In Support of EMDR Online – an Internet Discussion

With thanks to my EMDR Consultant colleague Deb Fish for the following article, summarising an online discussion of using the internet and video-conferencing for remote, online EMDR with clients. We spoke in November 2017, and the article appeared shortly afterwards in the house journal of the EMDR Association UK and Ireland EMDR Now.

(Deb works in private practice, and also for the NHS in Dorset, within secondary services, and fuller summary here Some key points from EMDR Online discussion Dec 8 2017.)

EMDR ONLINE DISCUSSION

In response to a Jiscmail question for do’s and don’ts when offering EMDR therapy online, Mark Brayne, EMDR Europe Consultant, kindly and very deftly organised and chaired a well-structured and informative online discussion – in the process introducing most of the participants to the professional, online platform, called Zoom.

Seventeen EMDR therapists (one of whom was based abroad), participated in this event, with varying ranges of experience and qualification – from the very recently trained to (mostly) accredited Practitioners and a sprinkling of Consultants.  Some were venturing into online EMDR with trepidation, focusing upon resourcing, whilst others were enthusiastic and experienced, with many successes behind them.

To briefly summarise key points discussed:

To offer online EMDR therapy or not?

Online EMDR therapy can offer clients more choice, as it helps overcome geographic and logistical constraints.  Whilst some therapists might find it less satisfying than in-person sessions, it can nonetheless feel very close and intimate, and from a client’s perspective facilitate an effective treatment outcome.

As with in-person EMDR therapy, client readiness, stability and risk need to be carefully assessed, to determine the most suitable treatment option.  For containment, the client needs to feel safe both with technology, and relationally.

What online platform to use?

Although Skype is familiar to therapists and clients, with encryption now acceptable to the UKCP, the connection quality can be inconsistent.  Skype also uses more bandwidth than Zoom and VSee, which can be problematic at midday, for those in countries such as Germany and Finland.  WhatsApp is encrypted, and popular with younger clients, although it too can have variable quality.  Facebook and Facetime were considered less appropriate, although professional and personal accounts can be separate.

What form of bilateral stimulation to use?

The participants had tried and tested various options including: the butterfly hug, asking clients to tap on their own knees or the table in front of them (with eyes following from side to side).  Some watched a moving dot via YouTube on a phone or tablet app.   Others used headphones, with the client stopping and starting BLS from an app such as BSDR Player.  With couples work, clients could face each other and do knee taps.

How to get started?

It is essential for your technology and apps to be up to date, and to be able to coach a client to use a particular system.  For professionalism, consider what will be visible around you, for a neutral backdrop.  Also, is the telephone your standby plan, if needed?

Address safety procedures and expectations for treatment.  Find out specifically where the client will be located during the session, what equipment they plan to use, the size of screen, how uninterrupted confidentiality can be ensured for the session, as well as space for them to quietly unwind afterwards.  You might also want an agreement with the client not to record or share session content with others, e.g., via social media.

What about professional liability insurance?

Check with your own insurer if you are planning to provide online EMDR therapy.  However, Towergate include indemnity for online clients in the UK and abroad, provided the therapist is UK-based.  Balens also cover online work, although they exclude clients in the US and Canada.

Additional considerations to explore:

  • If working internationally, might you be liable for tax in the jurisdiction where the work is being done?
  • One participant recommended the Association of Counselling and Therapy Online as helpful for best practice guidance: https://acto-org.uk.
  • If the client were to dissociate how could you deal with it?

The consensus was that this event was engaging, informative, motivational and validating.  Thanks to online technology and Mark Brayne’s generous involvement and expertise making it possible, we were able to feel connected, despite being geographically dispersed.  Thanks to everyone who contributed to this stimulating discussion.

 

First Annual Conference of the Parnell Institute: Laurel inspires in the Californian Redwoods

Mark Brayne with Laurel Parnell in the glorious Redwoods of Scotts Valley.

More than 100 delegates from across the US met for the recently established Parnell Institute’s first Annual Conference held at the 1440 Multiversity Conference Centre deep in the majestic redwoods of California’s Scotts Valley, just south of San Francisco. Mark Brayne, an EMDR Europe Consultant and Parnell Institute Facilitator, reports on the proceedings

The choice of venue could not have been more appropriate. Named for the 1440 precious minutes that make up each day, the 1440 Multiversity enabled us to use our time well, with plenaries and workshops facilitated by Dr Laurel Parnell, my now-fellow PI trainers and facilitators, and also Somatic Experiencing luminary Maggie Phillips.

