  s u s t a i n e d the same r e c u r r i n g nightmares . . . [of being] back t h e r e f a c i n g the same dangers,  witnessing  the same i n c a l c u l a b l e s u f f e r i n g , waking suddenly a l e r t , sweating, scared.  [At a m e d i t a t i o n r e t r e a t ] the  nightmares d i d not occur d u r i n g s l e e p , they f i l l e d mind's eye d u r i n g the day  . . . .  the  H o r r i f i c wartime  f l a s h b a c k s were superimposed over a q u i e t redwood grove a t the r e t r e a t c e n t e r . dormitory  Sleepy  students  i n the  became body p a r t s strewn about a  morgue on the DMZ  makeshift  ( K o r n f i e l d , 1993).  Horowitz (1976), b e l i e v e s t h a t the  repetitive,  i n t r u s i v e thoughts and memories which haunt the trauma v i c t i m are an attempt by the mind t o r e s o l v e the d i s c r e p a n c i e s between the new incompatible  trauma-related  e x i s t i n g schemata.  The  information  and  intrusive re-  e x p e r i e n c i n g c o u l d be viewed as a b i p r o d u c t of " a c t i v e memory's" attempt t o i n t e g r a t e t r o u b l i n g i n f o r m a t i o n which i s o u t s i d e the realm of p r e v i o u s l y h e l d b e l i e f s or schemata; t h a t i s , t o r e c o n s t r u c t " s h a t t e r e d assumptions."  Completion  ( i . e . , an abatement of i n t r u s i v e symptoms) occurs when the  14  new  d i s t u r b i n g i n f o r m a t i o n has been i n t e g r a t e d i n t o , or made  compatible  with, e x i s t i n g schemata; or c o n v e r s e l y , when o l d  schemata have been a d j u s t e d t o allow f o r the i n t e g r a t i o n of the new  information.  T h i s l a t t e r i d e a i s s i m i l a r t o Kuhn's  (1962), n o t i o n of a paradigm s h i f t i n s c i e n c e , or P i a g e t ' s (1952) concept  of accommodation.  Hyperarousal.  Whereas the mental components of trauma  are p a r t i a l l y r e f l e c t e d by the s h a t t e r i n g of assumptions  and  s e l f , and the i n t r u s i o n of d i s t u r b i n g memories, t h e p h y s i o l o g i c a l aspects are manifested two  by h y p e r a r o u s a l .  or more of the f o l l o w i n g w i l l be experienced  victim:  And  by the PTSD  (a) d i f f i c u l t y f a l l i n g or s t a y i n g a s l e e p ;  b)  i r r i t a b i l i t y or o u t b u r s t s of anger; (c) d i f f i c u l t y c o n c e n t r a t i n g ; (d) h y p e r v i g i l a n c e ; (e) exaggerated response (APA,  1994).  As a r e s u l t of h i s work with World War Abram K a r d i n e r  startle  II soldiers,  (1947) coined the term p h v s i o n e u r o s i s  to  d e s c r i b e the c o n t i n u o u s l y h i g h l e v e l s of autonomic nervous system s t i m u l a t i o n he witnessed.  I t appeared t o him  that  these symptoms were i n d i c a t i v e of the body's almost c h r o n i c preparedness f o r what may  be termed " f i g h t or  S i m i l a r l y , G r i n k e r and S p i e g a l (1945) observed traumatized  that  s o l d i e r s s u f f e r e d from what seemed l i k e a  " c h r o n i c s t i m u l a t i o n of the sympathetic 219).  flight."  nervous system" (p.  More r e c e n t l y , r e s e a r c h e r s have been a b l e t o c o n f i r m  e x t e n s i v e and enduring p s y c h o p h y s i o l o g i c a l changes r e s u l t i n g from trauma.  15  A c c o r d i n g t o van der Kolk  (1987) due t o prolonged o r  r e p e a t e d exposure t o traumata, t h e body's use o f catecholamines  (the n e u r o t r a n s m i t t e r s  norepinephrine,  e p i n e p h r i n e and dopamine) may exceed p r o d u c t i o n , and a d e p l e t i o n may occur, l e a d i n g t o a neuronal h y p e r s e n s i t i v i t y t o l a t e r s t i m u l a t i o n by these same n e u r o t r a n s m i t t e r s .  The  r e s u l t i s t h a t subsequent t o trauma, even minor s t r e s s o r s o r s t i m u l a t i o n may t r i g g e r o v e r a r o u s a l o f t h e autonomic nervous system. Janoff-Bulmann w r i t e s t h a t  t h e r e i s now some evidence t h a t a s i n g l e case o f overwhelming t e r r o r may be capable o f changing b r a i n chemistry  such t h a t some s u r v i v o r s a r e more s e n s i t i v e  t o a d r e n a l i n e surges even decades l a t e r  Hyperarousal  (1992, p. 68).  can p e r s i s t d u r i n g t h e waking s t a t e ,  a f f e c t i n g c o n c e n t r a t i o n , causing h y p e r v i g i l e n c e , i n c r e a s e d s t a r t l e response o r angry r e a c t i o n s , e t c . ; as w e l l as d u r i n g sleep, r e s u l t i n g i n sleep disturbance.  Those s u f f e r i n g from  PTSD take longer t o f a l l asleep, awaken more f r e q u e n t l y (Herman, 1992) and may experience  a dysregulation of rapid  eye movement REM s l e e p (Ross, B a l l & S u l l i v a n , 1989) . F u r t h e r , i t now appears t h a t c h r o n i c , h i g h l e v e l s o f s t r e s s can r e s u l t i n s t r u c t u r a l changes t o t h e b r a i n , i . e . , neuronal  death and subsequent compensation (Ver E l l e n & van  Kammen, 1990).  16  Constriction.  Symptoms i n t h i s category i n v o l v e "a  p e r s i s t e n t avoidance o f s t i m u l i a s s o c i a t e d w i t h the trauma and numbing of g e n e r a l r e s p o n s i v e n e s s "  (APA,  p. 210).  A  PTSD v i c t i m w i l l e x h i b i t one or more of the f o l l o w i n g : an avoidance  (a)  of thoughts or f e e l i n g s a s s o c i a t e d w i t h the  trauma; an avoidance of (b) a c t i v i t i e s , p l a c e s or people t h a t arouse these f e e l i n g s or thoughts;  (c) amnesia f o r  c e r t a i n a s p e c t s of the trauma; (d) a d i m i n i s h e d i n t e r e s t i n participating in significant activities;  (e) f e e l i n g s o f  detachment; (f) r e s t r i c t e d a f f e c t ; or (g) a sense  of  f o r e s h o r t e n e d f u t u r e (p. 209). In the months f o l l o w i n g a t r a u m a t i c event, as the i n t r u s i v e and h y p e r a r o u s a l symptoms tend t o d i m i n i s h somewhat, c o n s t r i c t i v e symptoms may (Herman, 1992,  begin t o predominate  p. 48).  The v i c t i m may  begin t o a v o i d people, p l a c e s or t h i n g s  which he or she a s s o c i a t e s with the t r a u m a t i c event, i n o r d e r not t o experience p o t e n t i a l l y overwhelming r e l a t e d thoughts  and f e e l i n g s  (Janoff-Bulman).  In an attempt  g a i n c o n t r o l over what i s experienced, the v i c t i m  may  s e v e r e l y l i m i t h i s or her a c t i o n s , thereby a f f e c t i n g e n t i r e f i e l d of p u r p o s e f u l a c t i o n and i n i t i a t i v e " p.  to  "the  (Herman,  46). J u s t as a change i n v i c t i m s ' catecholamine  and s e n s i t i v i t y may  production  occur a f t e r trauma, l e a d i n g t o  heightened a n x i e t y s t a t e s ; so too may  a dysregulation of  endogenous o p i o i d s l e a d t o s i m i l a r f e e l i n g s of a n x i e t y and  17  emotional d i s c o m f o r t (Pitman, van der Kolk, & Orr, 1990). T h i s i n t u r n may encourage those without t h e c a p a c i t y f o r d i s s o c i a t i o n t o s e l f - m e d i c a t e through t h e use o f drugs o r a l c o h o l i n order t o c o n s t r i c t t h e i r range o f n e g a t i v e affect. However, n e i t h e r drugs nor conscious avoidance o f n e g a t i v e s t i m u l i can ward o f f the p e r s i s t e n t emotional and p s y c h o l o g i c a l post-trauma  distress.  Hence, t h e v i c t i m may  u t i l i z e t h e "automatic d e n i a l p r o c e s s " (Janoff-Bulman, 97)  p.  o f d e n i a l , which h e l p s i n " t u r n i n g o f f awareness o f t h e  event o r i t s i m p l i c a t i o n s capacity t o f e e l "  . . . [or] . . . s h u t t i n g down t h e  (p. 97).  D e n i a l may serve a h e a l i n g f u n c t i o n i n h e l p i n g t h e v i c t i m pace h i s o r h e r r e c o v e r y , by n o t a l l o w i n g t h e organism at  t o be overloaded w i t h t o o much n e g a t i v e i n f o r m a t i o n  one time  (Janoff-Bulman,  1992).  However, as noted by Janet  (1919) l a t e i n t h e l a s t  century, a trauma v i c t i m can i s o l a t e t r a u m a t i c i n f o r m a t i o n more o r l e s s completely from conscious awareness, i n what we today d e s c r i b e as fugue s t a t e s , d i s s o c i a t i v e disorder  identity  (APA, 1994; p r e v i o u s l y known as m u l t i p l e  p e r s o n a l i t y d i s o r d e r , APA, 1987), o r amnesia.  In such  d i s s o c i a t i v e s t a t e s , although the t r a u m a t i c i n f o r m a t i o n i s s p l i t from conscious awareness, i t does not d i s a p p e a r completely from the organism. tendency ways,  Hence, t h e v i c t i m r e t a i n s a  t o r e a c t t o subsequent s t r e s s o r s i n i n a p p r o p r i a t e  as i f t h e trauma were r e c u r r i n g .  Van d e r Kolk and  18  K a d i s h (1987) w r i t e t h a t PTSD v i c t i m s may  experience  emotional i n t e n s i t y of o r i g i n a l trauma without awareness of the h i s t o r i c a l r e f e r e n c e " These o b s e r v a t i o n s  "the  conscious  (p. 7 ) .  b r i n g us f u l l c i r c l e t o the  of the fragmented or d i v i d e d s e l f ; and  l e a d us t o  notion  the  q u e s t i o n of what t h e r a p e u t i c agent the p s y c h o t h e r a p i s t apply t o r e t u r n the trauma v i c t i m t o a s t a t e of  might  relative  wholeness. Current Treatments f o r the E f f e c t s of Trauma  Humpty Dumpty s a t on a w a l l Humpty Dumpty had  a great  fall.  A l l the King's horses and a l l the King's Couldn't put him back together  men  again.  — T r a d i t i o n a l Nursery Rhyme  As s t a t e d i n E c c l e s i a s t e s , t h e r e i s no new the sun.  Centuries b e f o r e  t h i n g under  the advent of modern psychology,  t r a d i t i o n a l h e a l e r s , known as shamans were attempting  to  h e a l the trauma v i c t i m through r e i n t e g r a t i o n of fragmented p a r t s of s e l f . who  They, however, u n l i k e most modern t h e r a p i s t s  concern themselves with the "mental" h e a l t h  ( i . e . , mind)  of the v i c t i m , t r e a t e d the s o u l , which they b e l i e v e d had l e a s t p a r t i a l l y l e f t the v i c t i m ' s body d u r i n g the experience  (Ingerman, 1991).  the Shaman's v e n t u r i n g  H e a l i n g was  known as " s o u l r e t r i e v a l . "  To t h i s end,  traumatic  accomplished  i n t o the s p i r i t world i n an  at  by  exercise  he employed such  19  t o o l s as r a t t l e s , drugs  " s o u l c a t c h e r s , " drums and h a l l u c i n o g e n i c  (Ingerman, 1991; Achterberg, 1985). Although t h e t o o l s of t h e modern "shaman," o r  p s y c h o l o g i s t , may seem t o us l e s s f a n c i f u l , they a r e not n e c e s s a r i l y any more c o n s i s t e n t l y e f f e c t i v e i n r e l i e v i n g a l l of t h e symptoms o f PTSD than those o f t h e Shaman.  That i s ,  the concurrence o f p s y c h o l o g i c a l l i t e r a t u r e can be found i n the above nursery rhyme of Humpty Dumpty:  No p r e s c r i p t i v e  treatment i s a b l e , i n i t s e l f , o r even i n combination  with  o t h e r treatments, t o a l l e v i a t e c o n s i s t e n t l y , a l l o f t h e symptoms o f PTSD (Herman, 1992; Shapiro, 1995), and p u t t h e c l i e n t "together a g a i n . " The t h r e e treatments most f r e q u e n t l y r e f e r r e d t o i n t h e e x t a n t l i t e r a t u r e , and g e n e r a l l y regarded as most e f f e c t i v e i n t r e a t i n g trauma are f l o o d i n g , s y s t e m a t i c d e s e n s i t i z a t i o n , and hypnosis  (Herman, 1992; Shapiro, 1995).  Imaginal F l o o d i n g Imaginal f l o o d i n g  (or i m p l o s i v e t h e r a p y — a  variation  i n c o r p o r a t i n g hypothesized cues) i s a technique whose r a t i o n a l e borrows from the seminal work o f P a v l o v  (1927).  J u s t as a d o g — c o n d i t i o n e d t o s a l i v a t e a t t h e sound o f a bell  (a c o n d i t i o n e d stimulus [CS]) a f t e r t h a t b e l l i s  r e p e a t e d l y f o l l o w e d by food (the u n c o n d i t i o n e d s t i m u l u s [ U S ] ) — c a n be taught t o no longer do so i n t h e r e p e a t e d absence o f the US; so t o o can a trauma v i c t i m l e a r n t o respond t o mental or t a n g i b l e cues  (the CS) w i t h r e l a t i v e  20  n e u t r a l i t y , i n t h e repeated absence o f r e a l t h r e a t Stampfl and L e v i s  (the US).  (1967) w r i t e  the fundamental h y p o t h e s i s i s t h a t a s u f f i c i e n t c o n d i t i o n f o r the e x t i n c t i o n o f a n x i e t y i s t o r e p r e s e n t , r e i n s t a t e , o r s y m b o l i c a l l y reproduce t h e stimuli  (cues) t o which t h e a n x i e t y response has been  c o n d i t i o n e d , i n absence of primary reenforcement (p. 499) .  Pitman e t a l . w r i t e , "The treatment i s no r o s e garden; i t i s s t r e s s f u l by d e s i g n " (1991, p. 17). That i s , t h e c l i n i c i a n d e l i b e r a t e l y t r i e s t o e l i c i t a c l i e n t ' s a n x i e t y , through a mental r e - e x p e r i e n c i n g o f a t r a u m a - r e l a t e d event. Because t h i s r e - e x p e r i e n c e occurs i n t h e absence o f r e a l t h r e a t , i t i s deemed s a f e — e v e n n e c e s s a r y — a n d i s r e p e a t e d u s i n g i n c r e a s i n g l y a n x i e t y - p r o v o k i n g cues, u n t i l a n x i e t y i s i  s i g n i f i c a n t l y diminished. C r i t i c i s m o f imaqinal f l o o d i n g .  Pitman e t a l . (1991)  w r i t e t h a t although f l o o d i n g has been proven e f f i c a c i o u s i n the treatment o f phobias and o b s e s s i v e compulsive d i s o r d e r , PTSD i s a more complex c o n d i t i o n , o f t e n accompanied comorbid mental  by  disorders.  Whereas the emotional d i s t u r b a n c e i n phobias i s t y p i c a l l y l i m i t e d t o a n x i e t y , PTSD p a t i e n t s o f t e n a l s o s u f f e r from sadness, anger, g u i l t , and/or shame  21  a s s o c i a t e d w i t h the trauma . . . .  I t i s not  clear  whether these emotions obey the same law of e x t i n c t i o n as does a n x i e t y , upon which the r a t i o n a l e f o r f l o o d i n g i s t r a d i t i o n a l l y based  (p. 17).  They f u r t h e r suggest t h a t i f a c l i e n t ' s  emotional  d i s t r e s s i n v o l v e s negative p o s t t r a u m a t i c a p p r a i s a l s , r e p e a t e d f l o o d i n g may  i n f a c t be e x a c e r b a t i n g "the  feelings  of anger, shame, g u i l t , s e l f - a c c u s a t i o n , f e e l i n g s of f a i l u r e , and "What i f ? "  (p. 19).  They p r e s e n t c a s e s i n  which f l o o d i n g l e d t o worsened d e p r e s s i o n , r e l a p s e of a l c o h o l abuse, and the advent of p a n i c d i s o r d e r .  As  one  PTSD c l i e n t i s r e p o r t e d t o have s a i d i n r e f e r e n c e t o h i s treatment,  "There was  much mopping up"  a l o t of f l o o d i n g , but t h e r e wasn't  (Pitman e t a l . , p.  19).  A f u r t h e r weakness i s t h a t the e l i c i t a t i o n of  extremely  h i g h l e v e l s of a n x i e t y must be repeated over s e v e r a l t o many sessions  (Stampfl and L e v i s suggest between 1 and 15,  s e s s i o n s , "with t o t a l treatment time r a r e l y exceeding i m p l o s i v e h r . " (1967, p.  1-hr. 30  502).  F u r t h e r , f l o o d i n g i s of l i m i t e d t h e r a p e u t i c b e n e f i t . Although the most notable a m e l i o r a t i o n of symptoms o c c u r s w i t h i n the realm of i n t r u s i o n symptoms, numbing and avoidance  social  tend t o remain u n a f f e c t e d (Lyons and Keane,  Herman, 1992). A c c o r d i n g t o Shapiro,  1989;  (1989a) l a c k i n g a r e the  c o g n i t i v e elements necessary t o complete  treatment.  22  Hypnosis Use of hypnosis f o r the treatment l e a s t as f a r back as Freud  (1958), who  of trauma d a t e s a t b e l i e v e d t h a t the  c a t h a r s i s or a b r e a c t i o n induced d u r i n g such a l t e r e d s t a t e s was  s u f f i c i e n t f o r r e s o l u t i o n of d i f f i c u l t i e s .  proved too simple  This  concept  ( S p i e g e l , 1987), and he found t h a t such  a b r e a c t i o n alone c o u l d sometimes l e a d t o the d e m o r a l i z a t i o n of the p a t i e n t (p. 26), due t o p e r c e i v e d l a c k of c o n t r o l over the t r a u m a t i c m a t e r i a l :  The c l i e n t s were simply  overwhelmed by, and powerless  i n the f a c e o f , t h e i r emotion.  Janet  (1919) emphasized the need t o h e l p the p a t i e n t not  o n l y r e - e x p e r i e n c e but i n t e g r a t e t r a u m a t i c i n f o r m a t i o n which had become s p l i t o f f from consciousness. Brown and van der Kolk  Van der Hart,  (1989) w r i t e  Janet c o n s i d e r e d the i n a b i l i t y t o i n t e g r a t e t r a u m a t i c memories as the c o r e i s s u e i n p o s t - t r a u m a t i c syndromes:  Treatment of p s y c h o l o g i c a l trauma always  e n t a i l e d an attempt  t o recover and i n t e g r a t e the  memories of the trauma i n t o the t o t a l i t y of people's identities  (p. 380).. '  To t h i s end Janet pioneered p a r t i c u l a r h y p n o t i c t e c h n i q u e s , v a r i a t i o n s of which are s t i l l van der Hart, 1989).  i n use today  (van der Kolk &  Under hypnosis, t r a u m a t i c memories  which the c l i e n t had r e p r e s s e d were r e t r i e v e d  and  transformed or r e p l a c e d by n e u t r a l or p o s i t i v e images and  23  feelings  (a technique a n t i c i p a t i n g the  Erickson, victims  1980).  The  experience out  "frozen,"  l a t e r work of  Milton  i n t r u s i v e images which PTSD  of context and  i n l i e u of  memory, were transformed i n t o meaningful  "verbal"  narratives.  P r e s a g i n g l a t e r f l o o d i n g techniques, Janet employed a stepwise p r o c e s s of having the c l i e n t i n c r e m e n t a l l y e x p e r i e n c e and  express t h e i r t r a u m a t i c f e e l i n g s .  age  was  regression  re-  Hypnotic  a l s o used where deemed a p p r o p r i a t e .  S i n c e the time of Janet many authors have noted s i m i l a r i t i e s between d i s s o c i a t i v e s t a t e s and  a f t e r trauma, and  occurring  the h y p n o t i c s t a t e .  Bruer  d e s c r i b e d d i s s o c i a t i o n as a "hypnoidal" s t a t e . al.  (1987) d e s c r i b e h y p n o t i z a b i l i t y as  capacity  "the  during (1958)  Spiegel  In f a c t , authors of r e c e n t s t u d i e s  e t a l . , 1988)  (see  scores and  the d i a g n o s i s of PTSD.  the d i s s o c i a t i v e nature of many PTSD symptoms, and d i s s o c i a t i v e nature of hypnosis i t s e l f ,  Spiegel  Spiegal  hypnotizability; i n d i v i d u a l s may  be more s u s c e p t i b l e  trauma (p. 304). i n d i v i d u a l s who  or, c o n v e r s e l y , h i g h l y  t o the  enhance  after effects  cannot spontaneously d i s s o c i a t e induce d i s s o c i a t i o n through the 1988).  the  hypnotizable  I t i s further speculated that  (Spiegal,  Noting  et a l .  s p e c u l a t e t h a t e i t h e r the experience of trauma may  or a l c o h o l  setting"  have found a h i g h c o r r e l a t i o n between  hypnotizability  of trauma, may  et  fundamental  t o experience d i s s o c i a t i o n i n a s t r u c t u r e d  (p. 302).  the  of  those i n the use  face  of drugs  24  An advantage of u s i n g hypnosis over o t h e r s t a n d a r d t e c h n i q u e s i s t h a t , due t o the e f f e c t s of memory (see Bower, 1981) memories may  state-dependent  the i s o l a t e d , d i s s o c i a t e d t r a u m a t i c  more e a s i l y be accessed i n a s i m i l a r ,  a r t i f i c i a l l y induced d i s s o c i a t i v e s t a t e ( h y p n o s i s ) . Although, hypnosis  as Freud found, simple a b r e a c t i o n under  (without i n t e g r a t i o n ) can prove c o u n t e r p r o d u c t i v e ,  a modulated r e - e x p e r i e n c i n g can h e l p f o s t e r i n the c l i e n t a sense o f e f f i c a c y and c o n t r o l  (Smith, 1989) .  This perceived  sense of c o n t r o l can a r i s e when the c l i e n t — w i t h  the  t h e r a p i s t ' s h e l p — r e a l i z e s he or she has the power t o slow down r e c a l l of the e v e n t ( s ) , and r e - e x p e r i e n c e o n l y p o r t i o n s of  the trauma, "drawing on the heightened  capacity for  p h y s i c a l and emotional c o n t r o l t h a t the h y p n o t i c s t a t e provide" One (Watkins,  (Smith, p.  130).  h y p n o t i c technique, c a l l e d the " a f f e c t b r i d g e " 1971)  i s used t o h e l p the c l i e n t r e t r i e v e p r e v i o u s  t r a u m a t i c i n f o r m a t i o n which i s s i m i l a r i n a f f e c t i v e to  can  t h a t o f which the c l i e n t i s c u r r e n t l y aware.  " s p l i t s c r e e n " technique  (see S p i e g a l , 1987)  content  In the  the  client  s i m u l t a n e o u s l y imagines the t r a u m a t i c events appearing  on  one s c r e e n , w h i l e on another, what he or she d i d a t the to  time  cope, thereby a i d i n g the c l i e n t i n g a i n i n g a b i g g e r , more  i n t e g r a t e d p i c t u r e of the trauma and h i s or her r o l e i n i t . C r i t i s i s m of hypnosis.  Although hypnosis  facilitates  access t o , and c o n t r o l over, d i s s o c i a t e d s t a t e s , as S p i e g e l w r i t e s , "There i s nothing t h a t can be done w i t h  hypnosis  25  t h a t c o u l d not be done without  i t " (1987, p. 30).  