The Positive Cognition and VOC

Shapiro states,

Once the negative cognition is identified, the positive cognition should be developed. The positive cognition is a verbalization of the desired state (a self-belief that is a distillation of the positive affects) and is generally a 180-degree shift from the negative cogni- tion. It is an empowering self-assessment incorporating the same theme or personal issue as the negative cognition. (2001, p. 136) The positive cognition gives hope and direction to the client, and implies that the person is larger than the “pathology.”

When clients state long-held and long-hidden secrets about themselves that they associate with the worst picture from the traumatic incident, they are opening up visual and auditory channels sequentially. It is my experience, in many cases, that when these two channels are opened up and activated, it means “the train has left the station,” as Shapiro puts it. When this is clearly the case, I may diverge from the procedural steps out- line by postponing getting the positive cognition and VOC at this junc- ture. (Remember, I made a list of the client’s positive cognitions during history taking, and I will elicit them again at the end of Phase 4.) I may omit the positive cognition in Phase 3 only after observing how my client processes — thus, I never omit it during the first protocol — and only when the client is already activated into state-dependent memory and has shown signs in the first protocol that the positive cognition and VOC cause deactivation. Then, in my best judgment, I deem it unwise to inter- rupt for fear of lowering arousal and slowing down the process.

In these cases I ask what emotion was sparked when the picture and negative cognitions were linked. I ask the client to rate it quickly on the

Phase 3 • 97

SUDS Scale. Then I ask about body sensations. Next, the moment the client is able to name the part of the body where he or she feels signs of increased negative arousal, I begin bilateral stimulation. Remember, though, that during Phase 1, trauma case conceptualization, I spend a good deal of time asking clients where they want to be and what they want to believe about themselves when the treatment is over.

Since my experience has taught me that some clients are already starting to become activated by this time, I interpret Phase 3 as the trauma activation sequence. I understand from Shapiro that the term assessment is used to connote a phase where a traumatic memory can be broken down into its component parts and some of those parts measured. This is in keeping with the scientific method. Measuring the distress level of the client via self-ratings that are taken before and after processing certainly seems like a sound idea. It also is a left-brain function, and, because of that, bilateral stimulation should follow, so we — clinician and client — want measurable starting points. The picture and negative cognition are right-brain activities, the positive cognition and VOC are left-brain, the SUDS level is both, and identifying the activated part of the body is a whole-brain task. However, I have found on occasion that stopping to ask for the positive cognition and VOC can interfere with the attunement I have established with my client by interrupting the activation of the mem- ory network where the trauma is stored.

Giving a specific case example is probably the best way to illustrate this. Ira is a 52-year-old laborer who lays ceramic floors. He has two teenage sons from his first marriage and has been married to his second wife for 4 years. Ira and his ex-wife have maintained a civil attitude since his divorce 10 years ago. When they were married, Ira used to go out several times a week to the bar to “have a few with the boys.” After the divorce, Ira started attending Alcoholics Anonymous, and he has been sober for 9 years. He was born Jewish but does not identify himself with any orga- nized religion.

When Ira was 12, he was having the traditional shaving cream fight that boys have on Halloween. He and his friends were doing this in the park near his house. A gang of Irish boys from another neighborhood showed up. His friends ran away, but Ira froze. The boys asked him if he was Jew- ish. He said yes. Then the boys beat him up and poured prune juice over him.

Ira entered treatment when his 12-year-old son started being a bully at school. Ira’s temper had gotten the best of him, and he had humiliated his son in front of other children. Ira saw that his rage was way out of propor-

98 • EMDR and the Relational Imperative

tion to the situation. Realizing that he had to address this issue, he sought treatment and was referred to me.

Phase 1 and Phase 2 took us 5 weeks to complete as Ira’s insurance coverage only allowed for single sessions. When we began Phase 3, Ira chose to work on the memory of the Halloween beating. His DES rating was low. The picture he chose was being surrounded by the gang while the biggest boy asked him in a threatening voice if he was Jewish. His negative cognition was I’m helpless. At this point, tears welled up and Ira started to shake softly.

We moved on to the positive cognition. I asked Ira, “When you bring up that picture, what would you like to believe about yourself now?

He paused and then said, “I’d like to believe that it never happened.” Now, during our orientation to trauma work in Phase 2, we had carefully gone over examples of positive cognitions and discussed how magical wishes would not help information processing. But Ira’s traumatic re-arousal was so great that his brain’s retrieval abilities were temporarily diminished, and he experienced being overwhelmed. He was unable to access his knowl- edge of how to formulate an appropriate positive cognition. After we talked together a bit, Ira stated a new positive cognition: I can take care of

myself. This took about 2 minutes.

Then I asked, “When you think about that picture, how do those words, ‘I can take care of myself,’ feel to you now on a scale of 1 to 7, where 1 is completely false and 7 is completely true?” Ira replied, “Do you mean can I take care of myself now?” I guided him back to the protocol and asked him to link the target memory with the positive cognition and rate how true the positive words felt when he connected them to the target memory. He paused and scratched his head. Eventually he looked up and said, “I guess about a 5.”

Next I asked Ira to go back to the target memory and connect it with the negative cognition (I’m helpless) and notice what emotions came up. He shrugged his shoulders. The tears were gone from his eyes and he had stopped shaking. He told me he did not feel much at all.

I think you can see my dilemma. Asking him to choose a target memory, a picture, and a negative cognition had “started the train down the track.” The associative channels in his brain were opening up. He was feeling sad and frightened, as evidenced by his tears and shaking. But when I asked Ira to formulate a positive cognition and give it a VOC rating, I was, in effect, asking him to put on the brakes, jump the right-brain track, and go into an analytical, left-brain mode. When he followed my instructions, he first had difficulty coming up with an appropriate positive cognition, and then he was tripped up by the wording

Phase 3 • 99

of my request for the VOC. He may also, as other clients have told me, have been confused by using a scale that works in the opposite way to the SUDS Scale and across a different range of numbers (1 to 7 instead of 0 to 10). Since this was our first active trauma-processing session, it was neces- sary to bring in the positive cognition and VOC. In future protocols, leav- ing this part out proved useful when Ira again became activated by linking the picture with his negative cognition.