Themes explored ranged from the body and spirituality in EMDR and the challenges of working with gender identity, and from how with EMDR we can rewire how dysfunctional early attachment experiences are stored in the brain to processing the primal wound of adoption and strategies for when an EMDR session “goes south” as the Americans say, or off the rails.

As many readers will know, I am an enthusiast for Dr Parnell’s model of what she calls Attachment-Focused EMDR, emphasising the importance of resourcing clients not just with a safe or calm place but also with Nurturing, Protector and Wise figures, allowing for simple modifications to Phase Three of the Standard Protocol, and encouraging the forensic and central use of bridging (which some prefer to call floatback or the affect bridge) for identifying the target memories that most effectively shift dysfunction.

My enthusiasm for her work has led me to bring Laurel Parnell to the UK where, over the past three years of our work together, she has trained more than 200 practitioners in an approach which has, it has to be acknowledged, attracted criticism from some quarters for perceived deviation from the Standard Protocol – a discussion perhaps better left to the EMDR UK & Ireland Association’s 2018 Annual Conference next March where I’m presenting a paper to explore this more fully.

EMDR, as I believe we all understand it, involves – after establishing safety in the therapeutic relationship and resourcing the client appropriately – accessing first of all a distressing memory which generates a presently held level of disturbance, identifying the components of image (if possible), cognitions, emotions and body sensations.

Then, simply summarised, EMDR Therapy stimulates this disturbing memory bilaterally using Dual Attention, facilitating clients’ awareness during their processing of the present as well as the past.

The aim, when done well, is to access and integrate the felt right-brain and often limbic-system memory – somatically in terms of subjective disturbance, and psychologically in terms of meaning – and in effect liberate clients from their traumatic past.

As our Association President Derek Farrell has helpfully phrased it in a JiscMail discussion, all the rest is detail.

Laurel in full cheerful flight at 1440 Multiversity, California.

Dr Parnell now has a richly-skilled team of colleagues helping her deliver her EMDRIA-accredited Parts One and Two trainings in the US, as well as the Part Three Advanced EMDR workshops she also brings to the UK, and in many a spirited and inspiring discussion in the Californian redwoods, we discussed the essential importance of new trainees internalising the standard procedural steps of EMDR, rather as anyone learning to dance properly must have the basic rhythms of Salsa, Lindy Hop, Waltz, Foxtrot and the rest, without which dance can be a mess of spills, confusion and trodden toes.

There was so much to find stimulating; here a few of the gems I brought home with me:

  • How, with proactive and imaginal interweaves at appropriate moments in Phase Four processing, a client-attuned EMDR therapist can help a client creatively repair even the very earliest attachment wounds. She can ask for example what the child ego state needs at critical moments of remembered trauma, and invite the client to imagine that different, warm, supportive, protective experience – with help if necessary from the imaginal resource team tapped in/installed earlier in Phase Two preparation. It doesn’t change what happened, but it can profoundly change how that experience is remembered in the brain.
  • Successful therapy relies not just on what the therapist does and what the client says, but how the client talks and what they do inside their bodies. We can search for more nuanced meanings – for example the sorrow in sadness;
  • From Somatic Experiencing, the extra question: ‘How present ARE you?’ ‘How do you know you feel distressed?’ Or, when relaxed, ‘How do you know it’s pleasing to you?’ The explicit reconnecting of body and mind with the goal of therapy, restated at the beginning of every session, can make such a difference.
  • Orient to the body, and – such a lovely interweave – ‘Bring your awareness to what you’ve just said, and let’s spend some time (or just hang out) with that.’
  • And, how about just inviting a client to ‘Notice your adult body,’ or to ‘Let that thought/awareness seep into your body like a slow rain…’
  • At the end of a powerful session, therapists might offer to place their stockinged feet gently over the client’s feet to ground them back to present reality – tender, and powerful.
  • Or to regulate arousal, clients might be encouraged to press their knees outwards with the palms of each opposite hands. Or, when processing, to stand up with tappers/buzzers under their feet.
  • And did you know a basic fact of evolutionary biology, that females when in danger orient to a person, where males orient to the source of the danger? Makes sense, but it was new to me.

The setting at Fourteen-Forty as the locals call it (financed by the way by a seriously rich internet power-couple from Silicon Valley just up the road – this is after all California) inspired us to think bigger, to revel in the power of the imagination.

Many of the techniques advocated by experienced trainers and facilitators seemed to have at their roots a wonderful and liberatingly holistic view of life, of the true nature of our mind-bodies or body-minds.