Further,  d e s p i t e the tendency toward i n c r e a s e d h y p n o t i z a b i l i t y among PTSD v i c t i m s , not a l l are h y p n o t i z a b l e . (1919), some traumatized  As noted by  s u b j e c t s take weeks o r months  b e f o r e they can enter i n t o a h y p n o t i c  s t a t e (presumably  t o a f e a r of r e - e x p e r i e n c i n g the trauma-related i f they enter a t a l l .  Janet  due  emotions),  S p i e g e l (1987) notes the danger  l a t e n t i n hypnotic transference:  P a t i e n t s may  have the  sense of being r e a s s a u l t e d (by an i n s e n s i t i v e t h e r a p i s t ) d u r i n g the h y p n o t i c  procedure.  Systematic D e s e n s i t i z a t i o n Developed by Joseph Wolpe (see Wolpe, 1959,  1990),  s y s t e m a t i c d e s e n s i t i z a t i o n i s based on the assumption t h a t because an a n x i e t y response i s l e a r n e d or c o n d i t i o n e d , " i t can be i n h i b i t e d by s u b s t i t u t i n g an a c t i v i t y t h a t i s a n t a g o n i s t i c t o the f e a r response" (Kanfer & G o l d s t e i n , 1991,  p. 163).  Hence, a t h e r a p i s t u s i n g t h i s  exposes the c l i e n t ,  i n s m a l l graduated s t e p s , t o  d i s t u r b i n g memory, w h i l e having the c l i e n t emotions incompatible with a n x i e t y calmness).  technique the  experience  ( i . e . , r e l a x a t i o n and  An a s s o c i a t i v e l i n k i s then formed between  r e l a x a t i o n and the p r e v i o u s l y a n x i e t y provoking  memory.  In  o t h e r words, the c l i e n t l e a r n s t o remain calm i n the f a c e of t h a t which once was d i s t u r b i n g . C r i t i c i s m of systematic d e s e n s i t i z a t i o n . t h e r e i s some support  Although  f o r using systematic d e s e n s i t i z a t i o n  i n the treatment of PTSD (Russel, 1991), s e v e r a l  authors  26  (Lyons & Kean, 1989;  Shapiro, 1989a; Spector & Huthwaite,  1992;) are c r i t i c a l of t h i s procedure First,  f o r s e v e r a l reasons.  systematic d e s e n s i t i z a t i o n requires a h i e r a r c h i c a l  o r d e r i n g of a n x i e t y r e l a t e d m a t e r i a l (Wolpe, 1959)  which i s  i n a p p r o p r i a t e and o f t e n impossible t o a t t a i n w i t h PTSD symptoms (Shapiro, 1989a; Spector & Huthwaite, 1992). Second, i t tends t o address o n l y i n t r u s i v e , and  not  c o n s t r i c t i v e , symptoms or i n a p p r o p r i a t e c o g n i t i o n s (Shapiro, 1989a).  I t a l s o has been c r i t i c i z e d due t o l e n g t h of  treatment r e q u i r e d (Shapiro, 1989a); and f o r s u b j e c t noncompliance  (Lyons & Kean, 1989).  Eye Movement D e s e n s i t i z a t i o n and  Reprocessing  The O r i g i n a l P r o t o c o l As the reader i s p o s s i b l y u n f a m i l i a r w i t h r e l a t i v e l y new  procedure,  (see Shapiro, 1989a, 1995  this  a b r i e f d e s c r i p t i o n w i l l be g i v e n f o r complete d e t a i l s ) .  In the o r i g i n a l p r o t o c o l , treatment  begins by having a  t r a u m a t i z e d c l i e n t focus on the t r o u b l i n g memory or image from which he or she wants r e l i e f .  For example, i f the  c l i e n t i s s u f f e r i n g from PTSD from having been i n an automobile  a c c i d e n t , he or she would p i c t u r e the most  a n x i e t y provoking image of the a c c i d e n t and would c o v e r t l y r e h e a r s e the concomitant  c o g n i t i v e b e l i e f , i . e . , "I'm  t o d i e , " or "I should have done something," e t c .  going  Then, he  or she r a t e s the l e v e l of a n x i e t y experienced i n d o i n g  this,  u s i n g the S u b j e c t i v e U n i t s of Discomfort S c a l e (SUDs; Wolpe, 1982), an 11-point L i k e r t s c a l e , w i t h 0 being no a n x i e t y ,  27  and  10 r e p r e s e n t i n g  extreme p a n i c .  The c l i e n t then imagines  a p r e f e r r e d c o g n i t i o n , such as "I'm s a f e now," e t c . , and rates i t s v a l i d i t y using the V a l i d i t y of Cognition (VOC;  Scale  Shapiro, 1989a), a seven-point L i k e r t s c a l e .  and VOC scores  serve as b a s e l i n e measures, a g a i n s t which any  changes w i l l be compared. experiencing  The SUDs  Then, w h i l e once a g a i n  t h e d i s t u r b i n g image, f e e l i n g and c o g n i t i o n ,  the c l i e n t f o l l o w s the t h e r a p i s t ' s index f i n g e r , which he o r she moves h o r i z o n t a l l y , back and f o r t h , a c r o s s  the c l i e n t ' s  l i n e o f v i s i o n , from extreme r i g h t t o extreme l e f t , distance and  o f 12-14 inches from the c l i e n t ' s f a c e .  at a  Each back  f o r t h movement of the f i n g e r (a saccade) i s r e p e a t e d 12-  24 times (one s e t ) .  A f t e r each s e t o f saccades, t h e c l i e n t  r e l a x e s and blanks out the p i c t u r e .  They then generate t h e  p i c t u r e and c o g n i t i o n once again and a new SUDs l e v e l i s taken. one  The procedure i s repeated u n t i l SUDs r a t i n g s r e a c h  o r zero. A c c o r d i n g t o most p u b l i s h e d  s t u d i e s , a f t e r one t o  s e v e r a l s e t s o f saccades, t h e d i s t u r b i n g image changes o r disappears,  and the concomitant a n x i e t y  Sometimes, b e f o r e o r a f t e r t h e f i r s t a d i f f e r e n t , but s e m a n t i c a l l y  also dissipates.  image i s d e s e n s i t i z e d ,  or a f f e c t i v e l y r e l a t e d image  w i l l appear, and the above procedure i s used t o d e s e n s i t i z e it.  The procedure ends when a l l t r a u m a t i c images have been  desensitized.  28  The Revised  Protocol  As w i t h most t h e r a p e u t i c techniques,  t h e o r i g i n a l EMDR  p r o t o c o l has undergone an e v o l u t i o n which has l e d t o a l t e r a t i o n s i n the procedure. Most n o t i c e a b l y , i n the c u r r e n t p r o t o c o l t h e c l i n i c i a n no  longer has t h e c l i e n t remain focused o n l y on the  original  d i s t u r b i n g image throughout treatment, w h i l e i n s t i g a t i n g eye movements, b u t more g e n t l y f o l l o w s t h e c l i e n t ' s e v o l v i n g processing.  F o r example, a t t h e end o f a s e t , t h e c l i n i c i a n  w i l l ask the c l i e n t ,  "What do you get know?" (Shapiro, 1995,  p. 37) and w i l l have the c l i e n t h o l d the new image, f e e l i n g , thought, e t c . , i n mind through the next s e t o f saccades (p. 37).  Shapiro  writes  No matter how the i n f o r m a t i o n s u b j e c t i v e l y emerges, as long as p r o c e s s i n g has continued,  the c l i e n t  should  simply be d i r e c t e d f o r t h e next s e t w i t h t h e g l o b a l statement "Think o f i t . "  In other words, t h e c l i n i c i a n  needs t o address the t a r g e t e d memory i n whatever form i t a r i s e s (1994, p. 77).  F u r t h e r , t h e r e v i s e d EMDR p r o t o c o l (see Shapiro, 1995, f o r d e t a i l s ) i n c l u d e s a complete treatment p l a n c o n s i s t i n g of e i g h t phases: (b) p r e p a r a t i o n ;  (a) C l i e n t h i s t o r y and treatment  planning;  (c) assessment; (d) d e s e n s i t i z a t i o n  ( g e n e r a l l y eye movements); (e) i n s t a l l a t i o n o f p o s i t i v e cognition;  (f) body scan;  (g) c l o s u r e ; and (h) r e -  29  e v a l u a t i o n ; and an 11-step standard procedure which i n c l u d e s the f o l l o w i n g :  1. C l i e n t accesses traumatic  an image which r e p r e s e n t s t h e e n t i r e  event.  2. C l i e n t develops the negative conveys an u n d e r l y i n g l i m i t i n g  "I am" s e l f - s t a t e m e n t ,  which  belief.  3. C l i e n t c r e a t e s a d e s i r a b l e p o s i t i v e s e l f - s t a t e m e n t which (when p o s s i b l e ) i n c o r p o r a t e s an i n t e r n a l l o c u s o f c o n t r o l .  4. C l i e n t determines t h e v a l i d i t y o f t h e p o s i t i v e s e l f statement  (the V a l i d i t y of C o g n i t i o n ; VOC), on a s c a l e o f l  t o 7.  5. C l i e n t i d e n t i f i e s the d i s t u r b i n g emotion which  linking  the image and negative c o g n i t i o n produce.  6. C l i e n t uses SUDs t o determine the s u b j e c t i v e l e v e l o f d i s t u r b a n c e when t h e memory of t h e t r a u m a t i c event i s stimulated.  7. C l i e n t l o c a t e s where t h e concomitant p h y s i c a l s e n s a t i o n s i n t h e body a r e f e l t .  30  8. C l i e n t processes a l l d i s t u r b i n g i n f o r m a t i o n  (using  c l i n i c i a n - i n s t i g a t e d eye movements, e t c . )  9. C l i n i c i a n i n s t a l l s the p o s i t i v e c o g n i t i o n .  10. C l i e n t mentally  scans body f o r any r e s i d u a l p h y s i c a l  s e n s a t i o n , w h i l e h o l d i n g event and p o s i t i v e c o g n i t i o n i n mind.  11. C l i n i c i a n ends s e s s i o n , i n s u r i n g c l i e n t i s r e l a t i v e l y relaxed.  V a r i a t i o n s on the above standard  protocol also exist  f o r t h e treatment of phobias (simple and complex); g r i e f ; and i l l n e s s and somatic d i s o r d e r s  (Shapiro,  Shapiro (1995) notes t h a t s i n c e 1990 those  excessive 1995).  teaching  EMDR have i n s t r u c t e d students i n the use of not o n l y eye movements, but hand taps and a u d i t o r y cues; and t h a t have made use o f f l a s h i n g l i g h t s as w e l l .  others  She w r i t e s ,  that  d e s p i t e apparent e f f i c a c y , " f u r t h e r i n v e s t i g a t i o n may  find  t h a t eye movements have a unique s t a t u s as a s t i m u l u s  that  i s a l s o an observable inherent p h y s i o l o g i c a l of some types of c o g n i t i v e p r o c e s s i n g "  manifestation  (p. 24).  Healing Mechanisms In her seminal a r t i c l e  (1989a) Shapiro c i t e s P a v l o v ' s  (1927) s p e c u l a t i o n t h a t "traumatic  overload"  p a t h o l o g i c a l n e u r a l changes which keep the  leads t o traumatic  31  i n f o r m a t i o n i n a " f r o z e n s t a t e " (p. 220). Wolpe w r i t e s t h a t i f e x c i t a t i o n and i n h i b i t i o n come i n t o c o n f l i c t w i t h  each  o t h e r a t a g i v e n l o c u s o f t h e c o r t e x , "the n e u r a l elements concerned may be unable t o bear t h e s t r a i n and so undergo a p a t h o l o g i c a l change . . . " (Wolpe, 1959). technique  The EMDR  ( r e p e a t i n g eye movements w h i l e h o l d i n g t h e memory  i n awareness) p u r p o r t e d l y f a c i l i t a t e s p r o c e s s i n g o f t h i s "frozen" information neurological  (p. 220), thereby r e s t o r i n g  balance.  S e v e r a l e a r l y authors,  noting the s u p e r f i c i a l  p h y s i o l o g i c a l s i m i l a r i t i e s between EMDR eye movements and those  found i n r a p i d REM s l e e p , s p e c u l a t e d t h a t EMDR may  p r o v i d e an i n f o r m a t i o n p r o c e s s i n g f u n c t i o n s i m i l a r t o t h e p u t a t i v e p r o c e s s i n g mechanism o f REM s l e e p  (Shapiro,  1989a;  Ross e t a l . 1994). To make sense o f EMDR's r a p i d h e a l i n g e f f e c t s working h y p o t h e s i s makes use o f an " A c c e l e r a t e d  Shapiro's  Information  P r o c e s s i n g " model (Shapiro, 1995, p. 28). According  t o t h i s model, t h e i n f o r m a t i o n , which has  become " f r o z e n " due t o traumatic o v e r l o a d ,  i sisolated i n  the nervous system i n i t s " d i s t r e s s i n g , e x c i t a t o r y s t a t e s p e c i f i c form" (p. 30), and i n t r u d e s i n t o c o n s c i o u s n e s s i n the form o f t h e i n t r u s i v e symptoms d i s c u s s e d above.  Shapiro  (1995) w r i t e s  In e f f e c t , t h e i n f o r m a t i o n i s f r o z e n i n time,  isolated  i n i t s own neuro network, and s t o r e d i n i t s o r i g i n a l l y  32  d i s t u r b i n g s t a t e - s p e c i f i c form.  Because i t s  b i o l o g i c a l / c h e m i c a l / e l e c t r i c a l r e c e p t o r s are unable t o a p p r o p r i a t e l y f a c i l i t a t e t r a n s m i s s i o n between n e u r a l s t r u c t u r e s , the neuro network i n which the o l d information i s stored i s e f f e c t i v e l y i s o l a t e d .  No new  l e a r n i n g can take p l a c e because subsequent t h e r a p e u t i c i n f o r m a t i o n cannot l i n k a s s o c i a t i v e l y w i t h i t (p. 40) .  Hence, one may glean new, c o n t r a d i c t o r y i n f o r m a t i o n from y e a r s o f therapy  o r new l i f e experiences,  but t h i s  i n f o r m a t i o n may prove i n e f f e c t u a l , as i t i s s t o r e d i n i t s own  neuro network, separate  from the t r a u m a t i c  information.  EMDR's eye-movements (or a l t e r n a t i v e s t i m u l i ) " t r i g g e r a p h y s i o l o g i c a l mechanism t h a t a c t i v a t e s t h e i n f o r m a t i o n p r o c e s s i n g system" (p. 30), thereby  linking previously  i s o l a t e d d i s t u r b i n g i n f o r m a t i o n with c u r r e n t l y h e l d beliefs  adaptive  (p. 31).  For now, the h e a l i n g mechanisms o f EMDR, remain speculative.  Shapiro w r i t e s t h a t "the a c t u a l n e u r o l o g i c a l  concomitants may not be d i s c o v e r e d w i t h i n t h i s  generation"  (1994, p. 3 ) . P r e v i o u s Research i n t o Eye Movement D e s e n s i t i z a t i o n and Reprocessing In e v a l u a t i n g r e s e a r c h i n t o EMDR, the reader must keep i n mind t h a t t h e r e e x i s t s e v e r a l extraneous v a r i a b l e s which render  evaluation d i f f i c u l t .  F i r s t , t h e r e are, a t p r e s e n t ,  a number o f v e r s i o n s o f EMD, o r EMDR, c u r r e n t l y b e i n g used  33  and  tested.  Those i n c l u d e Shapiro's o r i g i n a l EMD p r o t o c o l  (1989a, 1989b); t h e EMD o r i g i n a l l y taught by S h a p i r o i n 1990;  t h e r e v i s e d p r o t o c o l taught by Shapiro s i n c e 1991 (see  Shapiro,  1995); as w e l l as t h e r a p i s t s ' own c r e a t i v e  v a r i a t i o n s o f t h e procedure (Greenwald, 1994). Controlled The  Studies  seminal study i n EMDR was done by S h a p i r o  A f t e r s e r e n d i p i t o u s l y observing  t h a t she c o u l d  (1989a).  desensitize  h e r s e l f t o d i s t u r b i n g thoughts and f e e l i n g s by r a p i d l y moving h e r eyes from s i d e t o s i d e (Herbert  & Mueser, 1992),  she engaged i n c l i n i c a l experiments w i t h t h e eye movement procedure on approximately 70 c l i e n t s and v o l u n t e e r s (Shapiro,  1989b).  A systematic  i n v o l v i n g 22 rape/molestation veterans,  study was then undertaken  v i c t i m s and Vietnam combat  a l l o f whom were diagnosed by t h e i r c o u n s e l l o r s as  h a v i n g PTSD.  Subjects  were d i v i d e d randomly i n t o a  treatment group, which r e c e i v e d EMDR, and a c o n t r o l group, which r e c e i v e d a m o d i f i e d  f l o o d i n g procedure.  reasons, EMDR was administered  For e t h i c a l  t o t h e c o n t r o l group a f t e r  h a v i n g p a r t i c i p a t e d i n t h e placebo c o n d i t i o n . The  r e s u l t s were as f o l l o w s :  In t h e treatment group,  the mean SUDs score dropped from 7.45 ( p r e t e s t ) t o 0.13 ( p o s t - t e s t ) ; and t h e mean VOC score  ( r e p r e s e n t i n g an  increase i n subjects' b e l i e f i n t h e i r p o s i t i v e cognition) r o s e from 3.95 t o 6.75. a c t u a l l y increased  In t h e placebo group, t h e mean SUDs  from 6.77 t o 8.31, u n t i l  subjects  r e c e i v e d EMDR, a f t e r which t h e i r SUDs l e v e l dropped t o a  34  n e g l i g i b l e l e v e l w i t h i n s e v e r a l s e t s o f saccades. scores  i n t h i s group dropped from 2.95 t o 2.36,  increased  from 2.36 t o 6.77 a f t e r EMDR was  Mean VOC  and l a t e r  administered.  A l l s u b j e c t s r e p o r t e d e i t h e r a decrease o r t o t a l e l i m i n a t i o n of t h e i r primary p r e s e n t i n g  problem, t h e e f f e c t s o f which  were maintained a t a t h r e e month  follow-up.  Marquis (1991) undertook a study t o " . . . e x p l o r e t h e range o f problems amenable t o eye movement d e s e n s i t i z a t i o n " (p. 187).  There were 78 s u b j e c t s i n h i s study, 16 o f whom  s u f f e r e d from PTSD.  Some, but n o t a l l , o f t h e o t h e r  c o n d i t i o n s t r e a t e d i n the study i n c l u d e d e a t i n g  disorders,  agoraphobia w i t h p a n i c d i s o r d e r , simple phobias, r e l a t i o n s h i p problems, substance abuse, l e a r n i n g disabilities,  and p e r s o n a l i t y d i s o r d e r s . H i s r e s u l t s proved  s i m i l a r t o Shapiro's: apparently unimproved. and  Seventy-three s u b j e c t s were  cured o r had improved, and o n l y f i v e were Four o f those s u f f e r e d from severe  s e l f - e f f i c a c y problems.  self-esteem  The f i f t h was a woman who had  been d e s e n s i t i z e d t o her husband's " f e t i s h i s t i c  activity,"  and whose a v e r s i o n t o him was q u i c k l y r e - e s t a b l i s h e d . Marquis r e p o r t s t h a t , "In g e n e r a l ,  sources o f d i s t r e s s t h a t  are i n the p a s t and i s o l a t e d were e a s i l y d e s e n s i t i z e d . Themes t h a t were d i f f u s e l y connected o r h i g h l y or t h a t represented  generalized,  mood-dependent s t a t e s o r a d d i c t i o n s i n  the broadest sense, were l e s s s u c c e s s f u l l y t r e a t e d " (p. 189).  The " o v e r a l l improvement r a t i n g " f o r PTSD was 2.9;  35  f o r agoraphobia, 2.8; and f o r simple phobias, 2.6 on a 0-3 scale. Sanderson and Carpenter (1992) compared EMDR t o image confrontation  (IC) i n a group o f 58 phobic s u b j e c t s (as  compared t o s u b j e c t s s u f f e r i n g from PTSD).  EMDR and IC  ( f l o o d i n g ) were used i n a s i n g l e - s e s s i o n c r o s s o v e r  trial.  Each procedure was g i v e n f o r seven s e t s o f 20 seconds. T h e i r r e s u l t s showed t h a t both EMDR and IC s i g n i f i c a n t l y reduced SUDs s c o r e s , b u t t h a t t h e r e was no s i g n i f i c a n t d i f f e r e n c e between the groups.  The authors conclude t h a t  b e n e f i t s o f EMDR do not come from eye movements, b u t from exposure t o the f e a r e d image ( f l o o d i n g / I C ) . Wilson, C o v i , and F o s t e r  (1993) t r e a t e d 18 i n d i v i d u a l s  s u f f e r i n g from t r a u m a t i c memories i n a s i n g l e s e s s i o n . Three groups  (n = 6 each) i n c l u d e d an EMDR treatment group,  a group i n which thumb-taps were s u b s t i t u t e d f o r eye movements, and another group i n which eye movements were omitted.  B e s i d e s SUDs and VOC s c o r e s , p h y s i o l o g i c a l  measures were taken.  The treatment group showed l a r g e and  s i g n i f i c a n t improvements  which were maintained a t 3, 9 and  12 months. R e c e n t l y , Boudewyns e t a l . (1993) u t i l i z e d both p h y s i o l o g i c a l and s t a n d a r d i z e d assessments f o r twenty Vietnam war v e t e r a n s t r e a t e d w i t h e i t h e r EMDR, i m a g i n a l exposure, o r m i l i e u therapy. PTSD S c a l e  The C l i n i c i a n A d m i n i s t e r e d  (CAPS); the M i s s i s s i p p i S c a l e ; t h e Impact o f  Event S c a l e (IES); t h e r a p i s t r a t i n g s o f treatment  36  r e s p o n s i v e n e s s ; and SUDs were implemented, a l o n g w i t h p h y s i o l o g i c a l assessments o f h e a r t - r a t e ; response  (EMG); e l e c t r o d e r m a l response  electromyographic  (EDR); and s k i n  temperature. I n t e r e s t i n g l y , t h e r e was a g r e a t e r r e d u c t i o n o f SUDs l e v e l s f o r the EMDR group than f o r the exposure c o n d i t i o n d u r i n g treatment;  y e t no d i f f e r e n c e s were found between  groups, on SUDs o r p h y s i o l o g i c a l r a t i n g s , d u r i n g p o s t treatment  exposure t o s u b j e c t ' s i n i t i a l  audiotaped  d e s c r i p t i o n o f the traumatic memory, nor on s t a n d a r d i z e d post-treatment  measures o f PTSD.  Wilson, T i n k e r and Becker (1994) undertook r e s e a r c h on 80 i n d i v i d u a l s who had been traumatized by a v a r i e t y o f experiences, mental abuse.  i n c l u d i n g combat, rape, as w e l l as p h y s i c a l and The traumatic event(s) had o c c u r r e d from  between t h r e e months and 54 years b e f o r e t h e study began. S u b j e c t s were randomly assigned t o one o f two groups: r e c e i v e d the EMDR procedure;  One  the other r e c e i v e d no treatment  of any k i n d f o r 30 days, a f t e r which time, they too r e c e i v e d EMDR.  F o l l o w i n g treatment,  t h e EMDR group showed immediate,  s i g n i f i c a n t improvement as measured by the Impact o f Events Scale  ( Horowitz,  Wilner & A l a v a r e z , 1979), SUDs (Wolpe,  1956), and the A n x i e t y dimension  o f the Symptom Check L i s t  (SCL-90-R; D e r o g a t i s , 1992); whereas the d e l a y e d  treatment  group showed no improvement u n t i l EMDR was a d m i n i s t e r e d , a t which time they too showed s i g n i f i c a n t  improvement.  37  Using Shapiro's  (1989a, 1989b) o r i g i n a l EMD p r o t o c o l ,  Vaughn (1993) t r e a t e d 10 i n d i v i d u a l s with a d u a l of PTSD and substance abuse d u r i n g 4 s e s s i o n s . and  diagnosis Significant  s u s t a i n e d improvement was found a t post-treatment,  month follow-up;  y e t the a r o u s a l subsale on the Hamilton  a n x i e t y s c a l e , r e t u r n e d t o near pre-treatment months.  