The Negative Cognition

In the previous section, I discussed how specific the picture that goes with the targeted memory should be. The bottom line is that the picture needs to be detailed enough to cause activation of the associated negative cogni- tions, disturbing emotions, and body sensations. Once the picture has been identified, it is time to look at the negative judgment that the person has made about himself or herself as a result of the traumatic experience being targeted. Patterns of cognitions — derived from the history taking — may become clearer. For the client, one of the best ways to come up with a negative cognition is to state a long-held and long-hidden “truth” about himself or herself, related to the picture of the memory. If the clinician has established a solid relationship with the client, the client will feel safe enough to share this often shameful belief.

The negative cognition may be held in an age-dependent way. Consider how old the person was at the time of the trauma. Knowing this will give the clinician a clue about how much psychosocial development (with its attendant learning as well as neurological development) the client had achieved before the trauma. A typical negative cognition at the beginning of treatment for a client who was sexually abused as a young boy may be “I am to blame.” For example, a young boy who is subjected to sodomy by

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a relative when he is 6 will not have the neurological development or life experience to “know” that he is not to blame.

Other things to look for include the theme(s) in the client’s life that arose from this dysfunctionally stored memory. Does the client show signs of believing that he or she will never heal, for instance? Does the client believe he or she is “damaged goods”? Note whether the negative cognition varies. What is it now as opposed to then? If the memory is state specific, the evaluations, emotions, and sensations will be stored in episodic memory with linkages to the implicit memory networks.

We use the word now when asking the question, “What words go best with that picture (or incident) that express your negative belief about yourself now?” The word now has been a source of confusion to many clients when they begin EMDR treatment. The word is used because state-dependent memory is held in the present but is not acknowledged as such. As was discussed in Chapter 5, this point needs to be made to the client in Phase 2, with examples and explanations, as part of the orienta- tion to active trauma work. It cannot be emphasized sufficiently that the client and clinician are working with state-dependent memory during the trauma-processing phase. It is also crucial to remember that, according to the adaptive information processing model, there is an inherent part of ourselves that strives toward self-healing. (This construct, based upon Shapiro’s observation of the equivalent physiological process, states that the organism, when unfettered by traumatic blocks and genetic limita- tions, will transform to greater and greater levels of complexity.) “In this way,” says Siegel, “living systems are open systems capable of responding and adapting to the environment.” As Siegel defines the scope of his thesis, he says that he draws from a “variety of related theories,” including the information-processing theories of “parallel distributed processing” or “connectionism” (1999, p. 215).

An important point must be made here. The negative cognition will largely depend on what state dependent memory network was activated, so a variety of responses can be expected. The most important thing to notice is how the client has become activated. For example, do tears fill the client’s eyes? For a client with blocking beliefs about letting go, I sug- gest closely watching the jaws and the breathing. A tight jaw and shallow breath are indicators of activation. Changes in breathing patterns are especially important indicators for clients who present with panic disor- der. Every clinician treating panic-disordered clients should take the time to learn about breathing physiology.

Determining the negative cognition is not as easy as it may sound, even if the client appears to understand the concepts and demonstrate them as

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well. A client in Phase 2 may have demonstrated an understanding of the principle of linking the picture of the traumatic event with a negative self-belief. But in Phase 3, the client may block upon hearing the word now

when you ask, “What words go best with the picture and express your belief about yourself now?” Many clients reply by asking, “Do you mean how I feel now?” (There is general cloudiness in everyday language about the distinction between thoughts and feeling states.) Other clients will ask, “Do you mean do I still believe this irrational belief?” (Of course, the answer is that the person still does believe it — but not with the thinking left brain. The client believes it because it is still deeply imprinted in the traumatic memory.) It is this deep imprinting that thwarts response flexibility in traumatized humans. Many clients seem to have habituated to partitioning their outer and inner worlds into the sharply divided now and

then. In state-dependent memory there is no little neurobiological then, it is still now.