At the heart of attachment rupture is a splitting of that body and mind, and Dr Parnell’s Attachment-Focused EMDR has become, to me, a central and powerful way of using our amazingly powerful therapy to facilitate the essential repair work of trauma therapy.

EMDR and the Transpersonal

A weekend workshop for Qualified Professionals

Friday June 23 –  Sunday June 25 2017

The Turning Point, Sheringwood, Norfolk, NR26 8TS

EMDR – Eye Movement Desensitisation & Reprocessing – is one of the hottest and best-researched new approaches to psychotherapy, recommended for PTSD by organisations around the world.

What’s less well known is how perfectly EMDR, with its understanding of trauma and neuro-biology, meshes with the transpersonal and the relational in psychotherapy, and how powerfully it can enhance an integrative, person-centred approach to healing.

In this first-of-its-kind workshop, EMDR-Europe Accredited Consultant and Parnell institute training facilitator Mark Brayne from the Centre for Counselling and Psychotherapy (CCPE) in London offered 16 psychotherapist colleagues, all but two already trained in EMDR, an introduction to how EMDR with a transpersonal and attachment-focused dimension can enhance and support their own work with clients and patients.

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The weekend was introduced and hosted by Annie Lloyd, also ex-CCPE, in her stunning new training venue, The Turning Point, in the woods above Sheringham on the beautiful North Norfolk coast. Annie brings her own transpersonal perspective on the role of safety and mindfulness when working with complex trauma.

The weekend included presentations, group discussions and pairwork – and some fabulous cooking from Annie’s partner Katrina Cole…

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The Turning Point is a therapy centre where animals are used for limbic system support – and Alfie the Great Dane was a star…

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COST was £225 including CPD certificate, and light meals/refreshments.

See also www.artismedicine.co.uk and www.annielloyd.co.uk

 

Facilitator Training in preparation for September

AF-EMDR Trainee Facilitator team, London April 9 2017 – from l to r: Iram Shah, Mel Temple, Alison Teal, Jutta Brayne, Annabel McGoldrick, Mark Brayne, Jayne Averill-Smith, James Thomas, Joe Kearney, Gerry Virgo, Shawn Katz.

Gearing up for Laurel Parnell’s September trainings in the UK in her attachment-focused EMDR model, we’ve had a first-class day in London in partnership with Laurel’s West Coast colleague Alison Teal preparing our team of AF-EMDR facilitators for the trainings in York and London.

With commercial EMDR trainers in the UK focusing their efforts and marketing largely on basic training, and with other senior EMDR folk and regional groups offering only sporadic weekends of CPD, there’s a real need in the UK for post-basic training that equips therapists to use EMDR with more complex client presentations.

And that’s the gap we at EMDR Focus are aiming at least to begin to address, in partnership with the Parnell Institute in the US.

As all of us agreed with our half day of discussion and half day of role play facilitation, the basic EMDR training in the Standard Protocol is brilliant as far as it goes – but evidence-based as it is only for single-incident adult PTSD, it leaves many practitioners thirsting for support on how to use EMDR with more complex, attachment-based and often even pre-verbal trauma.

So, with our enthusiastic and fast-evolving team of colleagues from London, the English North-East and the East and South coasts, we hope to build and grow safe learning spaces where EMDR therapists keen to go deeper can practise new skills in working with flexibility with the most complex range of client presentations.

Thanks to the team – and with hopefully a couple of more practice runs before Laurel is with us in the last 10 days of September, we look forward to delivering our EMDR therapist colleagues a first-class attachment-focused experience in September.

 

Parnell on the way, and new focus for Focus

After 18 months of silence on this blog, it’s time to update briefly with the exciting news that Laurel Parnell’s workshops in September this year are already filling fast, with York generously over-subscribed (sorry to those who are missing out) and London heading over the half-way mark towards our max of 150 delegates.

The enthusiasm among our EMDR colleagues in the UK to learn Laurel’s attachment-focused way of using EMDR is most gratifying, given also the reservations some in our community have about whether her modified protocol is kosher, with its simplification of Phase Three assessment and special emphasis on resourcing, interweaves and structure.

It’s good to see the future of the Standard Protocol high on the agenda of this week’s annual EMDR UK and Ireland conference in London, since without flexibility and innovation, all models of therapy risk atrophy and marginalisation.

Occasional or indeed regular visitors to our EMDR Focus website might notice that the design is changing – and will do so again in the near future as we switch to a self-hosted site – and that with the help of our colleague in the west country Justin Havens we’ve added the legendary Sandra Paulsen to our gallery of global EMDR experts.