and 4  l e v e l s by f o u r  Vaughn (1993) a l s o r e p o r t e d a study  i n which he  p l a c e d 36 PTSD s u b j e c t s i n t o one o f t h r e e treatment groups (with members o f each o f those group e i t h e r r e c e i v i n g treatment o r being p l a c e d on a w a i t i n g l i s t ) , r e c e i v e d e i t h e r EMD (Shapiro, 1989a, 1989b),  i n which they Anxiety  Management T r a i n i n g (AMT; a r e l a x a t i o n t e c h n i q u e ) ,  o r Image  H a b i t u a t i o n T r a i n i n g (IHT; an exposure t e c h n i q u e ) . A l l treatment groups showed g r e a t e r improvement than w a i t - l i s t e d groups; w i t h the EMD group showing most improvements.  This  group was f o l l o w e d by the AMT and IHT groups, r e s p e c t i v e l y . F i n a l l y , r e g a r d i n g the sometimes c o n t r a d i c t o r y f i n d i n g s of EMDR e f f i c a c y r e s e a r c h , Greenwald, (1996) w r i t e s t h a t d i s c r e p a n c i e s are due t o "the s u b s t a n t i a l i n f o r m a t i o n gap between those who have and those who have n o t undergone t h e formal, supervised  [EMDR] t r a i n i n g "  (p. 67); and t h a t  "the  c r i t i c a l v a r i a b l e appears t o be f i d e l i t y t o t h e EMDR protocol"  (p. 69). Case S t u d i e s  Greenwald w r i t e s t h a t "as c o n t r o l l e d s t u d i e s b e g i n t o be r e p o r t e d , case s t u d i e s p l a y a d i m i n i s h e d  role i n the  38  e v a l u a t i o n o f EMDR's e f f i c a c y "  (1994, p. 21).  He goes on t o  note t h a t  w h i l e many o f t h e case r e p o r t s do i n c l u d e . . . s t a n d a r d i z e d measures, b e h a v i o r a l i n d i c e s , and l o n g term follow-up, most f a i l t o meet t h e d e s i g n expected o f s i n g l e - s u b j e c t i n v e s t i g a t i o n s  Puk  standards  (p. 21) .  (1991) r e p o r t s t r e a t i n g a 23-year-old woman having  d i s t u r b i n g dreams and s o c i a l a n x i e t y as a r e s u l t o f b e i n g raped, as w e l l as a 33-year-old woman s u f f e r i n g  from  f r e q u e n t , i n t r u s i v e images o f her dying s i s t e r ,  f o r whom she  had c a r e d d u r i n g t h e f i n a l stages o f cancer.  Presenting  symptoms f o r both women were e l i m i n a t e d a f t e r one s e s s i o n o f EMDR, and b e n e f i t s maintained a t 12 months a f t e r  treatment.  Wolpe and Abrams (1991) a l s o s u c c e s s f u l l y t r e a t e d a rape v i c t i m , a f t e r 15 s e s s i o n s o f t r a d i t i o n a l therapy had f a i l e d t o a l l e v i a t e h e r f e a r o f l e a v i n g her home.  L i p k e and B o t k i n  (1992) used EMDR w i t h f i v e h o s p i t a l i z e d Vietnam combat veterans.  Of t h e f i v e , two showed dramatic improvement.  A  t h i r d d i d n o t improve due t o t h e r a p i s t e r r o r i n u s i n g t h e procedure.  A f o u r t h s u b j e c t had w i l l f u l l y n o t complied  t h e r a p i s t ' s i n s t r u c t i o n s ; and t h e f i f t h , who s u f f e r e d b i z a r r e t h i n k i n g and temporal the procedure  with  from  lobe e p i l e p s y , asked t o s t o p  f o r f e a r t h a t l o s i n g t h e image would r e s u l t i n  harm t o h i s f a m i l y .  K l e i n k n e c h t and Morgan (1992)  s u c c e s s f u l l y t r e a t e d a 40-year-old male who had s u f f e r e d  39  PTSD symptoms f o r e i g h t years a f t e r having been shot and l e f t to die.  S i m i l a r l y , McCann (1992) c l a i m e d s u c c e s s w i t h  a 4 1 - y e a r - o l d burn v i c t i m who a l s o had d i s p l a y e d PTSD symptoms f o r e i g h t y e a r s .  Wernik (1993) r e p o r t s h a v i n g  s u c c e s s f u l l y t r e a t e d 21- and 45-year-old males f o r premature e j a c u l a t i o n and impotence,  respectively.  Pellicer  (1993)  r e p o r t s having s u c c e s s f u l l y t r e a t e d a t e n - y e a r - o l d g i r l who had s u f f e r e d most o f her l i f e from r e c u r r i n g nightmares o f h a v i n g snakes c r a w l i n g i n her bed.  She, as most s u b j e c t s i n  t h e above s t u d i e s , was s u c c e s s f u l l y t r e a t e d i n o n l y one session. Cocco and Sharpe (1993) r e p o r t having used an a u d i t o r y v a r i a n t o f EMDR w i t h a f o u r year, n i n e month o l d boy, "Sam," who had been e x p e r i e n c i n g nightmares, bedwetting, home.  i n t r u s i v e thoughts and  a f t e r having witnessed an armed robbery i n h i s  The authors r e p o r t t h a t , a f t e r one s e s s i o n , t h e  s u b j e c t "no l o n g e r evidenced any o f t h e symptoms thought t o be a s s o c i a t e d w i t h i n t r u s i v e thoughts", and t h a t " t h e r e was a dramatic r e d u c t i o n i n t h e b e h a v i o u r a l symptoms  immediately  f o l l o w i n g t h e s e s s i o n " (p. 375). Although asymptomatic a t t h r e e month f o l l o w up, t h e c h i l d had r e t u r n e d t o s l e e p i n g i n his  p a r e n t s ' bed, and was a f r a i d t o go t o t h e t o i l e t  alone  late at night. Kleinknecht  (1993) r e p o r t s t r e a t i n g a 2 1 - y e a r - o l d woman  s u f f e r i n g from an i n j e c t i o n and blood phobia i n f o u r t h i r t y minute s e s s i o n s .  S e l f - r e p o r t and p h y s i o l o g i c a l measures  40  (blood p r e s s u r e and h e a r t r a t e ) showed s i g n i f i c a n t improvement, which was maintained a t 1, 14 and 24 weeks. A c i e r n o Tremont, L a s t & Montgomery (1994) w r i t e o f a 4 2 - y e a r - o l d female s u f f e r i n g from m u l t i p l e simple phobias o f images r e l a t e d t o dead bodies e t c . ) and darkness.  ( i . e . , hearses, f u n e r a l homes,  EMDR was compared w i t h a t e c h n i q u e  which was i d e n t i c a l i n a l l aspects, except t h a t i t d i d n o t implement the normally p r e s c r i b e d eye movements.  The two  treatment c o n d i t i o n s were administered " c u m u l a t i v e l y and s e q u e n t i a l l y i n multiple-baseline design fashion across fear areas"  (Acierno e t a l . ,  1994,  p. 295).  A t r i p a r t i t e e v a l u a t i o n o f (a) m o t o r i c assessment (avoidance b e h a v i o u r ) ,  (b) p h y s i o l o g i c a l responses  and (c)  s t a n d a r d i z e d s e l f - r e p o r t measures (see A c i e r n o e t a l . , 1994 f o r d e t a i l s ) showed a s l i g h t EMDR performance advantage r e g a r d i n g avoidance behaviour r e l a t e d t o dead b o d i e s , b u t n e i t h e r group proved s u p e r i o u r i n any o t h e r measures, i n c l u d i n g SUDs. C r i t i c i s m o f EMDR Research Herbert and Mueser c a u t i o n c l i n i c i a n s a g a i n s t t h e u n c r i t i c a l acceptance conducted  o f EMDR, n o t i n g t h a t the " r e s e a r c h  i n t h i s area has s e r i o u s m e t h o d o l o g i c a l f l a w s ,  p r e c l u d i n g d e f i n i t e c o n c l u s i o n s r e g a r d i n g the e f f e c t i v e n e s s of the procedure"  (1992, p. 169).  Some o f these flaws i n c l u d e (a) l a c k o f s t a n d a r d i z e d measurement used i n g a t h e r i n g b a s e l i n e data and e s t a b l i s h i n g a PTSD d i a g n o s i s (Lohr e t a l . ,  1992); (b)  subjects'  41  c o n c u r r e n t l y r e c e i v i n g treatment other than EMDR, which b r i n g s i n t o q u e s t i o n the c a u s a l r e l a t i o n s h i p between treatment,and  outcome (Page & C r i n o , 1993); (c) t h e r a p i s t  demand c h a r a c t e r i s t i c s 1993) ; and  (Page & C r i n o , 1993;  Acierno et a l . ,  (d) p o s s i b l e u n i n t e n t i o n a l experimental b i a s  (Acierno e t a l . ,  1993;  Herbert & Mueser, 1992).  E t h i c a l Considerations Page and C r i n o w r i t e "[EMDR] stands t o c h a l l e n g e many fundamental b e l i e f s h e l d by c l i n i c i a n s about the nature treatment of PTSD, and may  r e p r e s e n t y e t another  about whose mechanism we must p l e a d ignorance" 293).  and  technique  (1993, p.  They go on t o e x p l o r e the e t h i c a l i m p l i c a t i o n s should  such a simple and p o t e n t i a l l y r a p i d treatment prove t o be widely  effective:  F i r s t l y , what are the i m p l i c a t i o n s f o r c l a i m s f o r damages f o l l o w i n g t r a u m a t i c events?  For example, i f  the p s y c h o l o g i c a l e f f e c t s of rape can be  rapidly  removed, w i l l the case f o r the p r o s e c u t i o n be weakened? Secondly, Finally  should everyone be t r e a t e d immediately?  ...  . . .  i f [EMDR] were t o s u c c e s s f u l l y a m e l i o r a t e  g r i e f , should the d i s t r e s s of bereavement be removed? (p.  293).  C o n t i n u i n g i n t h i s v e i n , should a t h e r a p i s t attempt r e l i e v e a 10-year-old of her r e c u r r i n g nightmares, are a r e f l e c t i o n of a d i s t u r b e d home l i f e  to i f they  (Pellicer,  1993)?  42  D e s c r i p t i v e Accounts  o f EMDR E x p e r i e n c e s  As mentioned i n t h e i n t r o d u c t i o n , although s e v e r a l authors  (see Greenwald, 1994; K l e i n k n e c h t & Morgan, 1992;  McCann, 1992, f o r example) have noted phenomenological  particular  experiences d e s c r i b e d by t h e i r  clients  d u r i n g EMDR therapy, t h e r e has as y e t been no s y s t e m a t i c study i n t h i s area. In h e r book, Eye Movement D e s e n s i t i z a t i o n and Reprocessing:  B a s i c P r i n c i p l e s . P r o t o c o l s and Procedures  (1995), Shapiro l i s t s some o f t h e p a t t e r n s o f responses which she and other EMDR t h e r a p i s t s have observed thus f a r . She w r i t e s , " C l i n i c a l o b s e r v a t i o n i n d i c a t e s t h a t approximately  40% o f t h e time c l i e n t s e x p e r i e n c e a  c o n t i n u a l , p r o g r e s s i v e s h i f t toward a r e s o l u t i o n o f t h e t a r g e t event"  (p. 76).  P r o c e s s i n g i s always assessed i n r e l a t i o n t o t h e t a r g e t memory o r memories.  Because d u r i n g treatment new memories  may s u r f a c e , o r t h e c l i e n t may simply s t a y w i t h t h e o r i g i n a l t a r g e t memory, two  categories:  Shapiro d i v i d e s such p r o c e s s i n g e f f e c t s  into  Single-memory p r o c e s s i n g e f f e c t s ; and  Multimemory p r o c e s s i n g e f f e c t s . Single-Memory P r o c e s s i n g E f f e c t s In cases where t h e a t t e n t i o n does n o t s h i f t from t h e t a r g e t memory, t h e r e may s t i l l be changes i n any o f " f i v e d i s t i n c t a s p e c t s o f t h e memory:  image, sounds, c o g n i t i o n ,  emotion, o r p h y s i c a l s e n s a t i o n s " (p. 81).  43  Changes i n the Image The  image may  fade or s h i f t t o a d i f f e r e n t a s p e c t of  the t a r g e t event; and may  even change i t s content o r  appearance (see a l s o K l e i n k n e c h t & Morgan, 1992; 1993;  Puk,  1991;  Spector & Huthwaite, 1993).  O'Brian,  Shapiro gives  the example of a f a c e which the c l i e n t remembers as " l e e r i n g " changing t o a " s m i l i n g one"  (p. 81).  She  notes t h a t items such as weapons can " d i s a p p e a r "  also  (p. 81) ,  and t h a t the "scene" can expand t o i n c l u d e more d e t a i l s of t h i n g s the c l i e n t has f o r g o t t e n , as the p r o c e s s i n g of the predominant a f f e c t which occurred a t the time of trauma a l l o w s the c l i e n t t o f i n a l l y see the event i n i t s l a r g e r context  (p. 81).  Hence, the more s e l f - a f f i r m i n g i n f o r m a t i o n  such as "I d i d a l l I c o u l d , " which has remained b l o c k e d i n the nervous system s i n c e the trauma, can now  become  integrated. Changes i n Sounds Shapiro w r i t e s t h a t sounds may or may  become l o u d e r or s o f t e r ,  completely disappear from the memory.  d i a l o g u e may  s h i f t ; and c l i e n t s may  a s s e r t themselves d i a l o g u e which was changing  begin t o  Remembered spontaneously  with the remembered persons. completely f o r g o t t e n may  Also,  emerge w i t h  images (p. 83).  Changes i n C o g n i t i o n s Shapiro notes t h a t c l i e n t ' s l e v e l of i n s i g h t w i l l o f t e n i n c r e a s e from one s e t t o another, w i t h the  client's  c o g n i t i o n s becoming "more adaptive as the i n f o r m a t i o n i s  44  processed"  (p. 83).  "Polar responses"—dramatic  a negative t o a p o s i t i v e cognition—may treatment  (p. 83).  shifts  from  occur e a r l y on i n  For example, Shapiro w r i t e s t h a t "a  c l i e n t may s t a r t with the c o g n i t i o n "There i s something wrong w i t h me: i n r e l a t i o n t o s o c i a l s i t u a t i o n s and a f t e r a s i n g l e s e t may s t a r t t h i n k i n g , "I'm f i n e "  (p. 83).  Changes i n Emotions A c c o r d i n g t o Shapiro, many c l i e n t s d e s c r i b e a change i n the emotion they a r e e x p e r i e n c i n g (see a l s o K l i e n k n e c h t & Morgan, 1992).  That i s , they may begin f e e l i n g sad, and  then become angry.  Emotions may a l s o d i m i n i s h , o r may  become more profound before s u b s i d i n g .  She w r i t e s ,  The c l i e n t w i l l o f t e n r e p o r t a p r o g r e s s i v e s h i f t toward more e c o l o g i c a l l y v a l i d , o r a p p r o p r i a t e , emotions. T h i s s h i f t w i l l manifest i t s e l f as movement  through  d i f f e r e n t " l a y e r s " of emotion (e.g., from g u i l t t o rage t o sorrow t o acceptance).  Once a g a i n , each c l i e n t  r e a c t s u n i q u e l y . . . (p. 84).  F u r t h e r , some c l i e n t s may o v e r t l y manifest t h e s e emotions i n a b r e a c t i o n , o t h e r s w i l l show l i t t l e o v e r t d i s p l a y . Changes i n P h y s i c a l Sensations A c c o r d i n g t o Shapiro, "When a memory i s b e i n g processed, most c l i e n t s experience some m a n i f e s t a t i o n o f t h e i n f o r m a t i o n on a somatic l e v e l "  (p. 84). There may be a  r e l e a s e o f p h y s i c a l s e n s a t i o n s , l e a d i n g t o a decrease i n  45  i n t e n s i t y w i t h each s e t ; o r c o n v e r s e l y , t h e r e may be a temporary i n c r e a s e o f somatic e x p e r i e n c i n g .  The p h y s i c a l  s e n s a t i o n s experienced d u r i n g t h e trauma may be r e e x p e r i e n c e d i n t h e same p a r t o f t h e body as i f they were o c c u r r i n g i n p r e s e n t time.  P a r t i c u l a r s e n s a t i o n s may move  through t h e body, from one l o c a t i o n t o another  (p. 85) .  Multimemory A s s o c i a t i v e P r o c e s s i n g Shapiro w r i t e s t h a t although memories may emerge d u r i n g EMDR treatment,  "no memory w i l l emerge t h a t i s n o t i n some  way a s s o c i a t e d w i t h t h e t a r g e t " (p. 78). As i n t h e above s e c t i o n , the f o l l o w i n g categories are hers  (Shapiro, 1995).  The Major P a r t i c i p a n t o r P e r p e t r a t o r The emergent memory may be l i n k e d by t h e common denominator o f who t h e a s s a i l a n t o r p e r p e t r a t o r was. F o r example, i f t h e t a r g e t memory i s o f an a b u s i v e p a r e n t molesting the c l i e n t ,  a r e l a t e d memory o f t h e same f a t h e r  b e a t i n g him o r h e r may occur  (p. 79).  The Pronounced S t i m u l i For t h i s category, Shapiro g i v e s t h e example o f a Vietnam v e t e r a n p r o c e s s i n g t h e memory o f an earthquake, "may suddenly r e c a l l  who  a combat experience i f t h e sounds o f  f a l l i n g o b j e c t s o r loud rumbling dominated both e v e n t s " (p. 79).  The dominant t h r e a d here may be t h e sensory  e x p e r i e n c e s themselves,  or t h e meaning which t h e v i c t i m  a s c r i b e s t o them (e.g., I am going t o d i e ) .  46  The S p e c i f i c  Event  Here, "emerging memories may be l i n k e d t o t h e t a r g e t e d memory by t h e nature o f t h e event i t s e l f "  (p. 7 9 ) . Hence,  when t h e t a r g e t memory i s a rape, memories o f o t h e r rapes o r m o l e s t a t i o n s may occur. The Dominant P h y s i c a l Sensations Because p h y s i c a l s e n s a t i o n s a r e s t o r e d i n t h e nervous system a t t h e time o f each t r a u m a t i z a t i o n (p. 79), memories i n which t h e c l i e n t experienced r e l a t e d s e n s a t i o n s may emerge d u r i n g treatment.  F o r example, S h a p i r o w r i t e s o f one  c l i e n t who r e p o r t e d having h e r hands t i e d t o a bed w h i l e she was beaten w i t h a broomstick by her mother.  During  p r o c e s s i n g , t h e s e n s a t i o n s i n her hands brought  t o mind t h e  memory o f h e r hands being f o r c e d on h e r f a t h e r ' s p e n i s , and l a t e r again, o f a r a p i s t h o l d i n g her hands t o g e t h e r d u r i n g the a t t a c k (p. 80). The Dominant Emotions Memories may be l i n k e d n o t n e c e s s a r i l y by c o n t e x t o r s e n s a t i o n s p e r se, but by t h e emotion(s) at  t h e time o f t r a u m a t i z a t i o n .  f e l t by t h e v i c t i m  Shapiro g i v e s t h e example o f  a c l i e n t d e s p a i r i n g a t t h e memory o f a f a i l e d  business  venture who may r e c o l l e c t a time i n which he o r she was abandoned by a parent and f e l t t h e same subsequent emotion (p. 8 0 ) . To r e i t e r a t e , although t h e above d e s c r i p t i o n s o f c l i e n t e x p e r i e n c e s a r e h e l p f u l , having been gleaned from many hours of  t h e r a p i s t s ' involvement  i n EMDR treatment,  still  lacking  47  i n the l i t e r a t u r e i s any systematic, phenomenological i n v e s t i g a t i o n moment EMDR experiences.  in-depth  i n t o i n d i v i d u a l s ' moment-to-  48  CHAPTER THREE: METHOD Rational In order t o document c o - r e s e a r c h e r s ' moment-to-moment i n - s e s s i o n EMDR experiences, t h e r e s e a r c h e r combined v a r i a t i o n s o f two e s t a b l i s h e d r e s e a r c h p r o t o c o l s : t h e phenomenological r e s e a r c h p r o t o c o l o f C o l a i z z i  (1978),  attempts t o g l e a n meaning from c o - r e s e a r c h e r s '  experiences;  and  1994) , a  I n t e r p e r s o n a l Process R e c a l l  procedure  (IPR; E l l i o t ,  which  used t o cue c o - r e s e a r c h e r s ' memories, and document  t h e i r i n - s e s s i o n therapy  experiences.  Phenomenological Research Phenomenological r e s e a r c h attempts t o a s c e r t a i n t h e meaning i n d i v i d u a l s a s c r i b e t o t h e i r e x p e r i e n c e s 1978;  van Manen, 1992).  (Collaizi,  The r e s e a r c h e r i n v e s t i g a t e s  d e s c r i p t i v e l y , i n order t o g a i n i n s i g h t i n t o the way i n d i v i d u a l s "experience the world p r e - r e f l e c t i v e l y , taxonomizing,  c l a s s i f y i n g , or a b s t r a c t i n g i t "  1992,  Subjects a r e seen by t h e r e s e a r c h e r as  p. 9 ) .  partners, or "co-researchers,  11  without  (van Manen,  i n the r e s e a r c h endeavor, and  g i v e n r e s p e c t , t r u s t and empowerment, t h a t they may b e t t e r t e l l t h e i r s t o r y ; thereby h e l p i n g t h e r e s e a r c h e r t o g l e a n a t r u e r p i c t u r e o f t h e experiences being i n v e s t i g a t e d ( M i s h l e r , 1988). A c c o r d i n g t o C o l a i z z i , what i s needed i n t h e i n v e s t i g a t i o n o f human experience i s a method which  49  n e i t h e r denies experience  nor d e n i g r a t e s  i t or  transforms i t i n t o o p e r a t i o n a l l y defined behavior; i t must be, i n s h o r t , a method t h a t remains w i t h human experience  as i t i s experienced,  s u s t a i n c o n t a c t with experience  one which t r i e s t o as i t i s g i v e n  (1978,  p. 53).  To a s s i s t i n t h e endeavor, I n t e r p e r s o n a l Process R e c a l l was a l s o used. I n t e r p e r s o n a l Process R e c a l l I n t e r p e r s o n a l Process R e c a l l (IPR; E l l i o t ,  1994) i s an  i n t e r v i e w procedure i n which t h e t h e r a p i s t a u d i o t a p e s t h e conversation  between him- o r h e r s e l f and t h e s u b j e c t ( o r  "informant") and p l a y s i t back immediately f o r t h e informant d u r i n g a second i n t e r v i e w . i n t e r v i e w , t h e informant  During what becomes a second  i s asked t o d e s c r i b e h i s o r h e r  moment-to-moment experiences,  as remembered, o f t h e f i r s t  interview. E l l i o t w r i t e s t h a t p l a y back o f t h e o r i g i n a l conversation  a c t s as a cue t o a s s i s t t h e p a r t i c i p a n t i n r e t r i e v i n g memory t r a c e s which would otherwise be l o s t i n t h e w e l t e r o f i n t e r f e r i n g i n f o r m a t i o n generated d u r i n g any communication episode (p. 505).  50  I n t e r p e r s o n a l Process R e c a l l was chosen t o h e l p t h e r e s e a r c h e r gather i n f o r m a t i o n about p a r t i c i p a n t s ' " s u b j e c t i v e impressions which are m i s s i n g from even t h e b e s t t r a n s c r i p t i o n s o r r e c o r d i n g s o f therapy s e s s i o n s " 1994,  (Elliot,  p. 505). The r e s e a r c h e r d e v i a t e d from the standard IPR p r o t o c o l  by p l a y i n g back the i n - s e s s i o n tape t o t h e c o - r e s e a r c h e r , not immediately,  but approximately  24 t o 48 hours a f t e r t h e  i n i t i a l taping.  T h i s was because immediate p l a y back o f t h e  therapy s e s s i o n , as p r e s c r i b e d by IPR,  would have been  i n a p p r o p r i a t e ; f o r , a c c o r d i n g t o EMDR l i t e r a t u r e  (Shapiro,  1995), some s u b j e c t s experience extreme d i s t r e s s and f a t i g u e during  (and sometimes a f t e r ) treatment.  