Ainslee Gibbs reports back on Part 3 Couples and Addictions

                                    Training with Mark Brayne and Annabel McGoldrick (UK)

The latest instalment of the “Unleash” online training series rolled out over 3 days from April 30 – May 2, with consideration given for Australia/NZ friendly time slots (less friendly for the UK facilitators though). The course built upon the Attachment Informed style of EMDR (AI-EMDR), as taught in previous Part 1 & 2 training.

Couple work: “The relationship is the client, not the individuals themselves”

The first half of the training focused on couples, with Mark at the helm. The key points to working with a couple in the room – lots of psycho-education, listening and attending to the story to create the right foundation for the work to unfold. The therapist must act as a neutral participant to avoid becoming trapped in transference, or the ‘drama’ of the difficulties between the two individuals.

The focus must always be the relationship, using neutrality to guide solutions and insight to the problems the relationship holds. Mark points out that most couples “don’t present for therapy because of the past, but because they cannot manage how the wounds of the past are impacting upon the present”. The goal therefore is to find a way into the historical targets that matter, which will make a difference to the relationship when processed and resolved.

In the first live demonstration, a couple appeared sitting facing one another, with Mark inviting them to identify a current issue, and then asked them what would be useful to work on shifting in the session. Once the couple agreed to focus on an avoidant communication style of one partner, Mark then made use of the AI-EMDR model that had been taught in previous “Unleash” trainings. The ‘joint bridge’ was used to identify past targets of the clients, and BLS knee tapping was introduced by the observing partner.

Making one partner the ‘technology’ works two-fold – it creates a joining experience for the couple, fostering both vulnerability and connection, whilst also regulating and soothing both parties as they both experience the BLS together. The therapist leads the session as usual, but the couple hold the intimate space for the healing to occur together – they are doing the attachment and repair work simultaneously, bearing witness together, which was powerful.

Mark went on to use a ‘joint bridge’ with another demonstration, inviting both parties to ‘drop back in time’ with their current feeling, thought and body sensation, and then decided which of the two needed the processing for that session. This type of work requires intuition and experience, and Mark showed much skill and mastery to tease out what needed to be resolved to make a difference to the relationship.

As Mark stated, “EMDR separates out what needs to be separate, and joins what needs to be joined”, which is an apt way of describing the therapeutic dance to help couples bond and to feel close again.

Addictions: “Lifting the lid of the addiction, then processing”

The second half of training focused on addictions, adding more layers of complexity to the work. Astonishingly, excess alcohol kills more than three million people a year, worldwide. With this sobering statistic in mind, Annabel McGoldrick presented a protocol that distilled the work of Robert Miller (Feeling State Addiction), Arnold Popky (DeTUR), Jim Knipe and Laurel Parnell (Connecting the Consequences). Attention was also given to Prochaska’s Stages of Change model, and how best to work with the client depending on what stage of recovery they are at.

Addictions come in many forms (shopping, eating, sex, screen time, gambling, etc), so it’s important to look at the habit loop – the link between positive feeling and a memory of how to recreate a positive feeling. Dopamine is fired in the brain when the behaviour occurs, marking the memory as a feelgood experience. Over time, the feelgood memory also becomes locked in with embedded survival feelings, so the work of the addiction protocol involves ‘lifting the lid’ of the behaviour, so that the trauma underneath can be processed.

Clients starting therapy can feel anxious about ‘lifting the lid’, so installing a positive future image or goal can help to strengthen motivation and hope. If a future image is hard to elicit, asking the client to find a past image where they felt good and healthy might be useful too. This resource can be used or reverted back to after difficult sessions or life events.

Desensitising the ‘buzz’ is next, to neutralise the pleasure from the addiction memory itself. Identifying the best bit in the sequence of planning through to finishing the behaviour itself is key – the buzz sensation is linked with beliefs or thoughts about survival, feeling safe/bonded, successful or alive. Robert Miller calls these Assured Survival Feelings (ASF), and they act as a false positive cognition in the client. It’s important to shift the ASF to become a negative. The intensity of link between the addictive behaviour and the ASF, along with the body sensation, is then measured (Link of Positive Affect, or LOPA 0-10). This part of the processing is EMD only, without reprocessing – it’s important to note that the LOPA often increases before decreasing, and may shift to an unpleasant feeling.

Once this is established, the client is asked to check in on the urge or need for the feeling (ASF) itself (Level of Urge or LOU 0-10). This is desensitised too.

Targeting memories of recent using, the very best buzz/highs, and also the first time they got their ASF is important. This process needs repeating should the client have different ASFs for the same memories too.

AI-EMDR can be introduced once the EMD has occurred, by asking the client to identify the ASF, what it says about them, then using the belief, emotion, body steps to bridge back in time and find the early life targets to process. You can also ask the client to find the picture of the moment just before using if the conventional AI-EMDR approach isn’t working.

The addictions training could have taken the whole 3 days itself – it was multi-layered, complex and takes time to distill all the information that was delivered at a cracking pace. Annabel has managed to take the best bits of current addiction protocols and condensed them into a helpful script sheet, but more practice time was necessary to really get a handle of ‘lifting the lid’ to develop familiarity and confidence in this way of working.