Clinician, Know Thyself — and Thy Methodology

Clinical experience indicates that it is best to allow the neurophysiological processes that have been jumpstarted to do the healing. As Shapiro puts it, as long as the train is moving down the tracks, the clinician should stay out of the way and let the client’s brain do the work. This is very empower- ing to the client and very validating. It is also an amazing experience to behold.

In and of itself, the experience of safely releasing one’s state-dependent memories in an atmosphere of support and compassion is very healing. But that is not the end of the story. Many times I have seen clients spontane- ously link to the adaptive perspective, coming to far different conclusions about the traumas they suffered without my intervention. These are awe-inspiring moments. They make all of the preparation work worthwhile.

The clinician’s self-knowledge is as crucial in Phase 4 as it is earlier in treatment. While the client is processing, the clinician has to be continu- ally aware of anything else that is occupying his or her own mind. Is the clinician fully present? Is the client’s abreaction affecting him or her? If so, how? Is one of his or her own state-dependent memories being activated? (This situation will be covered in detail in Chapter 8.) Is the client’s trauma so horrific that the clinician is becoming vicariously traumatized? Knowing how clients react to the protocol and knowing oneself will help the clinician tell when he or she is being triggered. When misattunement occurs, trauma processing may become corrupted by either client or clini- cian, and it is time for more active therapeutic strategies. By corrupted, I mean that the process goes off track, with the client flooding or shutting down. Even when all the preparatory work is done carefully, the clinician cannot know what is in the client’s Pandora’s Box. Once that box has been opened via the procedural steps and bilateral stimulation, the clinician sometimes just has to hang on for the ride.

Another issue is that no matter how much I prepare them, I find that most of my clients still attempt to direct their thoughts and make some- thing happen during processing. I guess that is part of human nature. When they experience difficulties, I assure them that this is common. (I mention this as a possibility during the preparation phase.) I then guide them back to a place of just noticing. Now that the train is moving down the tracks, they are the passengers watching and experiencing the scenery from the safe vantage point of being in my office. I use the expression “tick-tock-time” to differentiate the now of the literal present from the

now of state-dependent memory. Once they “get” it and let go, processing

usually proceeds.

Clinicians can corrupt the process in two ways. First, they may become activated by their own unfinished work. In that case, admitting that some- thing got in the way and processing the client’s reactions through a rela- tional interweave will usually get things back on track. I will discuss this further in Chapter 9. For now, suffice it to say: How many trauma victims have you known who had the good fortune to have their perpetrator realize in the middle of an unconscionable act that he or she was doing something wrong and immediately stop and make amends?

Second, the clinician can corrupt the process through faulty judgment or insufficient knowledge of EMDR. The clinician may feel the need to break into the client’s abreaction and comfort him or her, or feel the need to say something to show how insightful he or she is. I do not know the extent to which this happens, but I do know that it does. An ethical clinician, realizing this error, will seek an Approved Consultant (a title conferred on

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an EMDR clinician by the EMDR International Association who has met certain rigorous requirements) for further training. (This title is relevant to those practicing mainly in the United States and Canada.) However, once the EMDR clinician has become proficient in the methodology, the clinician’s issues are the source of most difficulties.

EMDR clinician Bennet Wolpert (personal communication, Dec. 14, 2004) states

After many years of doing clinical consultation (in EMDR), it is remarkable how infrequently it is simply lack of technical ability that hampers the experienced (EMDR) clinician. The problems are more likely to be found in the demand characteristics of the rela- tional context between them. In this moment of encounter, where the therapist has ‘reacted TO the client’ the problem is revealed and so is the potential solution. That is, if the clinician can access their internal processes. For it is in these moments that a therapist has the greatest opportunity to create both the most powerful and meaningful interventions. It is in this contextual space that the therapist truly ‘knows the client’ and themselves because they have allowed themselves to be acted upon, and have experienced their own personal reactions to the clients emotional intensity and pain. This moment is the essence of psychotherapy.