Hence, had t h e  r e s e a r c h e r d i r e c t l y f o l l o w e d a 1 1/2 hour EMDR s e s s i o n w i t h a second i n t e r v i e w , he would have r i s k e d t a x i n g t h e emotional  and p h y s i c a l resources o f t h e c o - r e s e a r c h e r s ,  which might have u l t i m a t e l y l e a d t o a poorer interview.  quality  As r e s e a r c h i n t o memory suggests t h a t cued  r e c a l l i s o p t i m a l w i t h i n approximately  48 hours o f an event  ( E l l i o t , p. 504), t h i s time i n t e r v a l was deemed a p p r o p r i a t e . Overview o f the Research Method To r e i t e r a t e , r e s e a r c h e r and c o - r e s e a r c h e r s i n t h i s study were seen, by the former,  as " p a r t n e r s " i n t h e  endeavor; and i n t e r v i e w s were conducted  i n a context of  r e s p e c t , t r u s t and empowerment o f t h e c o - r e s e a r c h e r , i n o r d e r t o best g l e a n t h e i r experiences, and the meaning they make o f them.  51  Meaning, as i t i s used here, may be o f broad o r narrow import  ( M a r r i s , 1982).  I t may denote one's simply making  sense o f something (a s e n s a t i o n i n the stomach a r e a may mean one  i s hungry);  o r i t may have t h e broader d e f i n i t i o n  of  one's a s c r i b i n g importance t o something (as i n , "My w i f e means a l o t t o me").  Both "types" o f meaning were o f  r e l e v a n c e t o the present The  investigation.  f i r s t step o f i n q u i r y i n t o c o - r e s e a r c h e r s ' EMDR  e x p e r i e n c e s i n v o l v e d the a t t e n d i n g p s y c h o l o g i s t ' s t a p e r e c o r d i n g , f o l l o w e d by the r e s e a r c h e r ' s t r a n s c r i b i n g o f , t h e EMDR s e s s i o n .  Subsequent t o t h i s , t h e second, o r  " c l a r i f i c a t i o n i n t e r v i e w " occurred, d u r i n g which t h e r e s e a r c h e r asked c o - r e s e a r c h e r s t o e l a b o r a t e upon t h e i r i n s e s s i o n EMDR experiences. recorded. first,  T h i s i n t e r v i e w was a l s o tape  A t r a n s c r i p t i o n was made and compared t o t h e  i n order t o g a i n the c l e a r e s t p o s s i b l e p i c t u r e o f  each c o - r e s e a r c h e r ' s experiences.  The r e s e a r c h e r performed  a n a l y s i s o f the data a c c o r d i n g t o the procedure  d e s c r i b e d on  page 55 o f t h i s t h e s i s . S e l e c t i o n o f Co-Researchers Selection  Criteria  In o r d e r t o q u a l i f y f o r p a r t i c i p a t i o n i n t h i s study,  each  c o - r e s e a r c h e r had t o meet s e v e r a l c r i t e r i a , t h e f i r s t  being  a DSM IV (APA,  by t h e  1994) d i a g n o s i s o f PTSD, as determined  attending psychologist. was  The c r i t e r i o n o f a s i n g l e d i a g n o s i s  imposed t o l i m i t t h e number o f p o s s i b l e  v a r i a b l e s which a d i f f e r e n t i a l l y diagnosed  confounding  p o p u l a t i o n might  52  introduce.  As EMDR was o r i g i n a l l y developed  f o r , and t e s t e d  on, a PTSD p o p u l a t i o n (Shapiro, 1995), t h i s p o p u l a t i o n was chosen.  Second, c o - r e s e a r c h e r s were r e q u i r e d t o be w i l l i n g  t o have t h e i r i n i t i a l EMDR s e s s i o n audio-taped by t h e p a r t i c i p a t i n g p s y c h o l o g i s t , and t o be i n t e r v i e w e d by t h e r e s e a r c h e r w i t h i n 48 hours o f i t s occurrence.  Third, co-  r e s e a r c h e r s were r e q u i r e d t o possess s u f f i c i e n t v e r b a l s k i l l s t o adequately communicate t h e i r e x p e r i e n c e s . r e s e a r c h e r s met these  A l l co-  criteria.  Demographic Information A l l c o - r e s e a r c h e r s were female, Caucasian, o f t h e middle c l a s s , and i n t h e i r e a r l y t h i r t i e s .  Two o f t h e t h r e e  were married, w i t h the t h i r d having been r e c e n t l y  separated  from her husband. Procedure Each c o - r e s e a r c h e r , having a l r e a d y e n t e r e d therapy f o r PTSD, was informed o f t h e study by h e r a t t e n d i n g psychologist. The consent form  (see Appendix A) r e q u i r e d f o r  p a r t i c i p a t i o n , f u l l y informed each o f t h e nature o f t h e study, and t h a t , should they decide n o t t o p a r t i c i p a t e , n e i t h e r t h e t h e r a p e u t i c agenda, nor r e l a t i o n s h i p , would be a f f e c t e d i n any way. Because t h e s t r u c t u r e o f t h e standard EMDR p r o t o c o l (Shapiro, 1995) r e q u i r e s the t h e r a p i s t t o f o l l o w each s e t w i t h a q u e s t i o n ( i . e . , "what d i d you g e t ? " ; 1995, p. 3 7 ) ; and r e q u i r e s t h e c l i e n t t o answer ( d e s c r i b e h e r e x p e r i e n c e ) ,  53  i t may be s a i d t o c o n s t i t u t e an i n t e r v i e w . audiotaped  Hence, t h e  EMDR s e s s i o n i s here termed t h e " i n - s e s s i o n  interview."  T h i s was f o l l o w e d by t h e " c l a r i f i c a t i o n  i n t e r v i e w , " d u r i n g which the r e s e a r c h e r i n t e r v i e w e d t h e c o r e s e a r c h e r about h e r moment-to-moment e x p e r i e n c e s , p l a y i n g h e r a tape r e c o r d i n g o f t h e f i r s t memory.  while  s e s s i o n t o cue h e r  T h i s second i n t e r v i e w was a l s o audio-taped.  Each  i n t e r v i e w was conducted w i t h i n 48 hours o f t h e i n i t i a l EMDR s e s s i o n , w i t h t h e exception o f t h e i n t e r v i e w w i t h o c c u r r e d a f t e r an i n t e r v a l o f approximately  "C," which  72 hours, due t o  l o g i s t i c a l problems. The  EMDR In-Session  Interview  Treatment was conducted e x a c t l y as i t would have been under non-research circumstances, s e s s i o n was audio-taped  except t h a t t h e e n t i r e  by the p s y c h o l o g i s t , w i t h t h e  awareness and approval o f t h e c o - r e s e a r c h e r . was p l a c e d between t h e t h e r a p i s t and c l i e n t ,  A microphone i n order t o  r e c o r d both o f t h e i r v o i c e s ; and t h e c l i e n t was a l e r t e d when a c t u a l t a p i n g began and ended. The The  Clarification  Interview  second i n t e r v i e w was conducted t o c l a r i f y  i n f o r m a t i o n gathered  from t h e f i r s t .  F o l l o w i n g the EMDR s e s s i o n , t h e p a r t i c i p a t i n g p s y c h o l o g i s t telephoned  the r e s e a r c h e r t o c o n f i r m t h a t a  s e s s i o n had taken p l a c e , and t o p r o v i d e i n f o r m a t i o n about how t o c o n t a c t t h e co-researcher. c o n t a c t e d t h e co-researcher,  V  The r e s e a r c h e r  and scheduled  then  an appointment  54  for  the c l a r i f i c a t i o n interview. Each c o - r e s e a r c h e r was encouraged t o choose a meeting  p l a c e i n which she would f e e l comfortable, under t h e c o n d i t i o n t h a t i t be p r i v a t e enough t o a l l o w f o r u n d i s r u p t e d play-back  and d i s c u s s i o n o f t h e audio-tape r e c o r d i n g .  Co-researcher  "A" was i n t e r v i e w e d a t h e r home; "B," a t  a l o c a l beach o f h e r choosing; and "C," a t t h e home o f t h e researcher. The r e s e a r c h e r began the i n t e r v i e w by r e q u e s t i n g (a) p a r t i c u l a r demographic i n f o r m a t i o n ; (b) i n f o r m a t i o n about the nature o f t h e trauma experienced;  (c) post-trauma  symptoms; (d) i n f o r m a t i o n about c u r r e n t m e d i c a t i o n s  used;  (e) p o s t - s e s s i o n c o n d i t i o n o r e x p e r i e n c e s ; and ( f ) any comments, o f any s o r t , t h e c o - r e s e a r c h e r might l i k e t o make about h e r EMDR experiences. The r e s e a r c h e r then presented a t r a n s c r i p t o f t h e EMDR s e s s i o n t o the p a r t i c i p a n t , and began play-back audio-tape.  of the  Both r e s e a r c h e r and c o - r e s e a r c h e r had t h e  o p p o r t u n i t y t o stop play-back  a t any time,  i n order t o ask  q u e s t i o n s , comment o r e l a b o r a t e upon what was b e i n g  heard.  The r e s e a r c h e r asked mostly open-ended q u e s t i o n s ,  such  as, " c o u l d you t e l l me what was happening here?" o r " c o u l d you t e l l me more about t h a t ? " as w e l l as more s p e c i f i c questions relevant t o p a r t i c u l a r co-researcher Due  experiences.  t o r e l a t i v e inexperience, during the f i r s t  i n t e r v i e w w i t h co-researcher "A," t h e r e s e a r c h e r asked more p o i n t e d q u e s t i o n s than, i n r e t r o s p e c t , seems d e s i r a b l e .  55  However, as i n f o r m a t i o n gleaned was used t o c l a r i f y t h e f i r s t ,  from the second i n t e r v i e w i t d i d not prove d e t r i m e n t a l  t o t h e i n t e g r i t y o f t h e study. A n a l y s i s o f t h e Data F o l l o w i n g the verbatim t r a n s c r i p t i o n o f t h e c l a r i f i c a t i o n i n t e r v i e w , t r a n s c r i p t i o n s were a n a l y z e d phenomenologically,  beginning with a v a r i a t i o n o f t h e  r e s e a r c h p r o t o c o l o u t l i n e d by C o l a i z z i  (1978).  Each i n - s e s s i o n t r a n s c r i p t was read s e v e r a l times i n o r d e r f o r t h e r e s e a r c h e r t o g e t a g e n e r a l f e e l i n g f o r each c o - r e s e a r c h e r ' s o v e r a l l EMDR experience  ( C o l a i z z i , p. 59) .  F o l l o w i n g t h i s , t h e i n - s e s s i o n t r a n s c r i p t s were c l a r i f i e d through examination transcripts.  of the " c l a r i f i c a t i o n  interview"  Because, each co-researcher had, by t h i s  p o i n t , o f f e r e d two accounts  o f h e r EMDR e x p e r i e n c e s ,  little  i n f e r e n c e was r e q u i r e d by the r e s e a r c h e r . Once e s t a b l i s h e d , "moments o f meaning" were p l a c e d on a time l i n e — a  s t r a i g h t l i n e d i v i d e d i n t o even segments  i n d i c a t i n g movement through time.  T h e r a p i s t involvement  was  a l s o t r a c k e d and p l a c e d a t the a p p r o p r i a t e p l a c e s on t h e line.  The purpose o f t h i s was f o r t h e r e s e a r c h e r t o g a i n a  b e t t e r sense o f t h e o v e r a l l p a t t e r n s o f experience, between, and among, t h e t h r e e c o - r e s e a r c h e r s . t h a t were immediately  both  Categories  e v i d e n t , such as p h y s i c a l s e n s a t i o n s ,  emotions, and c o g n i t i v e experiences were colour-coded, t o make them more r e a d i l y d i s c e r n i b l e t o t h e eye.  56  F o l l o w i n g t h i s , t h e l a b o r i o u s process o f r e f i n i n g and c a t e g o r i z i n g t h e meaning o f a l l experiences began. elements,  as mentioned, seemed t o l e n d themselves  Some readily to  c a t e g o r i z a t i o n ; o t h e r s remained u n c a t e g o r i z e d u n t i l a c o n c e p t u a l framework was d i s c o v e r e d w i t h i n which they c o u l d be understood.  D e s c r i p t i o n s which appeared  superficially  redundant were e l i m i n a t e d i n favour o f a deeper commonality. For example, many o f t h e p h y s i c a l s e n s a t i o n s e x p e r i e n c e d by the c o - r e s e a r c h e r s i n v o l v e d t h e common theme o f t i g h t e n i n g of  t h e musculature;  merely  others, loosening.  Hence, r a t h e r than  l i s t i n g a l l such experiences t a x o n o m i c a l l y , those  such as "knot i n t h e stomach," o r " t e n s i o n i n t h e s h o u l d e r s " were p l a c e d i n one category; and those d e n o t i n g a l o o s e n i n g or  disappearance  o f such s e n s a t i o n s , under  another.  E v e n t u a l l y , these became p a r t o f t h e dimension  of experience  e n t i t l e d "heightened p h y s i c a l awareness." In  s h o r t , p r o g r e s s i v e attempts were made, through  l a b o r i o u s and methodical contemplation, q u e s t i o n i n g , and t r i a l and e r r o r , t o achieve a f i t t i n g o r g a n i z a t i o n o f c o r e s e a r c h e r s ' experience. Once completed,  t r a n s c r i p t s were r e - r e a d s e v e r a l times  i n l i g h t o f t h e above c a t e g o r i e s , t o check f o r i n c o n s i s t e n c i e s , e r r o r s or o v e r s i g h t s .  57  CHAPTER FOUR: RESULTS C a t e g o r i e s of Experience Using the above methodology, i t was  found t h a t  r e s e a r c h e r s ' experiences c o u l d be grouped i n t o one broad c a t e g o r i e s :  coof  three  P a r t i c i p a n t Experiences. S p e c t a t o r  E x p e r i e n c e s or Treatment S p e c i f i c E f f e c t s . P a r t i c i p a n t and Participant  Spectator E x p e r i e n c e s  Experiences  A c c o r d i n g t o Cochran (1990), i n d i v i d u a l s can l i f e ' s dramas from the p e r s p e c t i v e or S p e c t a t o r  of e i t h e r a  experience Participant  ( a l s o see B r i t t o n , 1970).  In the r o l e of a P a r t i c i p a n t , an i n d i v i d u a l i s a c t i v e l y engaged w i t h the a f f a i r s and  events of the world; and  focus  i s l i m i t e d t o the present moment. Cochran (1990) w r i t e s  [The  P a r t i c i p a n t ] decides, p l a n s , a c t s , and  a l l from the  l i m i t e d perspective  an a c t i v e p a r t (p. 46;  my  i n the  of one  evaluates,  who  is  immediate s i t u a t i o n  taking  . . . "  emphasis).  For the PTSD v i c t i m , the P a r t i c i p a n t r o l e emphasizes the  i n d i v i d u a l ' s involuntary  r e - e x p e r i e n c i n g of  the  immediate s i t u a t i o n of trauma from what i s h i s or extremely l i m i t e d p e r s p e c t i v e ;  although l a c k i n g may  same degree of i n t e n s i t y experienced d u r i n g the  her be  the  original  58  t r a u m a t i c event  ( p o s s i b l y due t o t h e d u a l focus o f p a s t and  p r e s e n t ; Shapiro, 1995, p. 90). As a l r e a d y s t a t e d , some of t h e c a r d i n a l symptoms o f PTSD i n c l u d e the i n t r u s i v e r e l i v i n g o f , o r p r e o c c u p a t i o n w i t h , p a r t i c u l a r aspects o f t h e t r a u m a t i c event The v i c t i m ' s nightmares,  (APA, 1994).  f l a s h b a c k s , a n x i e t y and r e a c t i o n s  t o otherwise n e u t r a l o b j e c t s o r events which have become emotional  " t r i g g e r s " f o r the v i c t i m , suggest he o r she s t i l l  experiences c o n t i n u a l l y — o r a t l e a s t  re-experiences  c o n t i n u o u s l y — t h e "immediate s i t u a t i o n " o f h e r t r a u m a t i c event. The c o n s t r i c t i v e PTSD symptoms (APA, 1994) a r e m i r r o r e d by t h e P a r t i c i p a n t ' s l i m i t e d emotional and c o g n i t i v e movement—her i n a b i l i t y t o see from a n y t h i n g but h e r "limited perspective."  As an u n w i l l i n g p l a y e r i n an  u n f o l d i n g drama, she can g a i n no i n s i g h t i n t o t h e nature o r s i g n i f i c a n c e o f her drama, any more than a n o v i c e a c t o r c o u l d g a i n a broad p e r s p e c t i v e on the h i s t o r i c a l o r a r t i s t i c s i g n i f i c a n c e o f a p l a y i n which she p a r t i c i p a t e s merely from r e a d i n g her l i n e s .  To a c q u i r e such a p e r s p e c t i v e , some  distance i s required. Spectator  The d i s t a n c e o f a S p e c t a t o r .  Experiences  Whereas t h e P a r t i c i p a n t i s engaged, o r caught-up i n t h e a c t i o n o f an event, and thereby l i m i t e d i n breadth o f her p e r s p e c t i v e , the Spectator enjoys a freedom o f mental movement not a f f o r d e d the P a r t i c i p a n t .  The S p e c t a t o r can  " p l a y " and be c r e a t i v e w i t h ideas i n t e g r a l o r p e r i p h e r a l t o  59  the a c t i o n s of "the p l a y e r . "  That i s , she  i s able to  see  h e r s e l f and her a c t i o n s c o n s i d e r a b l y more o b j e c t i v e l y than she can as a P a r t i c i p a n t . As a Spectator  she i s f r e e r than as a P a r t i c i p a n t t o  experiment with or manipulate her thoughts and her mind, she may experience;  t u r n over the o r i g i n a l shape of  In  her  t o s s i t about; reshape i t ; or juxtapose i t t o ,  or j o i n i t with, Spectator  feelings.  can  other "shapes" of experience.  " i m a g i n a t i v e l y re-enact  i n t e r p r e t i n g , adjusting expectation,  the  The  experience,  altering  vision,  s a v o r i n g p o t e n t i a l , and g a i n i n g i n s i g h t s " (Cochran, p. Through such manipulations,  the  Spectator's  r e l a t i o n s h i p t o the problem or event changes, and her concomitant f e e l i n g s and r e a c t i o n s .  . . . as a p a r t i c i p a n t , one  misery, and hardship, participant.  We  too,  Cochran w r i t e s  as  . . . f i n d i t to  can laugh a t our own  be  folly,  but not o r d i n a r i l y as a  S i m i l a r l y , we  can be saddened by our  g a i e t y , exuberance, or venturesomeness, but o r d i n a r i l y as a p a r t i c i p a n t .  We  own  not  need p e r s p e c t i v e t o  t h i s , and breadth of p e r s p e c t i v e i s what the r o l e o f f e r s (p.  so  c o u l d be t e r r i f i e d , y e t  a s p e c t a t o r upon one's experience, extremely humorous.  47).  do  spectator  46).  From a n a r r a t i v e p o i n t of view, t h i s "breadth of p e r s p e c t i v e " i n v o l v e s the v i c t i m ' s c o n t e x t u a l i z a t i o n of  her  60  t r a u m a t i c memory. "prenarrative, and  No longer a f r o z e n ,  (Herman, 1992,  11  wordless  p. 36), i t becomes a s t o r y ;  i n the p r o c e s s , imbued w i t h meaning.  Conceptually,  the  c o - r e s e a r c h e r i s a b l e t o separate the author from t h e a c t o r ; t h a t i s , the I, or witness, from the Me,  or  witnessed.  Hermans and Hermans-Jansen (1995) w r i t e t h a t , as a S p e c t a t o r , or I, the c o - r e s e a r c h e r  i s a b l e t o d e s c r i b e . . . h e r s e l f as an a c t o r .  In t h i s  c o n f i g u r a t i o n , the I can i m a g i n a t i v e l y c o n s t r u c t a s t o r y w i t h the Me as the p r o t a g o n i s t . . . .  Such  n a r r a t i v e c o n s t r u c t i o n i s p o s s i b l e because t h e I can imagine the Me i n the p a s t  i n the f u t u r e and can r e c o n s t r u c t the  Me  (p. 8 ) .  Inherent  i n the s t r u c t u r e of the new  wordless  r u b b l e of the v i c t i m ' s " s h a t t e r e d assumptions," are  the p i l l a r s and beams of a new, which can now information  s t o r y , b u i l t from the  more a p p r o p r i a t e paradigm,  house the i n t e g r a t e d t r a u m a - r e l a t e d  ( B r i t t o n , 1970;  Horowitz,  1976;  Janoff-Bulman,  1992) . Treatment S p e c i f i c  Effects  Treatment s p e c i f i c e f f e c t s are experiences which belong t o n e i t h e r the c l a s s i f i c a t i o n of S p e c t a t o r nor  Participant  (although they can occur simultaneously w i t h e i t h e r of these experiences). the treatment  They are, as the name suggests, p a r t i c u l a r t o itself,  and would not, i n a l l l i k e l i h o o d ,  be  61  o c c u r r i n g , were i t not f o r the s u b j e c t ' s undergoing  EMDR.  T h i s i s n o t t o say t h a t each such e f f e c t i s n e c e s s a r i l y e x c l u s i v e t o EMDR, i n t h a t i t c o u l d not, o r does not, d u r i n g o t h e r p s y c h o t h e r a p e u t i c procedures.  Rather,  it is  the frequency and context i n which these e x p e r i e n c e s which i d e n t i f y them as EMDR Treatment S p e c i f i c  occur  occur  Effects.  Such experiences have both p h y s i c a l and c o g n i t i v e manifestations. Dimensions o f Co-researchers'  Experiences  The c a t e g o r i e s o f P a r t i c i p a n t Experiences,  Spectator  E x p e r i e n c e s and Treatment S p e c i f i c E f f e c t s were found t o c o n t a i n a t o t a l o f 12 s u b c a t e g o r i e s , o r dimensions, r e s e a r c h e r s ' experiences.  Some dimensions  of co-  c o n t a i n items  which arguably would be a p p r o p r i a t e f o r more than one subcategory.  I n such cases, the r e s e a r c h e r has chosen what  he b e l i e v e s t o be the most a p p r o p r i a t e subcategory particular  for the  item. Participant  Experiences  W i t h i n the category o f P a r t i c i p a n t E x p e r i e n c e s , t h e f o l l o w i n g f o u r dimensions  o f experience were i d e n t i f i e d :  (a) p a s s i v e endurance o f trauma; (b) narrowness o f perspective; of  (c)  immediacy o f f o c a l image; and (d) i n t e n s i t y  ( r e l i v e d ) emotion;  P a s s i v e Endurance o f Trauma T h i s category emphasizes the c o - r e s e a r c h e r ' s p a s s i v e r e l a t i o n s h i p t o her i n t r u s i v e re-experiencing.  Lacking i s a  sense o f agency t o a c t upon her remembered e x p e r i e n c e s —  62  whether p h y s i c a l , emotional, she  c o g n i t i v e or v i s u a l .  i s as i f t h e i r p a s s i v e instrument,  Hence,  used a t t h e i r  will.  Narrowness of P e r s p e c t i v e Awareness i s l i m i t e d t o the  co-researcher's  r e c o l l e c t i o n s or r e l i v i n g of the o r i g i n a l  traumatic  e x p e r i e n c e ( s ) , i n c l u d i n g emotions, c o g n i t i o n s , p h y s i c a l s e n s a t i o n s and unintegrated  images.  i n f o r m a t i o n remains  i n t o a broader p e r s p e c t i v e or c o n t e x t .  