When this occurs, the clinician, as educator, needs to clarify four points for the client:

1. The client is finding a belief, not a feeling.

2. This belief, although it is part of state-dependent memory, is happen- ing right now in a number of old circuits in the brain.

3. We say “now” because we are speaking to those circuits. We need to reroute them to the present day in order to work on them.

4. From a relational point of view, the clinician acknowledges the diffi- culty of asking the client to accept the clinician’s language, instead of staying with the client’s own. I have found that when I explain this duality (and use copying a CD on the computer as a metaphor), clients usually are able to “get” it. Still, I need to remember that my cli- ent is filled with negative arousal so that my explanations may be diffi- cult to encode and to retrieve.

Once these points have been explained, the clinician again asks the client to bring up the most disturbing picture and to notice what negative self-beliefs he or she has in relation to it. If necessary, the clinician can help the client formulate a negative cognition based on his or her spontaneous utterances during history taking. These core negative self-judgments are also embedded in the client’s worst memories, and as the clinician listens to the client’s stories and observe his or her body language, schemas (such as vulnerability to harm or unrelenting standards) will become clear. The demand characteristics around which the client has organized his or her life will come into view. (Young’s Schema-Focused Questionnaire is excel- lent at pinpointing where the client is at risk in this regard.) Then the

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clinician can consider this question: Of the schemas observed during the history taking, which negative self-judgment strikes both me and my client as the most representative of this emotional pattern?

The degree to which the client is unable, after an adequate period of preparation, spontaneously to articulate a self-referencing negative belief may signal not just dissociation but also the degree to which he or she is apt to have further dissociative experiences during processing. Given that dissociation occurs on a continuum, a client who needs little clinician assistance in determining a negative cognition is likely to have only a mild dissociative reaction during processing, and vice versa.

If I judge that dissociation is the reason why the client seems unable to re-associate the target picture with a negative self-belief, I presume that he or she has already become activated and that activation has caused him or her to dissociate. (This can happen even with people who have low scores on the DES.) In this case, I use the negative cognition question as a diag- nostic tool to discover what has been too much for the client to handle. I do not believe that clients shut down, become confused or distracted, or use diversion explicitly. Trying to link the earliest or worst picture and its related negative cognition may have sparked a distressing feeling state, re- associating the client to the traumatic experience too intensely and causing an activation of dissociative defenses. Remember, the original trauma may have been accompanied by partial or full-blown dissociation.

This situation does not rule out doing active trauma work. However, it must be noted, understood, and taken into consideration as the clinician continuously evaluates the client’s readiness throughout the launch sequence. It is important to keep making this evaluation in the moment, because it may be at odds with the clinician’s overall evaluation of the client’s readiness to do active trauma work. In Phase 2, the client may have gone through all eight steps of the Safe Place exercise, but he or she needs to feel safe now, at the start of re-experiencing the trauma. In case of inter- personal trauma, there was often no choice but to dissociate, or so the immature brain of the developing child decided at the time. In choosing to re-experience the trauma, there is a price to pay. The client may experience a fully activated neurobiological state and abreact the trauma before becoming desensitized to it. (This is a point where the positive cognition serves as a valuable resource for hope. It gives initial direction and reminds the client that he or she is bigger than the “psychopathology.”). This is also the time when the clinician may be the strongest resource the client has when they are in a state of mental state resonance.

If a client cannot articulate a negative cognition, yet the clinician still believes he or she is ready for EMDR, the clinician can bring out the list of

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generic negative cognitions in Shapiro’s first book and ask the client which statement resonates the most or “feels most true.” (This may be akin to Perry’s example of “feeding” the client).

As discussed earlier, the clinician serves as the container for the client during trauma work. When a clinician shows a client the list of generic negative cognitions, for example, he or she is helping that client be in an organized, secure, attached relationship with the clinician. In fact, one of the chief goals of practicing EMDR relationally is to enable the client to have an organized, secure attachment relationship with the clinician — in contrast to the disorganized insecure attachments the client most likely had in childhood.