With Laurel Parnell, Jamie Marich and Jim Knipe as well as our growing team of UK-based facilitators and supervisors (watch this space) we hope that EMDR Focus will with time develop into a portal to connect colleagues to the very best expertise in bringing EMDR to bear on the widest range of clinical presentations in psychotherapy, complex as well as simple.

To which end, if you can’t make Laurel’s training in September, there’s still space on Mark Brayne’s Transpersonal EMDR weekend in glorious North Norfolk from June 23 to 25 (here’s an article explaining the focus), and at Jamie Marich’s day on EMDR and Mindfulness in London on Sunday April 23.

And don’t forget either the opportunity to hear Jamie explain how to Make EMDR Simple and use it with every client, at our EMDR Association East Anglia regional networking day at the UEA in Norwich on April 22.

If you like what we’re doing, let us know and we look forward to seeing you at future training events.

If you don’t like what we’re doing, all the more, let us know and give us your feedback, and we invite you with equal enthusiasm to join us and explore where we can make EMDR sing for our clients.

Unleashing EMDR, London, Round One

20150913_112531_HDRDr Parnell’s first two long-weekend Unleash your EMDR trainings in London on working at depth with complex clients were a resounding success, with enthusiastic feedback from the total of 72 participants.

Working with rich imaginary figures of protection, nurture and wisdom, with a highly effective bridging technique to identify key past experiences still affecting a client’s present life, and with proactive interweaves, trainees quickly found that targets, as they’re called in EMDR, can be resolved completely and effectively in a sometimes astonishingly short time.

As one participant emailed after the course was over:

I attended on the first weekend and from the Monday morning started working differently with my clients. Even in one week the benefits I am seeing are amazing.

Using the nurturing, protector and wise figures really helps the clients and they are reporting spontaneous ‘appearances’ of the figures when needed in their lives.

I’ve also felt at ease with myself to interact with the clients differently and use their imaginations more to great effect.

I understanding bridging much more and using it again to great effect, along with a diagram now to keep track of the memories that come up, ensuring they are all cleared and then future template.

I had times before when I was lost in the memory chaining. Going back to target more frequently is also really working, something I didn’t do as much before. I feel as if I have had an ‘advanced’ EMDR course that has improved my knowledge.

This is the only course I have been on and started using my learning straight away, so thank you once again. I look forward to her coming back.

The trainings were held at the Centre for Counselling and Psychotherapy Education (CCPE) in the heart of Little Venice in West London, and while the stairs in a 19th century building without lifts were something of a challenge, even the second weekend’s top-floor training left most participants buzzing with equal enthusiasm.

IMG_20150907_164945It wasn’t all hard work, though – with US-based Facilitator Harriet Sage and with Mark and Jutta Brayne, Laurel got to visit the BBC Proms with a programme of Russian music courtesy of the St Petersburg Philharmonic – standing room tickets in the Arena for just £5 though involving some hard sitting for a couple of hours in the Albert Hall queue.

We’re enormously grateful to Laurel and Harriet for spending these inspiring days with us, and now look forward to her return in Mach 2016, for two more weekends of Unleashing EMDR – courses expected to sell out as quickly as these September ones did.

If interested, join up soon….

Unleashing our EMDR

We’ve been having an exciting time with Laurel Parnell this long weekend at the CCPE in London, as she introduces 36 enthusiastic and experienced EMDR therapists to ways of unleashing their work-in-depth with a new understanding of attachment and deep processing.

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Dr Laurel Parnell at work in London

EMDR is increasingly evidence-based as a therapy of choice in addressing and clearing the symptoms of Post-Traumatic Stress Disorder – but as we’ve been hearing this weekend, when used in a client-focused and undogmatic way, it is also brilliant at drilling into the deepest roots of childhood distress, and releasing trauma that can have been locked into the system for a lifetime.

There are those in the international EMDR community who challenge Dr Parnell’s way of working as somehow “not authentic EMDR.”

We can only recommend that sceptics experience her training and this way of working themselves to clear misunderstandings about how powerful and appropriate this work can be for the widest range of clients.

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Dr Laurel Parnell teaching in London, CCPE Sept 2015

With 36 more coming in a week’s time for a reprise of the same approach to Unleashing their EMDR, we look forward to establishing Dr Parnell’s way of attachment-focused work securely in the mainstream of trauma therapy in the UK and the wider Europe – as we’re confident will happen.

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Dr Laurel Parnell lecturing London Attachment-Focused EMDR