event i s experienced As the Me  The traumatic  through the c o - r e s e a r c h e r ' s  "own  has not y e t emerged, she remains unable t o  The eyes." see  h e r s e l f i n the p i c t u r e . Immediacy of F o c a l Image The  " f o c a l image," (the p i c t u r e imagined by the  researcher)  appears r e l a t i v e l y c l e a r , v i v i d , and  proximity.  The  co-researcher  may  co-  close in  remember f o r g o t t e n d e t a i l s  of the image, such as a person's c l o t h i n g or h a i r c o l o u r , if  l o o k i n g a t a photograph or watching a f i l m .  nature  of the new  co-researcher's  However, the  d e t a i l e d i n f o r m a t i o n does not broaden the  p e r s p e c t i v e , and does not l e a d t o a  c o g n i t i v e or conceptual One  as  s h i f t i n r e l a t i o n t o the trauma.  i s not l o o k i n g a t a new  photograph, taken from a  d i f f e r e n t p e r s p e c t i v e , as i t were, but simply n o t i c i n g the f o r g o t t e n d e t a i l of a f a m i l i a r photograph. Co-researcher  "C" d e s c r i b e d her experience  I remember . . . e v e r y t h i n g around me, her g o l d e a r r i n g s , what her f a c e looked  the  this  way:  detail,  l i k e , what the  63  people looked l i k e .  I probably d i d n ' t remember i t so  i n t e n s e l y or so w e l l u n t i l I was  doing  [the t r e a t m e n t ] .  I n t e n s i t y of Emotion The c o - r e s e a r c h e r r e - e x p e r i e n c e s the emotions p r e s e n t at  the time of t r a u m a t i z a t i o n .  Although t h i s  i n v o l v e s f e a r , other r e l i v e d emotions may  primarily  a l s o be p r e s e n t .  For example, "C" r e - e x p e r i e n c e d the g u i l t she had r e a l i z i n g she might have caused an automobile  f e l t upon  a c c i d e n t ; and  she a g a i n experienced the anger she had f e l t when a woman a t the a c c i d e n t scene became h y s t e r i c a l . Whatever the emotion experienced by c o - r e s e a r c h e r s , the l e v e l of emotional i n t e n s i t y i s h i g h (although not n e c e s s a r i l y as h i g h as d u r i n g the o r i g i n a l e v e n t ) . Concomitant p h y s i c a l m a n i f e s t a t i o n s (Treatment E f f e c t s ) , i n v o l v e t i g h t e n i n g of the musculature,  Specific (such as a  knot i n the stomach; t i g h t shoulders; d i f f i c u l t y b r e a t h i n g ; nausea; as w e l l as " f i g h t or f l i g h t "  tingling).  Spectator Experiences T h i s category c o n t a i n s f o u r dimensions (a) a c t i v e a l t e r a t i o n of experience;  of e x p e r i e n c e :  (b) broadening  perspective;  (c) d i s t a n c i n g of f o c a l image; and  of  experience.  emotional  of  (d) v a r i e t y  A c t i v e A l t e r a t i o n of Experience Whereas the P a r t i c i p a n t i s the p a s s i v e instrument her t r a u m a t i c r e - e x p e r i e n c i n g , the S p e c t a t o r becomes an agent,  a c t i n g upon the trauma-related i n f o r m a t i o n , and  of  64  p u t t i n g i t i n t o a l a r g e r context.  However, a paradox  e x i s t s ; f o r t h e c o - r e s e a r c h e r i s not a w i l l f u l agent o f these p r o c e s s e s , but i r o n i c a l l y , a p a s s i v e one, i n much t h e same way a dreamer i s both t h e agent and instrument  of h i s  or h e r own dream. For example, when "B" imagines h e r s e l f a t t a c k i n g her assailant i n a role reversal  (suggesting agency),  drama o f revenge appears t o her spontaneously, willfully.  this  brief  but n o t  She regards i t with as much d e l i g h t and s u r p r i s e  as i f watching f i r s t time.  a c l e v e r t e l e v i s i o n advertisement  Although  f o r the  a t one l e v e l , her " m i n d " — i n t h e  broadest s e n s e — i s a c t i v e l y engaged i n t h e p r o c e s s o f understanding  and i n t e g r a t i n g d i s t u r b i n g , n o v e l i n f o r m a t i o n ,  her "ego," o r sense o f " I " i s p a s s i v e l y e x p e r i e n c i n g i t . F a n t a s i e s o r memories may a r i s e ; o r t h e c o n t e n t o f t h e f o c a l image may spontaneously whole o r i n p a r t .  change, o r "morph," e i t h e r i n  For example, a h i s t o r i c a l l y  accurate  f a c i a l e x p r e s s i o n , such as one e x p r e s s i n g f e a r , may change t o one t h a t i s calm and s m i l i n g . Broadening  of Perspective  The c o - r e s e a r c h e r begins t o move o u t s i d e t h e narrow s p o t l i g h t o f her trauma.  No longer t h e a c t o r , c o m p u l s i v e l y  r e p l a y i n g her traumatic scene,  she becomes an audience  member—a S p e c t a t o r — a b l e t o muse and p h i l o s o p h i z e about t h e drama i n g e n e r a l , and the s i g n i f i c a n c e o f t h e v a r i o u s players' roles within i t .  From v a r i o u s new p e r s p e c t i v e s ,  she c r i t i q u e s and e v a l u a t e s the drama i n ways she c o u l d n o t  65  as a P a r t i c i p a n t - A c t o r who p r a c t i c a l terms, she may  lacked r e l a t i v e o b j e c t i v i t y .  see h e r s e l f i n the p i c t u r e f o r the  f i r s t time, as i f a t h i r d p a r t y watching distance.  She may  the i n c i d e n t from a  experience i n s i g h t , or a c o g n i t i v e s h i f t ,  i d e n t i f y i n g w i t h o t h e r s who may  In  have s u f f e r e d s i m i l a r l y .  Or  she  f e e l compassion f o r her a s s a i l a n t .  D i s t a n c i n g of the F o c a l Image The q u a l i t y of the f o c a l image i s d i m i n i s h e d , as i f the c o - r e s e a r c h e r i s h e r s e l f becoming e m o t i o n a l l y d i s t a n t t h e event.  from  L o s t i s the " l i v i n g " v i v i d n e s s found i n the  P a r t i c i p a n t experience of the f o c a l image. appear faded; may  The  image  may  a l t e r n a t e between being c l e a r or c l o s e ,  and being d i s t a n t or faded; may a f l a s h ; or not appear a t a l l ,  appear momentarily, as i f i n d e s p i t e the c o - r e s e a r c h e r ' s  e f f o r t to retrieve i t . V a r i e t y of Emotional  Experience  Whereas h i g h i n t e n s i t y of r e l i v e d emotions c h a r a c t e r i z e s P a r t i c i p a n t experiences, g r e a t e r v a r i e t y both i n t e n s i t y  (of  [high and low] and type) d e f i n e s those of the  Spectator. The c o - r e s e a r c h e r i s a b l e t o s t e p o u t s i d e the narrow s p o t l i g h t of trauma-related f e e l i n g s , a l l o w i n g f o r emotions t o emerge.  She may  new  g r i e v e t h a t which i s l o s t ;  feel  rage a t an a s s a i l a n t f o r the i n j u s t i c e of an a s s a u l t ; or f e e l a sense of j o y or euphoria a t the absence of d i s t u r b i n g emotions and c o g n i t i o n s .  Lacking are the emotions  experienced during traumatization.  66  Whereas P a r t i c i p a n t emotional e x p e r i e n c e s a r e accompanied by a t i g h t e n i n g o f t h e musculature,  emotions i n  the S p e c t a t o r category tend t o be accompanied by a l o o s e n i n g ; by a l t e r n a t i n g t i g h t e n i n g and l o o s e n i n g ; o r by s h i f t s i n the l o c a t i o n of physical sensations. Treatment S p e c i f i c Four dimensions  Effects  o f experience were i d e n t i f i e d :  momentary c o g n i t i v e impairment; (b) heightened awareness; (c) change i n energy  (a)  physical  l e v e l ; and (d) meta  awareness o f t h e process. Momentary C o g n i t i v e Impairment In t h i s dimension  of experience, t h e c o - r e s e a r c h e r  undergoes a momentary a l t e r a t i o n o f h e r more f a m i l i a r cognitive state.  For example, t h e speed a t which she  p r o c e s s e s m a t e r i a l may seem g r e a t l y a c c e l e r a t e d ; s e v e r a l o r many thoughts may " r a c e " through h e r mind, t o t h e p o i n t where she can o n l y r e t a i n a f r a c t i o n o f t h e i r c o n t e n t i n memory.  She may a l s o experience a momentary, g e n e r a l  c o n f u s i o n , o r s l i g h t d i s o r i e n t a t i o n , as i f m i l d l y intoxicated.  For example, one c o - r e s e a r c h e r f e l t as i f  drugged on morphine o r Valium. Heightened  P h y s i c a l Sensations  Co-researchers experiences p h y s i c a l s e n s a t i o n s o f v a r y i n g i n t e n s i t y and type.  These s e n s a t i o n s do n o t remain  c o n s t a n t , but s h i f t a t v a r i o u s times throughout t h e treatment s e s s i o n .  67  When o c c u r r i n g w i t h P a r t i c i p a n t E x p e r i e n c e s ,  these  p h y s i c a l experiences tend t o i n v o l v e a t i g h t e n i n g of the musculature  ( t e n s i o n i n the  stomach; nausea), p a i n f u l emotions. musculature  shoulder area; a "knot" i n the  as i f the c o - r e s e a r c h e r were r e s i s t i n g Conversely, as a S p e c t a t o r , the  tends t o loosen and r e l a x , as one might  g i v e n t h a t the c o - r e s e a r c h e r has, by d e f i n i t i o n ,  expect,  gained  emotional d i s t a n c e from the p e r c e i v e d t r a u m a t i c t h r e a t . degree of t e n s i o n may i t s location.  change throughout  The c o - r e s e a r c h e r may  the s e s s i o n ; as  The may  f e e l warmer, or  e x p e r i e n c e t i n g l i n g , as i f i n " f i g h t or f l i g h t "  response  mode. Change i n Energy L e v e l The c o - r e s e a r c h e r may  f e e l f a t i g u e d or e n e r g i z e d a t  v a r i o u s times d u r i n g the treatment a l t e r n a t e l y f a t i g u e d and e n e r g i z e d . l e v e l may felt  s e s s i o n , or may  feel  T h i s change i n energy  be g e n e r a l , and i n c l u d e the e n t i r e body, or may  be  i n o n l y one s p e c i f i c l o c a t i o n , such as one s i d e of the  skull. Meta Awareness of the Process In t h i s dimension watches her own about i t .  of experience, the c o - r e s e a r c h e r  experience and has f e e l i n g s or  For example, i f she experiences her mind as  r a c i n g , she may  be s u r p r i s e d a t t h i s p r o c e s s , wonder i f i t  s h o u l d be o c c u r r i n g , and worry about i t . unexpected  thoughts  absence of f e a r may  i s b l o c k i n g her f e e l i n g s .  Or the sudden,  l e a d her t o s u s p e c t t h a t she  She may  wonder how  her  dramatic  68  c o g n i t i v e and emotional changes c o u l d be o c c u r r i n g ; t h a t i s , she may ask h e r s e l f , as one c o - r e s e a r c h e r d i d , what n e u r o b i o l o g i c a l changes are t a k i n g p l a c e i n the moment, t o f a c i l i t a t e such unexpected thoughts her  changes.  She may a l s o  experience  and f e e l i n g s about the t h e r a p i s t , i n r e l a t i o n t o  treatment. Co-Researchers'  Experiences  In o r d e r , t o h e l p the reader b e t t e r understand c o r e s e a r c h e r s ' i n - s e s s i o n EMDR experiences, a b r i e f of pre-treatment  synopsis  c o n d i t i o n , as w e l l as t h e nature and o r i g i n  of t h e t r a u m a t i c experiences, i s p r o v i d e d i n the f o l l o w i n g section. Co-Researcher "A" While working as a c a s h i e r a t a l i q u o r s t o r e 27 months p r i o r t o treatment,  "A" was robbed by two men wearing s k i  masks, one o f whom c a r r i e d a shot gun. "A"  The armed man, whom  d e s c r i b e d as " c r a z y , " removed h i s mask, s t a r t e d  kicking  the counter, and put h i s gun t o the back o f h e r head. Terrified,  "A" r e f u s e d t o look a t e i t h e r o f the men,  c h o o s i n g i n s t e a d t o stand "scrunched up" w i t h h e r eyes c l o s e d and f i s t s clenched; b e l i e v i n g t h a t , a t any moment, the " c r a z y " gunman would p u l l the t r i g g e r and k i l l  her.  Nineteen months l a t e r , w h i l e "A" was working i n t h e same s t o r e , a man entered, c a r r y i n g a l a r g e k n i f e i n t h e back o f h i s pants.  Again understandably  terrified,  "A" had  t o serve him a f t e r he began t o "scream" f o r s e r v i c e . Although no robbery o r a s s a u l t ensued, h e r p r e v i o u s a s s a u l t  69  had  l e f t her s e n s i t i z e d t o the p o s s i b i l i t y of danger,  and  she a f t e r w a r d found h e r s e l f "sobbing l i k e a baby." Her symptoms a f t e r the f i r s t trauma i n c l u d e d  nightmares  of b e i n g chased by loud people w i t h guns; and a f t e r second,  the  of being stabbed and s l i c e d by a s s a i l a n t s w i e l d i n g  knives.  The frequency of the nightmares  n i g h t s per week.  was  from 1 t o 3  F u r t h e r , she experienced f e a r a t work  whenever a customer entered.  Similar public  situations,  such as s t a n d i n g i n a bank l i n e - u p , a l s o evoked s t r o n g f e e l i n g s of a n x i e t y .  "A"  a l s o experienced  recurring  d e p r e s s i o n and anger t h a t "someone had taken away [her] life";  and her a n x i e t y profoundly a f f e c t e d her young  daughter,  who  subsequently became a f r a i d t o s l e e p a l o n e .  At the time of the c l a r i f i c a t i o n i n t e r v i e w , the coresearcher f e l t flu."  t i r e d , and s l i g h t l y i l l ,  as i f she had  "the  She d e s c r i b e d having had a dream i n which, f o r the  f i r s t time, she turned and a t t a c k e d her a t t a c k e r . EMDR Experiences of Co-Researcher Co-researcher  "A"  "A" manifested a c l e a r , unwavering  movement toward i n - s e s s i o n r e s o l u t i o n of her b a s e l i n e measures.  Quite l i t e r a l l y ,  her o n l y P a r t i c i p a n t  experiences  were those she brought with her i n t o the t h e r a p e u t i c s e s s i o n ( f e a r , narrow p e r s p e c t i v e of the event, p h y s i c a l t i g h t n e s s , etc.)  which ended d u r i n g the f i r s t s e t of eye movements.  In  o t h e r words, the f e a r , "knot" i n her stomach, and c l a r i t y of the d i s t u r b i n g f o c a l image, with which she began s t a r t e d t o d e t e r i o r a t e w i t h i n the f i r s t s e t of  treatment,  eye  70  movements.  H a l f way through the s e t , she began t o f e e l  " r e l a x e d " and "warm," as i f "wrapped i n a b l a n k e t , " which seemed t o p r o t e c t her from the a s s a i l a n t s who had, u n t i l t h i s p o i n t , been haunting her memory.  T h i s r e l i e f came w i t h  a momentary s e n s a t i o n of d i z z i n e s s , and s t a y e d w i t h her "throughout  the e n t i r e s e s s i o n . "  By the second s e t , her f e a r had s i g n i f i c a n t l y d i m i n i s h e d ; and by the t h i r d , the f o c a l image was more d i s t a n t , and f a d i n g i n and out.  As "A" d e s c r i b e d her  experience,  ...  I j u s t c o u l d n ' t b e l i e v e what was happening. . . .  I j u s t f e l t l i k e laughing. anymore.  I didn't f e e l frightened  I d i d n ' t f e e l anxious.  . . .  I t just  seemed  funny t o me.  The q u a l i t y of the f o c a l image continued t o d i m i n i s h , sometimes appearing and out.  Although  i n " f l a s h e s " ; a t other times,  fading i n  she o c c a s i o n a l l y saw seldom-remembered  a s p e c t s of the t r a u m a t i c event, t h i s new i n f o r m a t i o n was f l e e t i n g , and of a s u r r e a l q u a l i t y , evoking emotional response  i n her no  but a sense of r e l i e f , and t h e impulse t o  laugh. At times, d u r i n g the remaining  s e t s , no image appeared  t o her, o n l y the t h e r a p i s t ' s f i n g e r s :  71  I would j u s t see t h e f i n g e r s . on t h e f i n g e r s . hand. . . .  And I would c o n c e n t r a t e  And, you know, I saw h i s r i n g on h i s  The image j u s t disappeared.  I t was j u s t  gone.  When a f l e e t i n g , faded image would appear, she had d i f f i c u l t y remembering or f o c u s i n g on i t ,  "almost l i k e [the  event] d i d n ' t happen." S e v e r a l times t h e content o f t h e f o c a l image changed. For example, a t one p o i n t t h e a s s a i l a n t d i s a p p e a r e d from behind h e r ; a t another, t h e worried f a c e o f h e r co-worker took on a calm, s m i l i n g demeanor. A t times, "A" t r i e d t o f o r c e t h e o r i g i n a l f o c a l  image  t o mind, d e s p i t e t h e t h e r a p i s t ' s i n s t r u c t i o n s t o "go w i t h " whatever h e r experience happened t o be.  She a l s o became  p r e o c c u p i e d w i t h t h e p o s i t i v e changes which were o c c u r r i n g , and wondered about them. By t h e end o f t h e s e s s i o n , her SUDs l e v e l was a t 0, and her c o g n i t i v e a t t r i b u t i o n ,  "I f e e l s a f e ; he c a n ' t h u r t me";  r a t e d a 7 on t h e V a l i d i t y o f C o g n i t i o n s c a l e , i n d i c a t i n g t h e h i g h e s t measurable b e l i e f i n t h i s  attribution.  S e q u e n t i a l Experiences by Category In t h i s , and s i m i l a r s e c t i o n s t o f o l l o w , P a r t i c i p a n t Experiences  (PE), Spectator Experiences  Specific Effects  (SE), and Treatment  (TSE) a r e presented i n t h e sequence i n  which they o c c u r r e d .  C l a s s i f i c a t i o n and D e s c r i p t i o n o f Experience SE:  F e e l s s a f e , as i f wrapped i n a b l a n k e t .  TSE:  f e e l s d i z z y and warm  SE:  Decrease i n f e a r .  SE:  Image diminished;  comes and goes.  Sees  t h e r a p i s t ' s f i n g e r s i n s t e a d o f f o c a l image. SE:  Image faded; sees t h e r a p i s t ' s f i n g e r s .  TSE:  difficulty  SE:  Sees image without  concentrating. f e a r ; new  r e v e a l e d ; wants t o laugh; SE:  Sees image without  information  feels  relief.  f e a r ; content  o f image  changes. TSE:  Has d i f f i c u l t y b e l i e v i n g her e x p e r i e n c e .  SE:  Image diminished, image changes. f i r s t time.  comes and goes.  Content o f  Sees h e r s e l f i n image f o r  New i n f o r m a t i o n  revealed.  SE:  Wants t o laugh.  TSE:  Thinks urge t o laugh i s " s t r a n g e " ; has difficulty  SE:  concentrating.  Image i s reduced t o f l a s h e s .  New  information  revealed. SE:  F e e l s calm; sees a b r i e f p i c t u r e .  TSE:  Has d i f f i c u l t y b e l i e v i n g h e r e x p e r i e n c e ; wonders i f she i s " b l o c k i n g . "  73  Set  C l a s s i f i c a t i o n and D e s c r i p t i o n of  11:  SE:  Experience  Increased d i f f i c u l t y s e e i n g image; i n c r e a s e d relaxation.  TSE: Knot moved from stomach t o upper c h e s t ; f e e l s "drained." 12:  TSE: Knot disappeared; d i f f i c u l t y c o n c e n t r a t i n g .  13:  SE:  Cannot r e t r i e v e image; sees o n l y t h e r a p i s t ' s f i n g e r s ; f e e l s calm.  14:  SE:  F e e l s present and s a f e , without  fear.  TSE: Has d i f f i c u l t y b e l i e v i n g her EMDR e x p e r i e n c e . 15:  SE:  Sees h e r s e l f i n p i c t u r e , without f e a r ; wants to  laugh.  TSE: Wonders about the process  (how  i t works).  16:  SE:  No image; i n c i d e n t seems i n s i g n i f i c a n t .  17:  SE:  Sees b r i e f image; t r i e s ,  but cannot b r i n g t o  mind o r i g i n a l f o c a l image. 18:  SE:  Content of image changes, then image i s gone.  TSE: Wonders about the process  Summary of Experiences by  i t works).  Category  P a r t i c i p a n t experiences.  Co-researcher  P a r t i c i p a n t experiences which extended through the f i r s t s e t of  (how  "A"  beyond 1/2  had  no  way  saccades.  S p e c t a t o r experiences. 1. A c t i v e a l t e r a t i o n of experience: change i n content.  Aspects of f o c a l image  74  2.  Broadening of p e r s p e c t i v e :  (b) f e e l s p r e s e n t ; safe);  3.  (a) New  information  revealed;  (c) r e a l i z e s danger i s over (she i s  (d) sees h e r s e l f i n the p i c t u r e f o r the f i r s t  D i s t a n c i n g of f o c a l image:  (b) d i m i n i s h e s ; retrieve i t ) ;  The  time.  image (a) comes and  (c) does not appear ( d e s p i t e e f f o r t  goes;  to  (d) appears i n f l a s h e s ; (e) i s r e p l a c e d  by  therapist's fingers.  4.  V a r i e t y of emotional  experience.  decrease i n f e a r ; (c) d e s i r e t o  Treatment s p e c i f i c 1.  2.  (b)  laugh.  effects.  Momentary c o g n i t i v e impairment:  difficulty  (a) R e l i e f ;  (a) D i z z i n e s s ;  (b)  concentrating.  Heightened p h y s i c a l awareness:  (a) warmth; (b) t e n s i o n  m i g r a t e s upwards; (c) musculature loosens;  (d) t e n s i o n  disappears.  3.  Change i n energy l e v e l :  4.  Meta awareness of the process:  b e l i e v i n g her experience; wonders i f she experiences  Feels fatigued.  (a) Has  difficulty  (b) judges her urge t o laugh;  i s " b l o c k i n g " ; (d) wonders about how  are o c c u r r i n g .  her  (c)  75  Co-Researcher B The trauma h i s t o r y of "B" was, e x t e n s i v e and complicated  perhaps, the most  of the t h r e e  Eighteen months p r i o r t o treatment,  co-researchers. P a r t i c i p a n t "B"  been s e x u a l l y a s s a u l t e d w h i l e a p a t i e n t a t a l o c a l by a r a d i o g r a p h e r employed by the h o s p i t a l .  o c c u r r e d when she was at  thirteen.  the same h o s p i t a l , by a man  hospital,  T h i s was  second such a s s a u l t she had endured, the f i r s t  had  the  having  I r o n i c a l l y , both  occurred  of the same m i n o r i t y r a c e .  F u r t h e r adding t o her traumatized  s t a t e was  her  having  endured the l e g a l a r b i t r a t i o n of the second a s s a i l a n t , d u r i n g which i n f o r m a t i o n about the f i r s t a s s a u l t was  made  public. Approximately  s i x months p r i o r t o the second a s s a u l t ,  "B" had attempted t o become pregnant through fertilization. depression.  She  " l o s t the baby" and s u f f e r e d acute  Approximately  p a r t i c i p a n t and her husband To complicate matters, traumatic  invitro  one year a f t e r the a s s a u l t , the separated. there e x i s t e d other  repressed  i n f o r m a t i o n (revealed i n subsequent s e s s i o n s )  not  known t o c l i e n t or t h e r a p i s t d u r i n g the f i r s t EMDR s e s s i o n , which might have a f f e c t e d treatment. Her assault  symptoms i n c l u d e d i n t r u s i v e r e c o l l e c t i o n s o f the (a m e t a p h o r i c a l  image of the a s s a i l a n t c r a w l i n g  her back); severe d e p r e s s i o n and a n x i e t y ; d i m i n i s h e d  on  sexual  d e s i r e ; and d i f f i c u l t y m a i n t a i n i n g normal f r i e n d s h i p s .  Her  sense of t r u s t i n others had been s e v e r e l y i n j u r e d ; and  she  76  had been unable t o work f o r s e v e r a l months.  As "B"  s u c c i n c t l y s a i d o f t h e e f f e c t o f h e r second s e x u a l a s s a u l t : " I t j u s t b a s i c a l l y changed my e n t i r e  life."  At the time o f the c l a r i f i c a t i o n i n t e r v i e w "B" was p h y s i c a l l y exhausted, and appeared e m o t i o n a l l y f r a g i l e . EMDR E x p e r i e n c e s o f Co-Researcher "B" I f c o - r e s e a r c h e r "A" c o u l d be s a i d t o have moved more or l e s s s t e a d i l y down a g e n t l e s l o p e toward r e s o l u t i o n o f her t r a u m a t i c c o n d i t i o n , "B"'s t r a j e c t o r y was c l o s e r t o t h a t of a s h i p on stormy waters, as she was t o s s e d d r a m a t i c a l l y up and down through p r o f o u n d l y d i f f e r e n t emotional s t a t e s : Anger,  f e a r , sadness, j o y (euphoria), and g u i l t were a l l  experienced, as were the concomitant p h y s i c a l m a n i f e s t a t i o n s of nausea, t i g h t e n i n g and l o o s e n i n g o f the musculature, extreme f a t i g u e , r e j u v e n a t i o n , t i n g l i n g , and the e x p e r i e n c e of f e e l i n g as i f she were drugged on Valium, a m e d i c a t i o n w i t h which she was f a m i l i a r . She has two P a r t i c i p a n t e x p e r i e n c e s , d u r i n g which she r e l i v e d the t r a u m a t i c i n c i d e n t .  I n the realm o f f a n t a s y ,  "B" imagines g a i n i n g revenge from the a s s a i l a n t through r o l e r e v e r s a l , v i o l e n c e and c o n v i c t i o n f o r h i s crime. i d e n t i f i e s with three f i c t i o n a l characters: literature  one from  (Hamlet, whom she sees as t r a g i c ) ; another from a  children's' story film  She  (a v e r y sad g i r l ) ; and f i n a l l y ,  (the p r o t a g o n i s t i n I t ' s a Wonderful L i f e ) .  one from During the  l a t t e r , she watches h e r s e l f watching the f i l m i n " r e a l time," a t a p o i n t when the p r o t a g o n i s t f i n d ' s h i s daughter  77  Zu Zu's  flower p e t a l s i n h i s pocket, and r e a l i z e he has  k i l l e d himself.  During the c l a r i f i c a t i o n i n t e r v i e w ,  r e a l i z e d the s i g n i f i c a n c e of t h i s f o r her:  She  had  s e v e r a l i n s i g h t s she d i s p l a y s , and her  new  not  "B"  s u r v i v e d , and not k i l l e d h e r s e l f . The  compassion f o r the a s s a i l a n t , suggest some working through of her trauma occurs; however, complete r e s o l u t i o n of  her  symptoms i s not reached. By the end  of her s e s s i o n , "B"  somewhat m e n t a l l y  disoriented.  i s exhausted,  Both t h e r a p i s t and  t h e r e i s more work t o be done i n f u t u r e s e s s i o n s . l e v e l , which began a t "between nine and t e n , " i s  and she  agree  Her  SUDs  now  "sevenish—eight." S e q u e n t i a l Experiences  by Category  Set  C l a s s i f i c a t i o n and D e s c r i p t i o n o f E x p e r i e n c e  01:  SE:  Anger.  02:  SE:  Anger.  TSE:  T i g h t chest; d i f f i c u l t y  PE:  R e l i v e s event; f e e l s  SE:  F e e l s enough d i s t a n c e f o r sadness.  TSE:  R e a l i z e s treatment i s working.  04:  SE:  R e l i e f she i s s a f e .  05:  SE:  Anger.  06:  SE:  Anger; sadness.  07:  SE:  Anger.  03:  breathing.  vulnerable.  78  C l a s s i f i c a t i o n and D e s c r i p t i o n o f SE:  Experience  Blank (no image); f a n t a s i z e s going t o s a f e place  (beach).  TSE:  F e e l s exhausted.  SE:  P o s i t i v e i n s i g h t ; b e l i e v e s she i s s t r o n g .  TSE:  F e e l s energized; body r e l a x e d ; f e e l s more i n c o n t r o l of body.  SE:  Revenge f a n t a s y  (assaulting assailant).  SE:  Revenge f a n t a s y  ( r o l e r e v e r s a l ) ; anger.  SE:  Blank (no image).  TSE:  F r u s t r a t i o n a t her p r o c e s s ; body r e l a x e d .  SE:  Profound sadness and g r i e f ; i d e n t i f i e s  with  sad g i r l i n c h i l d r e n ' s s t o r y . SE:  Too d i s t r a u g h t t o continue. comforts s e l f with  TSE:  Asks f o r break;  self-talk.  F e e l s n e g a t i v e l y e f f e c t e d by t h e r a p i s t ' s change i n d i r e c t i o n of f i n g e r movements.  SE:  Revenge f a n t a s y  ( a s s a i l a n t being  punished).  SE:  Revenge f a n t a s y  ( c o n t i n u a t i o n of above).  TSE:  Head f e e l s heavy ("as  i f on morphine.");  wonders about (neurophysiology  of)  process;  wonders i f she i s u p s e t t i n g t h e r a p i s t . TSE:  Right s i d e of " b r a i n " f e e l s  energized.  SE:  F e e l s euphoric; wants t o  TSE:  Feels fatigued.  SE:  Cannot r e t r i e v e image; imagines s a f e p l a c e .  laugh.  79  Set  C l a s s i f i c a t i o n and D e s c r i p t i o n o f  23:  SE:  Complete mental and emotional  Experience peace;  feels  "wrapped i n a cocoon." 24:  TSE:  Right s i d e of b r a i n f e e l s heavy; i n c r e a s e d p h y s i c a l awareness.  25:  TSE:  Tension migrated  from c h e s t t o s k u l l ;  feels  drugged, sleepy. 26:  TSE:  Fingers f e e l  27:  TSE:  Body r e l a x e d .  28:  TSE: Muscles t w i t c h i n g .  29:  TSE:  Sleepy;  tingly.  angry a t s e l f f o r being  t i g h t n e s s i n c r e a s e s and 30:  TSE:  sleepy;  decreases.  D i s l i k e s p e r c e i v e d change i n f i n g e r movements.  P e r c e i v e s t h e r a p i s t as r e l a x e d .  SE:  F a n t a s i z e d watching h e r s e l f watch a movie.  TSE:  F e l l s drugged and  32:  SE:  Wants t o be  33:  TSE:  F a t i g u e d ; i n c r e a s e d p h y s i c a l awareness.  34:  TSE:  P e r c e i v e s f i n g e r s as "Grim Reaper", p o i n t i n g .  35:  SE:  Blank.  TSE:  Right s i d e of b r a i n s t i l l  36:  SE:  Childhood  37:  SE:  Sadness; wants t o f e e l s a f e  TSE:  Nausea; f a t i g u e ; embarrassed a t own  38:  TSE:  T i g h t chest; d i f f i c u l t y  39:  TSE:  Tension;  40:  PE:  A n t i c i p a t e s traumatic  31:  relaxed.  alone.  f e e l s drugged.  memory of h i d i n g i n s a f e p l a c e . again.  breathing.  exhaustion. event.  process.  80  C l a s s i f i c a t i o n and D e s c r i p t i o n of  Experience  SE:  Anger.  SE:  Insight (into metaphorical f o c a l  SE:  S e l f blame (she c o u l d n ' t stop  image).  incident).  TSE: T i g h t c h e s t . SE:  Anger.  TSE: F e e l s t i n g l y SE:  ( f i g h t or f l i g h t  feeling).  Sadness; b e l i e v e s she i s h e l p l e s s .  TSE: T i g h t n e s s ; f a t i g u e ; no longer f e e l s drugged; needs t o r e s t ; wonders about p r o c e s s  (how i t  works). SE:  Compassion f o r a s s a i l a n t .  SE:  Despair a t r e c o v e r i n g ; vague f l a s h b a c k or f a n t a s y of a s t a l k e r .  SE:  Wonders why  i n c i d e n t happened.  PE:  R e l i v e s traumatic i n c i d e n t .  SE:  Anger.  TSE: R e l u c t a n t t o look l e f t SE:  ("too much pain.")  Despair she won't r e c o v e r ; i d e n t i f i e s w i t h tragic figure  (Hamlet).  SE:  Blank; wants s e s s i o n t o end.  TSE:  Exhaustion; nausea; t i g h t n e s s .  TSE: F a t i g u e . TSE: Mental c o n f u s i o n ; d i f f i c u l t y f o l l o w i n g f i n g e r s ; p r e s s u r e on c h e s t . SE:  Sadness f o r s e l f and  SE:  Thinks of s u i c i d e .  world.  81  Set  C l a s s i f i c a t i o n and D e s c r i p t i o n o f  Experience  58:  SE:  G u i l t f o r having d i s c l o s e d .  59  SE:  I n s i g h t ( i t was  60:  SE:  Increased anger; f r u s t r a t i o n a t l e n g t h of  good t o d i s c l o s e ) .  h e a l i n g process; two  insights  saved o t h e r s ; hasn't k i l l e d  (she may  have  herself).  61:  SE:  Anger.  62:  TSE: G r a t e f u l f o r t h e r a p i s t ' s comment.  63:  TSE:  Sees f i n g e r s as t o o l s t o r e c o v e r y .  64:  TSE:  Exhaustion; d i f f i c u l t y  65:  TSE:  Exhaustion.  66:  TSE: Thoughts about t h e r a p i s t and  67:  SE:  Wonders, "Why  me?";  articulating.  insight  process. (answers  own  question). TSE: Mental c o n f u s i o n and d i s o r g a n i z a t i o n . 68:  TSE:  Fatigue.  Summary of Experiences bv  Category  P a r t i c i p a n t experiences. 1. P a s s i v e endurance of trauma.  (a) R e l i v e s event;  (b)  p a s s i v e l y endures i n t r u s i v e r e - e x p e r i e n c i n g .  2. Narrowness of p e r s p e c t i v e .  Momentary awareness does not  extend beyond r e l i v e d experiences.  3. Immediacy of f o c a l Image.  Image appears  c l o s e and  real.  82  4. I n t e n s i t y of emotion.  Spectator  (a) Fear;  vulnerability.  Experiences.  1. A c t i v e a l t e r a t i o n of experience. (b) f a n t a s i z e s a p e a c e f u l p l a c e ; h e r s e l f watch a f i l m ; place;  (b)  (a) F a n t a s i z e s revenge;  (c) imagines watching  (d) has c h i l d h o o d memory of s a f e  (e) has vague f a n t a s y or f l a s h b a c k of a s t a l k e r .  2. Broadening of p e r s p e c t i v e .  (a) B e l i e v e s she  i s safe;  f e e l s compassion f o r a s s a i l a n t ; (c) wonders why  incident  (b)  happened; (d) contemplates s u i c i d e ; (e) f e e l s g u i l t y f o r having  d i s c l o s e d ; (f) blames h e r s e l f ; (g) has p o s i t i v e  insights  ( i . e . , r e a l i z e s i t was  wonders, "why  me?";  good t o d i s c l o s e ) ;  ( i ) i d e n t i f i e s with v a r i o u s  (h)  fictional  characters.  3. D i s t a n c i n g of f o c a l image. (b) image comes as  flash.  4. V a r i e t y of emotions. profound g r i e f ; t o laugh;  (a) Cannot r e t r i e v e image;  (a) Anger; (b) sadness;  (d) r e l i e f ;  (g) d e s p a i r a t  Treatment s p e c i f i c  (e) j o y ( e u p h o r i a ) ;  (f) d e s i r e  recovery.  effects.  1. Momentary c o g n i t i v e impairment. mental c o n f u s i o n ;  (c)  (a) F e e l s drugged;  (c) d i f f i c u l t y f o l l o w i n g f i n g e r s ; (e)  d i f f i c u l t y a r t i c u l a t i n g her  experience.  (b)  83  2. Heightened  p h y s i c a l awareness.  (a) T i g h t c h e s t ; (b)  d i f f i c u l t y b r e a t h i n g ; (c) p r e s s u r e on c h e s t ; relaxed;  (d) f e e l s  (e) head f e e l s heavy; (f) r i g h t s i d e o n l y o f head  f e e l s heavy; (g) t e n s i o n moves from chest t o s k u l l ; (h) musculature  t i g h t e n s and loosens;  (i) f e e l s t i n g l y ; (j)  muscles t w i t c h .  3. Change i n energy l e v e l .  (a) F e e l s e n e r g i z e d ;  (b) f e e l s  exhausted; (c) r i g h t s i d e o f head f e e l s e n e r g i z e d ;  (d) f e e l s  sleepy.  4. Meta awareness o f process. working;  (a) R e a l i z e s treatment i s  (b) f r u s t r a t i o n a t h e r p r o c e s s ;  (c) concerned  with  d i r e c t i o n o f t h e r a p i s t ' s f i n g e r movements; (d) aware o f f e e l i n g r e l u c t a n t t o look l e f t ;  (e) angry a t s e l f f o r b e i n g  sleepy;  (f) embarrassed a t own p r o c e s s ;  process  (how i t works); (h) sees f i n g e r s as t o o l s t o  recovery;  (g) wonders about  ( i ) w o r r i e s how she i s a f f e c t i n g t h e r a p i s t ; ( j )  g r a t e f u l f o r t h e r a p i s t ' s comments. Co-Researcher "C" During an i c e storm, approximately f i r s t EMDR s e s s i o n , "C  11  6 weeks p r i o r t o h e r  had stopped her c a r i n o r d e r t o  a s s i s t a man and h i s daughter, f l a g g i n g her f o r a s s i s t a n c e .  whom she b e l i e v e d t o be  84  Immediately  p r i o r t o e x i t i n g h e r v e h i c l e , another c a r  c o l l i d e d w i t h h e r s , i n j u r i n g the man, and k i l l i n g h i s daughter. Although n o t i n j u r e d h e r s e l f , t h e c o - r e s e a r c h e r immediately began s u f f e r i n g emotional shock, w i t h which she coped by a t t e n d i n g t o the i n j u r e d p a r t i e s .  As she was a  nurse, and f a m i l i a r with emergency procedures, "C" attempted c h e s t compressions  on the i n j u r e d young woman, b u t  e v e n t u a l l y r e a l i z e d she c o u l d not save her. B e l i e v i n g she may have caused the a c c i d e n t by s t o p p i n g her c a r , "C" had s i n c e been plagued w i t h g u i l t and o b s e s s i v e t h i n k i n g about t h e a c c i d e n t .  E s p e c i a l l y t r o u b l i n g were  i n t r u s i v e images o f the v i c t i m s ' f a c e s , and v i o l e n t nightmares  i n v o l v i n g c a r crashes, s e r i a l k i l l e r s , and  dismembered people and animals. car  Although she had d r i v e n a  s i n c e t h e t r a u m a t i c event, i t was always w i t h a s t r o n g  sense o f t r e p i d a t i o n as she a n t i c i p a t e d another a c c i d e n t . P r i o r t o t h e EMDR s e s s i o n , she had d i f f i c u l t y s h a r i n g h e r f e e l i n g s about t h e event w i t h a l l accept h e r husband, who remained s u p p o r t i v e . At  t h e time o f t h e c l a r i f i c a t i o n i n t e r v i e w "C" f e l t  slightly tired.  She was c l e a r l y i n p h y s i c a l p a i n r e s u l t i n g  from her a c c i d e n t , and showed r e s t r a i n e d emotional vulnerability. EMDR Experiences o f Co-Researcher "C" Throughout  the g r e a t e r p a r t o f h e r EMDR s e s s i o n , "C"  r e - e x p e r i e n c e d , l a r g e l y i n sequence,  h e r automobile  85  a c c i d e n t , and the events immediately  afterward.  That i s t o  say, her t r a u m a t i c r e l i v i n g of the event began a t t h e moment of  impact, and progressed, more or l e s s  sequentially,  forward through time, w i t h each s e t of saccades moving her a l i t t l e farther.  She d e s c r i b e d her e x p e r i e n c e t h i s  way:  The f i r s t w h i l e . . . i t . . . almost went i n sequence of the a c t u a l a c c i d e n t . one t h i n g made me  So, t h i n k i n g  l e a d t o t h i n k about the next  about thing.  So, I worked through i t — t h e whole a c c i d e n t .  Semantic and emotional threads l i n k one s e t t o the next.  For example, i n s e t four, the anger she f e l t  screaming woman, r e c u r r e d i n the f i f t h  at a  s e t ; but t h i s  time  d i r e c t e d toward the d r i v e r s of the a c c i d e n t v e h i c l e .  The  s i x t h s e t a g a i n brought an image of the same v e h i c l e ,  but  t h i s time the focus was was  wearing,  on the d e t a i l s of the hat the woman  and so on.  C l a s s i f i c a t i o n of her experiences of g u i l t and was  at f i r s t d i f f i c u l t .  anger  For, although one would n o r m a l l y  t h i n k of these as secondary,  and hence, S p e c t a t o r  emotions,  because they were re-experienced, as i f o c c u r r i n g i n the moment, they f i t t e d best i n t o the category of P a r t i c i p a n t Experiences. Throughout " C ' s  f i r s t s e s s i o n , she d i d , by her  admission, r e s i s t the urge t o emote.  own  Each time she f e l t  impulse t o c r y , she stopped h e r s e l f , by choking back the  the  86  f e e l i n g s , and stopping eye movements, s t a r i n g s t r a i g h t ahead, as i f f i x a t e d on something.  T h i s impulse t o c r y  she  d e s c r i b e d as more profound and d i s t u r b i n g than mere sadness. At s e v e r a l p o i n t s d u r i n g treatment, "C" consecutive and why one  Spectator Experiences;  had  among them, wondering  how  the event happened; a d e s i r e t o l e a v e f l o w e r s f o r  o f the v i c t i m s , and a momentary sense o f r e l i e f  r e a l i z i n g the a c c i d e n t wasn't her At s e s s i o n s end, i n her a n x i e t y  fault.  t h e r e had been o n l y a s l i g h t  (SUDs) l e v e l , from 7.5  S e q u e n t i a l Experiences  at  to  decrease  6.5.  by Category  Set  C l a s s i f i c a t i o n and D e s c r i p t i o n of  01:  TSE:  Experience  D i f f i c u l t y c o n c e n t r a t i n g ; not sure what t o do, d e s p i t e i n s t r u c t i o n s .  02:  PE:  R e l i v e s moment of impact; p a n i c , f e a r  and  guilt. TSE:  S u r p r i s e d a t process; many images appear.  03:  PE:  Relives incident:  nausea; f e a r ; shock.  04:  PE:  Relives incident:  f e a r ; anger.  TSE:  D i f f i c u l t y c o n c e n t r a t i n g ; eye embarrassed a t her  05:  l i d s get heavy;  process.  PE:  Relives incident.  SE:  Anger.  06:  PE:  R e l i v e s i n c i d e n t ; remembers d e t a i l s .  07:  PE:  Relives incident.  SE:  Wants t o c r y ( b l o c k s ) .  C l a s s i f i c a t i o n and D e s c r i p t i o n o f E x p e r i e n c e PE:  R e l i v e s i n c i d e n t ; remembers d e t a i l s .  SE:  Wants t o c r y ( b l o c k s ) .  TSE: Knot i n stomach. PE:  R e l i v e s i n c i d e n t : remembers d e t a i l s .  PE:  R e l i v e s i n c i d e n t : f e e l s h e l p l e s s and vulnerable.  SE:  Increased  awareness of remembered  surroundings. PE:  Relives incident: g u i l t .  SE:  Increased  awareness of s u r r o u n d i n g s .  TSE: Confuses past and present  tenses;  tension i n  stomach f e e l s as i f i n t h r o a t ; shaky. PE:  Relives incident.  SE:  Remembers f e e l i n g of r e l i e f t h a t she was not r e s p o n s i b l e f o r a c c i d e n t ; wants t o c r y (blocked).  PE:  Relives  SE:  Anger.  (post i n c i d e n t ) .  TSE: Nausea. PE:  R e l i v e s : g u i l t and v u l n e r a b i l i t y .  PE:  Partial  relive.  PE:  Partial  relive.  SE:  Remembers f e e l i n g annoyed.  PE:  Partial  SE:  Wants t o c r y ( b l o c k s ) .  TSE: Stomach  relive.  tight.  88  C l a s s i f i c a t i o n and  D e s c r i p t i o n of E x p e r i e n c e  PE:  Partial  relive.  SE:  Wants t o c r y  PE:  Partial  SE:  Wants t o c r y  PE:  Partial relive: guilt;  SE:  Memory of r e l i e f i t wasn't her  PE:  Partial  SE:  Memory of r e l i e f i t wasn't her  SE:  Wonders how  i n c i d e n t happened; wants c l o s u r e .  SE:  Wonders how  i n c i d e n t happened; wants c l o s u r e ;  (blocks).  relive. (blocks). fear. fault.  relive. fault.  anger. TSE:  Mind r a c i n g : many thoughts.  SE:  Fed up with p a i n ; wants c l o s u r e .  PE:  Relives  incident  impact): f e a r ,  (from immediately a f t e r  panic.  PE:  Relives  incident:  shock: d i s s o c i a t i o n .  PE:  Relives  incident.  SE:  Insight  i n t o her p h y s i c a l v u l n e r a b i l i t y .  PE:  Partial  relive.  SE:  Anger; i n s i g h t (she helped o t h e r s t o  protect  herself). PE:  Partial  relive.  SE:  Wants t o be taken care o f .  PE:  P a r t i a l r e l i v e : re-experiences d i s s o c i a t i v e quality; vivid  SE:  detail  Swears she w i l l never  forget.  89  Set  C l a s s i f i c a t i o n and D e s c r i p t i o n o f E x p e r i e n c e  31:  SE:  F a n t a s i z e s l e a v i n g f l o w e r s f o r dead woman; wonders i f man blames her.  32:  SE:  Wonders how man  i s ; wonders i f he blames her;  g u i l t ; sadness; wants c l o s u r e . TSE: Fatigue 33:  SE:  begins.  Flashes of man's f a c e ; wonders why he waved; image of him on ground; s e l f - c o a c h e s :  Tells  h e r s e l f she d i d the r i g h t t h i n g . 34:  35:  PE:  Partial  relive.  SE:  Wonders why event happened.  SE:  I d e n t i f i e s with other v i c t i m s ; wonders  how  they cope. 36:  PE:  Relives incident; increased d e t a i l ;  SE:  Memory of being s u r p r i s e d a t her competence; insight  37:  (from p s y c h o l o g i s t ' s  fear.  question).  PE:  R e l i v e s i n c i d e n t : g u i l t , shock.  SE:  I n s i g h t (she wasn't c a l l o u s ) .  TSE: Mind r a c i n g ; many thoughts. 38:  PE:  Partial relive  (post i n c i d e n t ) .  SE:  Remembers wanting comfort; wonders how  cope. 39:  PE:  Partial relive  (post i n c i d e n t ) ; d e t a i l s  clearer.  40:  SE:  Wants t o c r y ( b l o c k s ) .  PE:  P a r t i a l r e l i v e of i n c i d e n t .  SE:  Experiences  insight.  others  90  Summary of Experiences by  Category  P a r t i c i p a n t experiences. 1. P a s s i v e endurance of trauma.  (a) R e l i v e s event;  (b)  p a s s i v e l y endures r e - e x p e r i e n c i n g of t r a u m a t i c memories.  2. Narrowness of p e r s p e c t i v e ;  Momentary awareness does not  extend beyond r e l i v e d experiences.  3.  Immediacy of f o c a l image:  F o c a l image appears  vivid  and  close; d e t a i l revealed.  4. I n t e n s i t y of emotion.  Experiences  (c) h e l p l e s s n e s s ; (d) v u l n e r a b i l i t y ; (f) anger  (a) f e a r ; (e) g u i l t  (b) shock; (relives);  (relives).  S p e c t a t o r experiences. 1. A c t i v e a l t e r a t i o n of experience.  (a) F a n t a s i z e s l e a v i n g  flowers.  2. Broadening  of p e r s p e c t i v e .  surroundings  (of trauma s i t e ) ;  (a) Increased awareness of (b) i n s i g h t i n t o her  p l a y e d d u r i n g trauma; (c) wonders how wonders why  event o c c u r r e d ;  event occurred; (e) wonders how  (f) i d e n t i f i e s w i t h other v i c t i m .  3. D i s t a n c i n g of f o c a l image.  None.  role (d)  o t h e r s cope;  91  4. V a r i e t y o f emotions. ("more than sadness");  Feels  (a) anger; (b) wants t o c r y  (c) r e l i e f ;  (d) f e e l s f e d up w i t h  f e e l i n g bad.  Treatment s p e c i f i c  effects.  1. Momentary c o g n i t i v e impairment. concentrating;  (b) mind r a c e s ;  (a) D i f f i c u l t y  (c) many images;  (d) confuses  p a s t and p r e s e n t t e n s e s .  2. Heightened p h y s i c a l awareness.  (a) Nausea;  become heavy;  (d) f e e l s as i f h e r  (c) knot i n stomach;  stomach i s i n her t h r o a t ;  3. Change i n energy l e v e l .  (e) f e e l s shaky.  Fatigue.  4. Meta awareness o f process. process;  (a) Embarrassed a t h e r own  (b) s u r p r i s e d a t mind r a c i n g ,  number o f images.  (b) e y e l i d s  (c) s u r p r i s e d a t h i g h  92  CHAPTER FIVE: DISCUSSION Review To b r i e f l y summarize, i n f o r m a t i o n from a t o t a l o f s i x i n t e r v i e w t r a n s c r i p t s was analyzed and found consonant w i t h t h r e e broad c a t e g o r i e s , o r themes, o f experience,  each o f  which f u r t h e r contained f o u r dimensions o f e x p e r i e n c e .  Two  of t h e t h r e e broad c a t e g o r i e s — P a r t i c i p a n t E x p e r i e n c e s , and Spectator Experiences—were Cochran (1990).  borrowed from t h e work o f  P a r t i c i p a n t Experiences emphasize  (a) t h e  p a s s i v e nature o f the c o - r e s e a r c h e r s ' i n t r u s i v e r e experiencing; vivid,  (b) the narrow p e r s p e c t i v e o r f o c u s ; (c) t h e  immediacy of t h e f o c a l image; and (d) t h e h i g h  i n t e n s i t y o f ( r e l i v e d ) emotion(s).  Within t h i s  category,  the c l i e n t may be s a i d t o be r e - e x p e r i e n c i n g , t o some degree, t h e o r i g i n a l traumatic m a t e r i a l .  The n o t i o n s o f  narrow p e r s p e c t i v e , h i g h i n t e n s i t y o f emotion, and t h e h e l p l e s s nature o f r e - e x p e r i e n c i n g , a r e compatible DSM IV (APA, 1994) c a t e g o r i e s o f c o n s t r i c t i o n , and  intrusion,  with the  hyperarousal  respectively.  S p e c t a t o r experiences suggest a movement away from t h e narrow, i n t e n s e r e - e x p e r i e n c i n g of t h e P a r t i c i p a n t , i n t o a realm i n which t h e co-researcher experiences  (a) a  p a r a d o x i c a l form o f agency, vaguely s i m i l a r t o dreaming, i n which t h e e x p e r i e n c e r i s both agent and instrument experience;  (b) a broadening  t r a u m a t i c event;  o f her  of p e r s p e c t i v e r e l a t i v e t o t h e  (c) d i s t a n c i n g o f the f o c a l image; and (d)  a v a r i e t y o f i n t e n s i t y and type o f emotion.  I t i s within  93  t h i s category t h a t the s u r v i v o r begins t o m e n t a l l y a c t upon and c o n t e x t u a l i z e her experience; t o r e c o n s t r u c t t h e assumptions t h a t were " s h a t t e r e d " (Janoff-Bulman,  1992) as a  r e s u l t o f her encounter w i t h the t r a u m a t i c . The category o f Treatment S p e c i f i c E f f e c t s , i n c l u d e s those experiences which would not, i n a l l p r o b a b i l i t y , be o c c u r r i n g , were i t not f o r the treatment  itself.  Various  elements o f t h i s category were found t o occur a l o n g w i t h P a r t i c i p a n t and Spectator Experiences, as w e l l as on t h e i r own.  They i n c l u d e (a) momentary c o g n i t i v e impairment; (b)  somatic e x p e r i e n c e s ; energy  (c) changes t o t h e c o - r e s e a r c h e r ' s  l e v e l ; and (d) a meta awareness o f t h e c o -  r e s e a r c h e r ' s own process. Each c o - r e s e a r c h e r manifested a s i g n i f i c a n t l y p a t t e r n o f experience. mentioned "approximately  different  "A" was among t h e p r e v i o u s l y 40%" o f i n d i v i d u a l s who e x p e r i e n c e  a c o n t i n u a l , p r o g r e s s i v e movement toward i n - s e s s i o n r e s o l u t i o n o f t h e t a r g e t event  (Shapiro, 1995, p. 76) .  C l e a r l y , t h e m a j o r i t y of her experiences were o f t h e S p e c t a t o r and Treatment S p e c i f i c E f f e c t s v a r i e t y .  No  P a r t i c i p a n t Experiences occurred a f t e r 1/2 way through h e r f i r s t s e t o f eye movements.  Co-researcher  "B," a l t h o u g h  spending much o f her time i n these same two c a t e g o r i e s , d i d have t h r e e P a r t i c i p a n t experiences, d u r i n g which she r e l i v e d , t o some extent, the h o r r o r o f her t r a u m a t i c  event.  Hers was a stormy voyage of a b r e a c t i o n , d r u g - l i k e euphoria, f a t i g u e , c o g n i t i v e i n s i g h t s , and p h y s i c a l t i g h t e n i n g and  94  loosening.  Although,  r e s o l u t i o n was not a t t a i n e d ,  s i g n i f i c a n t progress was made.  Co-researcher  "C," on t h e  o t h e r hand, spent much o f her time i n t h e realm o f P a r t i c i p a n t Experiences,  r e l i v i n g h e r trauma and t h e hours  t h a t f o l l o w e d , g a i n i n g l i t t l e p e r s p e c t i v e beyond h e r narrow P a r t i c i p a n t focus.  However, she d i d move t e m p o r a r i l y  the S p e c t a t o r realm s e v e r a l times as t h e s e s s i o n  into  progressed:  Among other t h i n g s , she questioned why and how h e r t r a u m a t i c event c o u l d have occurred, and imagined paying homage t o a woman k i l l e d a t t h e s i t e of her trauma.  As w i t h "B,"  r e s o l u t i o n was not a t t a i n e d , a p p a r e n t l y due t o r e s i s t a n c e t o treatment. I m p l i c a t i o n s f o r Theory The g l e a n i n g and c l a s s i f i c a t i o n o f e x p e r i e n c e — e s p e c i a l l y remembered experience, which i s p a r t i a l l y o f r e l e v a n c e t o t h e present s t u d y — i s , a t best, a t r i c k y endeavor.  Not o n l y i s t h e nature o f memory i t s e l f somewhat  c r e a t i v e , and f a r from t h e "play back" mechanism we t y p i c a l l y imagine (Loftus & Hoffman, 1989); but, any attempt t o separate t h e v a r i o u s components o f experience ( c o g n i t i v e , a f f e c t i v e , somatic, sighted. fluoxetine  e t c . ) , i s somewhat s u p e r f i c i a l and s h o r t  One need only glance a t t h e c u r r e n t p o p u l a r i t y o f (Prozac), o r t h e e f f e c t s o f v a r i o u s forms o f  "body work" (Upledger,  1990) on t h e mind and emotions t o  r e a l i z e t h e i n t i m a t e and i n s e p a r a b l e r e l a t i o n s h i p ( o r , perhaps, " u n i t y " ) o f c o g n i t i o n / s o m a / a f f e c t .  According t o  95  Damasio, (1994) our b e l i e f i n p u r e l y r a t i o n a l thought i s incorrect:  The  lower l e v e l s i n the n e u r a l e d i f i c e o f reason  are t h e same ones t h a t r e g u l a t e t h e p r o c e s s i n g o f emotions and f e e l i n g s , along w i t h t h e body f u n c t i o n s necessary f o r an organism's  survival.  In t u r n ,  these  lower l e v e l s maintain d i r e c t and mutual r e l a t i o n s h i p s w i t h v i r t u a l l y every b o d i l y organ, thus p l a c i n g t h e body d i r e c t l y w i t h i n the c h a i n o f o p e r a t i o n s t h a t generate t h e h i g h e s t reaches o f r e a s o n i n g . . . . Emotion, f e e l i n g , and b i o l o g i c a l r e g u l a t i o n a l l p l a y a r o l e i n human reason  (p. x i i i ) .  Hence, t o d e s c r i b e the upward m i g r a t i o n o f t i g h t n e s s i n "A"'s  body as somatic. as i f devoid o f emotional o r  c o g n i t i v e concomitants  o r precedents; o r "B"'s a b r e a c t i o n as  a f f e c t i v e , e x c l u s i v e o f t h e somatic o r r a t i o n a l , the same e r r o r as Descartes:  i s t o make  t h a t o f attempting t o d i v i d e  the i n d i v i s i b l e wholeness of the e x p e r i e n c i n g organism (Damasio, 1994).  That t o which we a s s i g n l a b e l s such as  " a f f e c t i v e , " "cognitive,  11  e t c . , i s simply t h e most s a l i e n t  a s p e c t o f a g r e a t e r wholeness o f experience a f f e c t i n g t h e e n t i r e person. The above caveat being s t a t e d , t h e r e was much found i n t h i s study which confirms Shapiro's (1995) d e s c r i p t i o n s o f c l i e n t experiences.  Although not every e x p e r i e n c e d e s c r i b e d  96  by Shapiro o c c u r r e d (nor would one expect them t o , g i v e n t h e s m a l l sample i n v o l v e d ) , no experiences o c c u r r e d which h e r t e x t had n o t a n t i c i p a t e d .  In f a c t , some o f the more unusual  EMDR e x p e r i e n c e s , such as p h y s i c a l s e n s a t i o n s , changes t o the f o c a l image, p o l a r i z e d c o g n i t i v e s h i f t s and so on, seemed taken almost verbatim from h e r t e x t .  F o r example,  both "A" and "B" experienced the upward m i g r a t i o n o f p h y s i c a l t i g h t n e s s ; "B," from her c h e s t t o h e r head; and "A,"  from her stomach t o h e r chest, whence i t disappeared,  " l i k e i t d i d n ' t want t o be t h e r e anymore."  Of t h i s type o f  s h i f t i n g s e n s a t i o n , Shapiro w r i t e s , "a c l i e n t may i n i t i a l l y i n d i c a t e a t i g h t n e s s i n the stomach, but w i t h each s e t t h e s e n s a t i o n s may seem t o move upward (to the c h e s t , t h r o a t , o r head) how  11  (p. 85).  Regarding  the f o c a l image, S h a p i r o w r i t e s  "a l e e r i n g f a c e can change t o a s m i l i n g one . . ."  (p.  81), which o c c u r r e d when "A" saw the f a c e o f h e r co-worker, which had p r e v i o u s l y looked worried, appear calm and smiling. Other  (but not a l l ) c o - r e s e a r c h e r e x p e r i e n c e s which  confirmed Shapiro's d e s c r i p t i o n s i n c l u d e changes i n cognition  (p. 83); l e s s i n t e n s e r e l i v i n g o f e x p e r i e n c e (p.  90); and changes i n emotions (p. 84). M i c r o p a t t e r n s o f experiences were a l s o a n t i c i p a t e d by Shapiro, i n c l u d i n g "C"'s  b l o c k i n g (p. 77), and "B"'s  profound a b r e a c t i o n s (p. 168). The p r e s e n t study extends p r e v i o u s EMDR t h e o r y by o f f e r i n g a conceptual framework f o r c l a s s i f y i n g and  97  understanding  type and movement o f c o - r e s e a r c h e r  experience,  which i s c o n s i s t e n t w i t h e x i s t i n g p e r s p e c t i v e s on PTSD (APA, 1994;  Shapiro, 1995; Herman, 1992), " s h a t t e r e d assumptions"  (Janoff-Bulman,  1992), and n a r r a t i v e t h e r a p i e s (Hermans &  Hermans-Jansen, 1995). Whereas Shapiro's  (1995) a c c e l e r a t e d i n f o r m a t i o n  p r o c e s s i n g model p r o v i d e s a metaphorical and b i o l o g i c a l "working h y p o t h e s i s "  (p. 29) of how EMDR b r i n g s about  changes t o t h e organism, the c u r r e n t study o f f e r s a framework f o r c o n c e p t u a l i z i n g and understanding t h e s i g n i f i c a n c e o f these changes  themselves.  To d e s c r i b e movement away from t h e P a r t i c i p a n t  realm,  t o t h a t o f a Spectator i s not only t o say one i s working through  t h e t r a u m a t i c m a t e r i a l , but a l s o t o say what t h e  s i g n i f i c a n c e and meaning o f such movement i s .  When, f o r  example, "A" sees h e r s e l f i n t h e p i c t u r e f o r t h e f i r s t it  time,  i s not o n l y a s i g n t h a t "two neuro networks [ a r e l i n k i n g ]  up w i t h each o t h e r " (Shapiro, 1995, p. 41), but, j u s t as important,  i t i s an i n d i c a t i o n o f what t h e c o - r e s e a r c h e r , i n  her p a r a d o x i c a l l y a g e n t i v e / p a s s i v e r o l e i s i n t h e p r o c e s s o f doing:  c o n t e x t u a l i z i n g , n a r r a t i n g , and hence, making  meaning o f her p r e v i o u s l y meaningless, memory.  wordless,  traumatic  I t i s t h i s n e g o t i a t i o n and r e c o n s t r u c t i o n o f  meaning which allows the traumatic e p i s o d e — n o w a s t o r y — t o be removed from " a c t i v e memory" (Horowitz, rest.  1976) and l a i d t o  98  The  dimensions o f experience,  (largely bipolar i n the  realms o f P a r t i c i p a n t and Spectator)  i n d i c a t e t h e dynamics,  or components, i n v o l v e d i n t h e s h i f t from t h e p r e n a r r a t i v e (Herman, 1992) t o t h e n a r r a t i v e (Hermans & Hermans-Jansen, 1995); from s t a s i s  (Shapiro,  1995; Janet,  ( F r a n k l , 1963); from fragmentation integration  (Janet,  1919) t o meaning  (Janoff-Bulmann, 1992) t o  1919).  T h i s c o n c e p t u a l i z a t i o n i s o f f e r e d by t h e author, n o t as an a l t e r n a t i v e t o t h e a c c e l e r a t e d i n f o r m a t i o n model, b u t an adjunct,  processing  adding a g r e a t e r depth t o our  understanding o f t h e s i g n i f i c a n c e o f c o - r e s e a r c h e r experiences. Implications f o r Counselling There a r e s e v e r a l p o i n t s t o be made r e g a r d i n g implications f o r counselling.  F i r s t , although t h e f i n d i n g s  of t h i s study do n o t suggest a need f o r a l t e r a t i o n o f t h e standard  EMDR p r o t o c o l (Shapiro,  1995), t h e  c o n c e p t u a l i z a t i o n s o f f e r e d may be o f v a l u e t o t h e r a p i s t s by i n c r e a s i n g awareness o f t h e dynamics i n v o l v e d i n c l i e n t s ' movement toward r e s o l u t i o n and meaning m a k i n g — t h e being an a p p a r e n t l y As EMDR continues  i n t e g r a l p a r t o f t h e EMDR  latter  experience.  t o evolve, t h i s awareness may e v e n t u a l l y  l e a d t o s u b t l e changes i n how some t h e r a p i s t s approach t h e o v e r a l l context  o f EMDR therapy, p l a c i n g a g r e a t e r  on meaning and s t o r y . The  second p o i n t i n v o l v e s t h e l e v e l o f f a t i g u e  experienced  by a l l co-researchers  (during and a f t e r  emphasis  99  therapy).  A t h e r a p i s t ' s emphasizing t o a c l i e n t i n advance  t h a t he o r she may experience -and  some degree o f f a t i g u e d u r i n g -  especially after—treatment,  would seem e t h i c a l l y  r e s p o n s i b l e , i n t h a t the c l i e n t c o u l d p l a n h i s o r h e r p o s t s e s s i o n time a c c o r d i n g l y .  T h e r a p i s t s should be aware t h a t  i n - s e s s i o n f a t i g u e , c o g n i t i v e impairment, o r t h e e f f e c t s o f a b r e a c t i o n may r e q u i r e c l i e n t s t o r e s t b r i e f l y , as d i d "B," when overwhelmed by her experiences. T h i r d , as two o f the t h r e e c o - r e s e a r c h e r s  were, a t some  p o i n t , unsure o f what t o do, d e s p i t e t h e r a p i s t ' s  previous  i n s t r u c t i o n s , a r e - e v a l u a t i o n o f how and what i n s t r u c t i o n s are g i v e n might be h e l p f u l . F i n a l l y , r e g a r d i n g the t h e r a p e u t i c r e l a t i o n s h i p ,  i t  would appear t h a t , as i n most t h e r a p i e s , encouragement can p l a y an important r o l e f o r c l i e n t s i n d i s t r e s s .  Given t h e  h i g h l e v e l o f meta awareness c l i e n t s d i s p l a y e d , arid t h e i r f e e l i n g s o f s u r p r i s e r e g a r d i n g t h e process,  i t would seem  t h a t t h e r a p i s t s should continue  c l i e n t s that  treatment i s proceeding  t o reassure  w e l l , i f such i s t h e case.  For some  c l i e n t s , such as "C," who d i d not y e t f e e l s a f e emoting i n f r o n t o f her t h e r a p i s t — a n d ,  i n essence, blocked h e r  treatment as a r e s u l t — g r e a t e r time and a t t e n t i o n might need t o be p a i d t o developing treatment  the t h e r a p e u t i c r e l a t i o n s h i p b e f o r e  begins. I m p l i c a t i o n s f o r Research  As e f f i c a c y r e s e a r c h continues usefulness  t o confirm the  o f EMDR i n the treatment of PTSD and o t h e r  100  conditions  (Shapiro, 1995; Greenwald, 1994, 1996), i t would  seem u s e f u l f o r r e s e a r c h e r s t o begin t o conduct f u r t h e r q u a l i t a t i v e i n v e s t i g a t i o n s into co-researcher  experiences,  e s p e c i a l l y r e g a r d i n g the dynamics o f meaning c r e a t i o n w i t h i n the t h e r a p e u t i c s e s s i o n ( s ) .  To t h i s end, i t i s hoped t h e  c o n c e p t u a l s t r u c t u r e s i d e n t i f i e d i n t h i s study w i l l be o f h e u r i s t i c value. As t h i s was t h e f i r s t systematic i n v e s t i g a t i o n o f t h e phenomenology o f EMDR, t h e r e remains a g r e a t d e a l t o be explored.  R e p l i c a t i o n o f t h i s study w i t h a much l a r g e r  sample, might v a l i d a t e the a p p r o p r i a t e n e s s , o r l a c k t h e r e o f , of  t h e c a t e g o r i e s and dimensions h e r e i n d e s c r i b e d . L i m i t a t i o n s o f t h e Study  Number o f S u b j e c t s Perhaps the most g l a r i n g l i m i t a t i o n o f t h i s study i s the i n c l u s i o n o f only t h r e e s u b j e c t s , o r c o - r e s e a r c h e r s . Had  every c o - r e s e a r c h e r manifested a s i m i l a r p a t t e r n o f  experience,  i t would s t i l l have remained d i f f i c u l t t o  g e n e r a l i z e t h e r e s u l t s beyond t h i s study. each c o - r e s e a r c h e r manifested a d i f f e r e n t  The f a c t t h a t experiential  p a t t e r n renders any such g e n e r a l i z a t i o n t h a t much l e s s certain.  For t h e t h r e e p a t t e r n s i d e n t i f i e d do, i n a l l  p r o b a b i l i t y , r e p r e s e n t only a s m a l l sample o f t h e many possible patterns.  G e n e r a l i z a t i o n i s f u r t h e r c o m p l i c a t e d by  the f a c t t h a t , although a l l c o - r e s e a r c h e r s shared a common DSM IV d i a g n o s i s o f PTSD (APA, 1994), "A" was b e i n g t r e a t e d for  a s i n g l e event trauma; "B" f o r a t l e a s t two; and "C,"  101  a l t h o u g h t r e a t e d p r i m a r i l y f o r a s i n g l e trauma, was, by h e r own admission,  r e s i s t i n g t h e treatment,  so as n o t t o f e e l  overwhelmed. L i m i t a t i o n s o f V e r b a l Communication Even w i t h t h e use of I n t e r p e r s o n a l Process R e c a l l t o cue c o - r e s e a r c h e r s ' memories, i t i s presumed t h a t n o t a l l o f the i n - s e s s i o n i n f o r m a t i o n c o u l d be r e t r i e v e d by t h e researcher or co-researcher.  For such i s t h e n a t u r e o f  memory and v e r b a l communication t h a t , even i f one possessed u n l i m i t e d time t o remember and d e s c r i b e one's e x p e r i e n c e (which c o - r e s e a r c h e r s d i d n o t ) , a p r e c i s e r e p r e s e n t a t i o n i s unlikely.  Some experiences may be o u t s i d e t h e realm o f  language.  A l a n Watts w r i t e s t h a t  words can express no more than a t i n y fragment o f human knowledge, f o r what we can say and t h i n k i s always immeasurably l e s s than what we e x p e r i e n c e .  T h i s i s not  o n l y because t h e r e a r e no l i m i t s t o t h e e x h a u s t i v e d e s c r i p t i o n o f an event, as t h e r e a r e no l i m i t s t o t h e p o s s i b l e d i v i s i o n s o f an i n c h ; i t i s a l s o because t h e r e are experiences which defy t h e v e r y s t r u c t u r e o f our language,  as water cannot be c a r r i e d i n a s i e v e (1983,  p. 3 ) .  Further, the f a l l i b i l i t y  o f memory i t s e l f may  u l t i m a t e l y render a l l accounts o f remembered e x p e r i e n c e a t l e a s t m a r g i n a l l y suspect  ( L o f t u s & Hoffman, 1989) .  102  Researcher  B i a s and I n f l u e n c e  D e s p i t e the r e s e a r c h e r ' s attempt  t o wade i n t o t h e l a r g e  body of c o - r e s e a r c h e r experience without p r e c o n c e p t i o n s or e x p e c t a t i o n s , i t would be naive t o assume such a n e u t r a l approach t o r e s e a r c h i s p o s s i b l e (Kuhn, 1962;  L a i n g , 1967).  For one cannot h e l p but i n t e r p r e t through the f i l t e r one's p r e v i o u s t r a i n i n g and  of  experience.  F u r t h e r , although the author has attempted  to  i n v e s t i g a t e each c o - r e s e a r c h e r ' s "experience as i t i s experienced" it  ( C o l a i z z i , 1978,  p. 53), as R. D. L a i n g w r i t e s ,  i s f a l l a c i o u s t o b e l i e v e we can i n v e s t i g a t e or  interpret  the experience of another, without becoming p a r t o f , and hence, i n f l u e n c i n g , the very t h i n g we are attempting  to  investigate.  S o c i a l phenomenology i s the s c i e n c e of my of o t h e r s ' experience. r e l a t i o n between my experience of me. p.  I t i s concerned  own  and  w i t h the  experience of you and  your  That i s , w i t h i n t e r e x p e r i e n c e (1967,  5)  Therapist  Style  Both of the p s y c h o l o g i s t s who  graciously participated  i n t h i s study, although f o l l o w i n g standard EMDR p r o t o c o l (Shapiro, 1995), manifested s l i g h t l y d i f f e r e n t s t y l e s i n they i n t e r a c t e d w i t h t h e i r  clients.  how  103  The p s y c h o l o g i s t who t r e a t e d "B" performed  over t w i c e  as many s e t s as the mean number o f h i s c o l l e a g u e , who t r e a t e d both "A" and "C." The former a l s o p l a c e d c o n s i d e r a b l y more emphasis on somatic e x p e r i e n c e s than t h e l a t t e r , by more f r e q u e n t l y a s k i n g h i s c l i e n t t o "scan h e r body."  Iti sdifficult  t o say how these d i f f e r e n c e s might  have a f f e c t e d c l i e n t experience, i f a t a l l . Medication Use o f medications was not c o n s i s t e n t a c r o s s a l l c o researchers.  A t t h e time o f t h e i n i t i a l EMDR s e s s i o n , "B"  was u s i n g a l p r a z o l a m (Xanax; a b e n z o d i a z e p i n e ) ; "C," nortriptyline whatsoever. treatment,  (a t r i c y c l i c ) ;  and "A" no m e d i c a t i o n  Regarding t h e e f f e c t s o f m e d i c a t i o n s on Shapiro w r i t e s t h a t "so f a r , no m e d i c a t i o n s  appear t o completely b l o c k EMDR p r o c e s s i n g , a l t h o u g h t h e benzodiazepines have been r e p o r t e d t o reduce efficacy"  treatment  (1995, p. 100). I t remains d i f f i c u l t  t o speculate  c o n f i d e n t l y how d i f f e r e n t i a l medications might have a f f e c t e d c o - r e s e a r c h e r experience i n t h i s  study.  Summary T h i s study i s t h e f i r s t t o s y s t e m a t i c a l l y  investigate  the moment-to-moment experiences o f t h r e e c o - r e s e a r c h e r s r e c e i v i n g t h e i r f i r s t s e s s i o n o f EMDR. Using a v a r i a t i o n o f both I n t e r p e r s o n a l P r o c e s s R e c a l l (IPR; E l l i o t ,  1994) and C o l a i z z i ' s  (1978)  phenomenological  r e s e a r c h methodology, f i n d i n g s confirmed many d e s c r i p t i o n s  104  of experience o f f e r e d by Shapiro  (1995); w i t h n o t h i n g of a  d i s c o n f i r m i n g nature being d i s c o v e r e d . Three d i s t i n c t p a t t e r n s of c o - r e s e a r c h e r were determined,  experience  with one c o - r e s e a r c h e r a t t a i n i n g f u l l i n -  s e s s i o n r e s o l u t i o n of her b a s e l i n e measures. Three broad c a t e g o r i e s of experience were a l s o identified  ( P a r t i c i p a n t Experiences, S p e c t a t o r  Experiences  and Treatment S p e c i f i c E f f e c t s ) each of which were found t o c o n s i s t of f o u r dimensions,  or components, of e x p e r i e n c e .  Movement from the P a r t i c i p a n t t o S p e c t a t o r realm was t o be c o n s i s t e n t with working through and of t r a u m a - r e l a t e d memories.  found  contextualization  105  References A c i e r n o , R., Meuser, K. T.  Hersen, M.,  (1994).  Van H a s s e l t , Tremont, G.,  Review of the v a l i d a t i o n  d i s s e m i n a t i o n o f eye-movement d e s e n s i t i z a t i o n reprocessing:  A scientific  &  and  and  and e t h i c a l dilemma.  Clinical  Psychology Review. 14(4). 287-299. Ainsworth, M. D. S.  (1979).  mother-infant i n t e r a c t i o n .  New  York:  Academic P r e s s .  and s t a t i s t i c a l manual of mental d i s o r d e r s  Diagnostic  (3rd e d . ) .  D.C.  American P s y c h i a t r i c A s s o c i a t i o n (1994). and s t a t i s t i c a l manual of mental d i s o r d e r s Washington,  H.  (Eds.) Advances i n the study o f  American P s y c h i a t r i c A s s o c i a t i o n (1987).  Washington,  as r e l a t e d t o  In J . B. R o s e n b l a t t , R.  Hinde, C. Beer, & M. B u s h e l l b e h a v i o r . v o l . 1.  Attachment  Diagnostic  (4th e d . ) .  D.C.  Azar, B.  (1994, October).  reduce trauma.  Controversial therapy could  APA Monitor, p. 6.  Becker, E. (1974).  The d e n i a l o f death.  New  York:  The Free P r e s s . Benyakar, (1989).  M.,  Kutz, I . , Dasberg, H.,  The c o l l a p s e of a s t r u c t u r e :  t o trauma.  A structural  approach  J o u r n a l of Traumatic S t r e s s . 2 ( 4 ) . 431-449.  Bloom, B. S. in discussion.  (1954).  The thought p r o c e s s o f s t u d e n t s  In S. J . French (Ed.), Accent on t e a c h i n g :  Experiments i n g e n e r a l e d u c a t i o n . Brothers.  & S t e r n , M. J .  New  York:  Harper &  106  Boudewyns, P. A., Stwertka, L. L., & Klosko, J . S. (1993).  Eye movement d e s e n s i t i z a t i o n f o r PTSD o f combat:  treatment outcome p i l o t study.  A  The Behavior T h e r a p i s t . 16.  29-33. Bower, G. H. (1981).  Mood and memory.  American  P s y c h o l o g i s t . 36. 129-148. Bowlby, J . (1969). Attachment.  London:  Attachment  and l o s s . v o l 1:  Hogarth.  B r i t t o n , J . (1970).  Language and L e a r n i n g .  Baltimore:  Penguin Books. Bruer, J . , & Freud, S. (1958).  The s t a n d a r d e d i t i o n o f  the complete p s y c h o l o g i c a l works o f Sigmund Freud.  London:  The Hogarth Press and I n s t i t u t e o f P s y c h o a n a l y s i s . Cocco, N., & Sharpe, L. (1993).  An a u d i t o r y v a r i a n t o f  eye movement d e s e n s i t i z a t i o n i n a case o f c h i l d h o o d p o s t traumatic stress disorder.  J o u r n a l o f Behavior Therapy and  E x p e r i m e n t a l P s y c h i a t r y . 24(4). 373-377. Cochran, L. (1990).  The sense o f v o c a t i o n :  c a r e e r and l i f e development.  Albany:  A study o f  State U n i v e r s i t y of  New York P r e s s . C o l a i z z i , P. F. (1978). phenomenologist  views i t .  P s y c h o l o g i c a l r e s e a r c h as t h e  In R.S. V a l l e , & M. K i n g  (Eds.),  E x i s t e n t i a l - P h e n o m e n o l o g i c a l A l t e r n a t i v e s f o r Psychology. New York:  Greenwood.  Crane, S. (1960).  The open boat.  In A. Fox (Ed.),  Maggie and o t h e r s t o r i e s by Steven Crane. Washington Square P r e s s , Inc.  New  York:  107  Damasio, A. (1994).  Descartes' error;  reason, and t h e human b r a i n . Elliot,  R. (1994).  New York:  Emotion,  Avon Books.  Interpersonal process r e c a l l .  C. Barker, N. P i s t r a n g , & R. E l l i o t  In  (Eds.), Research Methods  i n C l i n i c a l and C o u n s e l l i n g Psychology.  ChiChester:  J.  Wiley & Sons. F r a n k l , V. (1963). York:  Man's search f o r meaning.  New  Pocket Books. Freud, S. (1958).  The standard e d i t i o n o f t h e complete  p s y c h o l o g i c a l works o f Sigmund Freud, v o l 12.  London:  The  Hogarth Press and I n s t i t u t e o f P s y c h o a n a l y s i s . Greenwald, reprocessing  R. (1994).  (EMDR):  Eye movement d e s e n s i t i z a t i o n and  An overview.  J o u r n a l o f Contemporary  Psychotherapy, 24(1). Greenwald, controversy.  R. (1996).  The i n f o r m a t i o n gap i n t h e EMDR  P r o f e s s i o n a l Psychology;  Research and  P r a c t i c e . 2 7 f 1 ) . 67-72. Herbert, J . D., & Mueser, K. T. (1992). desensitization:  A c r i t i q u e of t h e evidence.  Eye movement Journal of  Behavior Therapy and Experimental P s y c h i a t r y . 23, 169-174. Herman, J . L. (1992).  Trauma and r e c o v e r y .  New York:  B a s i c Books. Hermans, H. & Hermans-Jansen, E. (1995). Narratives: New York:  The c o n s t r u c t i o n o f meaning i n psychotherapy. The G u i l f o r d P r e s s .  Horowitz, M. (1976). York:  Self-  Aronson.  S t r e s s response syndromes.  New  108  Horowitz, M., Wilner, N., & A l v a r e z , W. of Event S c a l e : Psychosomatic  Impact  A measure of s u b j e c t i v e s t r e s s .  Medicine. 41(3). 209-218.  Janet, P. (1919). York:  (1979).  P s y c h o l o g i c a l h e a l i n g , v o l 1.  New  Macmillan). Janoff-Bulman,  Toronto:  R. (1992).  Shattered  assumptions.  The Free P r e s s .  Kanfer, F. H., & G o l d s t e i n , A. P. (1991). people change:  A textbook o f methods.  Karen, R. (1990).  Helping  New York:  Becoming Attached.  Pergamon.  The A t l a n t i c  Monthly. February. Kiyuna, R. S., K o p r i v a , R. J . , & F a r r , S. J . (1993). The e x p e r i e n t i a l l e a r n i n g model as a c o n c e p t u a l framework f o r t h e treatment of post t r a u m a t i c s t r e s s d i s o r d e r . J o u r n a l o f S o c i a l Behavior and P e r s o n a l i t y . 8 ( 5 ) . 105-116. K l e i n k n e c h t , R. A., & Morgan, M. P. (1992).  Treatment  of p o s t - t r a u m a t i c s t r e s s d i s o r d e r w i t h eye movement desensitization.  J o u r n a l of Behavior Therapy and  Experimental P s y c h i a t r y . 23. 43-49. K l e i n k n e c h t , R. A. (1993).  Rapid treatment o f b l o o d  and i n j e c t i o n phobias w i t h eye movement d e s e n s i t i z a t i o n . J o u r n a l o f Behavior Therapy and Experimental P s y c h i a t r y . 24(3), 211-217. K o r n f i e l d , J . (1994) .  The path w i t h h e a r t .  New York:  Bantam Books. Kuhn, T. S. (1962). revolutions.  Chicago:  The s t r u c t u r e o f s c i e n t i f i c U n i v e r s i t y o f Chicago P r e s s .  109  L o f t u s , E. F., & Hoffman, H. G. and memory:  The c r e a t i o n of new memories.  Experimental Psychology. L a i n g , R. D. York:  (1989).  Misinformation Journal of  118(1). 100-104.  (1967).  The p o l i t i c s of e x p e r i e n c e .  New  Pantheon Books. L e r n e r , M. J . (1970).  reactions to victims:  The d e s i r e f o r j u s t i c e  and  S o c i a l p s y c h o l o g i c a l s t u d i e s of some  antecedents and consequences.  In M. Macaulay & L.  (Eds.) A l t r u i s m and h e l p i n g behavior.  New  York:  Berkowitz Academic  Press. L i p k e , H. J . , & B o t k i n , A. L.  (1992).  Case s t u d i e s of  eye movement d e s e n s i t i z a t i o n and r e p r o c e s s i n g (EMDR) w i t h chronic post-traumatic stress disorder.  Psychotherapy.  29.  591-595. Lohr, J . M., Cerro, S.,  K l e i n k n e c h t , R. A.,  Conley, A. T.,  Schmidt, J . , & Sonntag, M. E.  (1992).  Dal  A  m e t h o d o l o g i c a l c r i t i q u e of the c u r r e n t s t a t u s of eye movement d e s e n s i t i z a t i o n  (EMD).  J o u r n a l of Behavior  Therapy  and Experimental P s y c h i a t r y . 23., 159-167. Lyons, J . A.,  & Kean, T. M.  (1989).  f o r the treatment of combat-related PTSD.  Implosive therapy J o u r n a l of  Traumatic S t r e s s . 2. 137-152. Mandler,  G.  (1964).  The i n t e r r u p t i o n of b e h a v i o r .  Nebraska Symposium on M o t i v a t i o n , ed. D. L e v i n e . U n i v e r s i t y of Nebraska Press.  In  Lincoln:  110  Marquis, J . N.(1991).  A r e p o r t on s e v e n t y - e i g h t  t r e a t e d by eye movement d e s e n s i t i z a t i o n .  Journal  of  Behavior Therapy and Experimental P s y c h i a t r y . 22. M a r r i s , P.  (1982).  Attachment and  cases  319-323.  Society.  In C.  M.  Parkes & J . Stevenson-Hinde (Eds.) The p l a c e of attachment i n human behavior.  New  McCann, D. L. due  York:  (1992).  B a s i c Books,  Post-traumatic  Inc. stress disorder  t o d e v a s t a t i n g burns overcome by a s i n g l e s e s s i o n of  movement d e s e n s i t i z a t i o n . Experimental  P s y c h i a t r y . 23.  Meichenbaum, D., ethology:  J o u r n a l of Behavior Therapy  eye  and  319-323.  & Cameron, R.  (1979).  Cognitive  A s s e s s i n g the streams of c o g n i t i o n and  emotion.  In K. B l a n k s t e i n , P. P l i n e r , & J . P o l i v y (Eds.), Advances i n the study of communication and a f f e c t : m o d i f i c a t i o n of emotional behavior. M i s h l e r , E. G. and N a r r a t i v e .  (1986).  London:  Mueser, K. T.,  New  Assessment York:  and  Plenum.  Research i n t e r v i e w i n g :  Context  Harvard U n i v e r s i t y P r e s s .  Yarnold,  P. R.,  & Foy,  D. W.  S t a t i s t i c a l a n a l y s i s f o r single-case designs:  (1991).  Evaluating  outcome of imaginal exposure treatment of c h r o n i c PTSD. Behavior M o d i f i c a t i o n . 15. 0'Brian,  E.  (1993).  134-155. Pushing the p a n i c  button.  Networker. Nov/Dec. Osborne, J . W.  (1990).  Some b a s i c  existential-  phenomenological r e s e a r c h methodology f o r c o u n s e l l o r s . Canadian J o u r n a l of C o u n s e l l i n g . 24(2),  79-91.  Ill  Page, A. C., & C r i n o , R. D. (1993).  Eye-movement  desensitisation:  A simple treatment f o r p o s t - t r a u m a t i c  stress disorder?  A u s t r a l i a n and New Zealand J o u r n a l of  P s y c h i a t r y . 27. 288-293. Pavlov, I . P. (1927).  Conditioned r e f l e x e s .  New  York:  Liveright. Pellicer,  X. (1993).  Eye movement d e s e n s i t i z a t i o n  treatment o f a c h i l d ' s nightmares: of  Behavior Therapy  New York:  Pitman,  (1990).  The o r i g i n s of i n t e l l i g e n c e i n  International U n i v e r s i t i e s Press.  R. K. (1989).  hormones, and memory. Pitman,  Post-traumatic s t r e s s d i s o r d e r ,  B i o l o g i c a l P s y c h i a t r y . 26. 221-223.  R. K., van der Kolk, B. A., & O r r , S. P.  N a l o x o n e - r e v e r s i b l e a n a l g e s i c response t o combat-  r e l a t e d s t i m u l i i n post-traumatic s t r e s s d i s o r d e r : study.  Journal  and Experimental P s y c h i a t r y . 23. 73-75.  P i a g e t , J . (1952). children.  A case r e p o r t .  A pilot  A r c h i v e s of General P s y c h i a t r y 47. 544-547.  Pitman,  R. K., Altman, B., Greenwald, E., Longpre,  E., M a c k l i n , M. L., P o i r e , R. E., & Steketee, G. S.  R.  (1991).  P s y c h i a t r i c c o m p l i c a t i o n s d u r i n g f l o o d i n g therapy f o r posttraumatic stress disorder.  Journal of C l i n i c a l  P s y c h i a t r y 52. 17-20. Puk, G. (1991).  T r e a t i n g t r a u m a t i c memories:  r e p o r t on the eye movement d e s e n s i t i z a t i o n J o u r n a l of Behavior Therapy 149-151.  A case  procedure.  and Experimental P s y c h i a t r y . 22,  112  Ross, R. J . , B a l l , W. A., & S u l l i v a n , K. A.  (1989).  Sleep d i s t u r b a n c e as the hallmark o f p o s t t r a u m a t i c disorder.  stress  American J o u r n a l of P s y c h i a t r y . 146. 697-707.  Ross, R. J . , B a l l , W. A., Dinges,  D. F., K r i b b s , N. B.,  M o r r i s o n , A. R., S i l v e r , S. M., & Mulvaney, F. D.  (1994).  Rapid eye movement s l e e p d i s t u r b a n c e i n p o s t t r a u m a t i c disorder.  stress  B i o l o g i c a l P s y c h i a t r y . 35, 195-202.  R u s s e l , M. C. (1991).  PTSD;  c o g n i t i v e - b e h a v i o r a l approaches.  Treatment review o f Unpublished  Sanderson, A., & Carpenter, R. (1992).  manuscript. Eye movement  d e s e n s i t i z a t i o n versus image c o n f r o n t a t i o n :  A single-  s e s s i o n c r o s s o v e r study o f 58 phobic s u b j e c t s .  Journal of  Behavior Therapy and Experimental P s y c h i a t r y . 23. 269-275. Seligman, M. (1975). development and death.  Helplessness:  San F r a n c i s c o :  Shapiro, F. (1989a). d e s e n s i t i z a t i o n procedure memories.  Freeman.  E f f i c a c y o f t h e eye movement i n t h e treatment  J o u r n a l of Traumatic  Shapiro, F. (1989b). new treatment  On d e p r e s s i o n ,  of traumatic  S t r e s s . 2. 199-223.  Eye movement d e s e n s i t i z a t i o n :  f o r post-traumatic s t r e s s d i s o r d e r .  A  Journal  of Behavior And Experimental P s y c h i a t r y . 20. 211-217. Shapiro, F. (1994, S p r i n g ) . S t r a y thoughts. Network Newsletter.  1, 1-4.  Shapiro, R. (1995). reprocessing: New York:  The EMDR  Eye movement d e s e n s i t i z a t i o n and  B a s i c p r i n c i p l e s , p r o t o c o l s , and procedures.  The G u i l f o r d Press.  113  Smith, W. H.  (1989).  stress disorder:  Antecedents of p o s t t r a u m a t i c  Wasn't being raped enough?  American  J o u r n a l o f P s y c h i a t r y . 142(6). 129-133. Spector, J . , & Huthwaite, M.  (1993).  Eye movement  d e s e n s i t i z a t i o n t o overcome p o s t - t r a u m a t i c s t r e s s d i s o r d e r . B r i t i s h J o u r n a l of P s y c h i a t r y . 163, S p i e g e l , D.  (1988).  106-108.  D i s s o c i a t i o n and h y p n o s i s i n p o s t -  traumatic stress disorders.  J o u r n a l of Traumatic  Stress.  1(1), 17-33. S p i e g a l , D.,  Hunt, T.,  & Dondershine, H. E.  (1988).  D i s s o c i a t i o n and h y p n o t i z a b i l i t y i n p o s t t r a u m a t i c s t r e s s disorder.  American J o u r n a l of P s y c h i a t r y . 145(3), 301-305.  Stampfl, T. G., i m p l o s i v e therapy: b e h a v i o r a l therapy.  & L e v i s , D. J . (1967).  E s s e n t i a l s of  A l e a r n i n g - t h e o r y - b a s e d psychodynamic J o u r n a l of Abnormal Psychology.  72.  496-503. Stutman, R. K.,  & B l i s s , E. L. (1985).  Posttraumatic  s t r e s s d i s o r d e r , h y p n o t i z a b i l i t y , and imagery.  American  J o u r n a l o f P s y c h i a t r y . 142(6). 741-743. Upledger, J . E. (1990). Seattle:  Cranio s a c r a l therapy.  Eastland Press.  Van der Kolk, B. A.  (1988).  The trauma spectrum:  The  i n t e r a c t i o n of b i o l o g i c a l and s o c i a l events i n the g e n e s i s of the trauma response.  J o u r n a l of Traumatic S t r e s s .  1.  273-290. van der Kolk, B. A.,  & Kadish, W.  (1987).  d i s s o c i a t i o n , and the r e t u r n of the r e p r e s s e d .  Amnesia, In B.  A.  114  yander Kolk, (Ed.), P s y c h o l o g i c a l Trauma.  Washington:  American P s y c h i a t r i c P r e s s . Vaughn, K. (1993, March).  Research p r e s e n t a t i o n .  Paper p r e s e n t e d a t EMDR Annual Conference, San J o s e , CA. Ver E l l e n , P. & van Kammen, D. P. (1990).  The  b i o l o g i c a l findings i n post-traumatic s t r e s s disorder:  A  review.  1789-  J o u r n a l o f A p p l i e d S o c i a l Psychology. 20. 21.  1821. Watts, A. (1983).  The way o f l i b e r a t i o n :  l e c t u r e s on t h e t r a n s f o r m a t i o n o f t h e s e l f .  Essays and  New York:  Weatherhill. Weiss, D. S. (1993). traumatic stress.  Psychological processes i n  J o u r n a l o f S o c i a l Behavior and  P e r s o n a l i t y . 8 ( 5 ) . 3-28. Wilson, D. L., C o v i , W. G., & F o s t e r , S. (1993,  March).  Eye movement d e s e n s i t i z a t i o n and r e p r o c e s s i n g : E f f e c t i v e n e s s and autonomic  correlates.  Paper p r e s e n t e d a t  EMDR Annual Conference, San Jose, CA. Wilson, S. A., T i n k e r , R. H., & Becker, L. A. (1994, November).  E f f i c a c y o f eye movement d e s e n s i t i z a t i o n and  reprocessing  (EMDR) treatment f o r trauma v i c t i m s .  Paper  p r e s e n t e d a t t h e Annual Meeting o f t h e I n t e r n a t i o n a l  Society  f o r Traumatic S t r e s s S t u d i e s , Chicago, I L . Winnik, H. Z. (1969). trauma."  Second thoughts about " p s y c h i c  The I s r a e l Annals o f P s y c h i a t r y & R e l a t e d  D i s c i p l i n e s . 7 ( 1 ) , 82-95.  115  Wolpe, J . (1959). inhibition.  Stanford:  Wolpe, J . (1990). (4th  ed.)  Psychotherapy by r e c i p r o c a l  New York:  Stanford University Press. The p r a c t i c e of b e h a v i o r therapy,  Pergamon P r e s s .  Wolpe, J . & Abrams, J . (1991).  Post-traumatic stress  d i s o r d e r overcome by eye-movement d e s e n s i t i z a t i o n : report.  A case  J o u r n a l of Behavior Therapy and E x p e r i m e n t a l  P s y c h i a t r y , 22. 39-43. Yalom, V. J . & Yalom, I . (1990). group psychotherapy.  Brief  P s y c h i a t r i c Annals. 20(7). 362-367.  Z i l b e r g , N. J . , & Weiss, D. S. (1982). Scale:  interactive  Impact o f Event  A c r o s s - v a l i d a t i o n study and some e m p i r i c a l evidence  s u p p o r t i n g a c o n c e p t u a l model of s t r e s s response syndromes. J o u r n a l o f C o n s u l t i n g and C l i n i c a l Psychology. 50(3) , 407414.  116  APPENDIX A  117 Dear C l i e n t : I am a Master's student i n C o u n s e l l i n g Psychology a t UBC, i n v i t i n g you t o p a r t i c i p a t e i n a r e s e a r c h study I am conducting, f o r my t h e s i s , i n t o Eye Movement D e s e n s i t i z a t i o n And Reprocessing (EMDR), a procedure you are about t o experience. I am g a t h e r i n g i n f o r m a t i o n about the e x p e r i e n c e s i n d i v i d u a l s have d u r i n g t h e i r f i r s t s e s s i o n o f EMDR. Such i n f o r m a t i o n w i l l be u s e f u l t o f u t u r e c l i e n t s , by g i v i n g them a sense o f what they might expect d u r i n g t h e i r own EMDR treatment. Should you p a r t i c i p a t e , Dr. Wilensky w i l l tape r e c o r d your i n i t i a l 90 minute s e s s i o n . Then, a t your convenience ( p r e f e r a b l y w i t h i n 48 hours), I w i l l arrange t o i n t e r v i e w you about your experiences u s i n g the tape r e c o r d i n g t o h e l p you remember. A f i n a l i n t e r v i e w w i l l be arranged a t a l a t e r date, d u r i n g which I w i l l show you what I have w r i t t e n , and ask f o r your feedback as t o i t s accuracy and completeness. The t o t a l time r e q u i r e d o f you (not i n c l u d i n g your i n i t i a l s e s s i o n w i t h Dr. Wilensky) w i l l be between t h r e e and f o u r hours. Your i d e n t i t y w i l l remain c o n f i d e n t i a l d u r i n g and a f t e r t h e study, w i t h your name being omitted and r e p l a c e d by a n u m e r i c a l code. A l l tapes w i l l be erased immediately a f t e r t h e p r o j e c t i s completed. P l e a s e note t h a t you may r e f u s e t o p a r t i c i p a t e i n t h i s study, and may withdraw a t any time, without, i n any way, a f f e c t i n g your t h e r a p e u t i c r e l a t i o n s h i p w i t h Dr. Wilensky. Should you have any q u e s t i o n s r e g a r d i n g the p r o j e c t , p l e a s e c o n t a c t me a t the telephone number below. Research T i t l e : S i x P a r t i c i p a n t s ' Experiences o f T h e i r F i r s t S e s s i o n o f Eye Movement D e s e n s i t i z a t i o n and Reprocessing. B r e t t Peterson 731-3457 F a c u l t y S u p e r v i s o r : L a r r y Cochran, Ph.D.  822-6139  I consent t o p a r t i c i p a t e i n t h i s study, and acknowledge r e c e i p t o f a copy o f t h i s form. NAME: ADDRESS: PHONE NUMBER: SIGNATURE: DATE: