Our book group has just finished Solomon & Siegel’s Healing Trauma: attachment, mind, body, and brain. It is one of the most difficult books I’ve read, and quite rewarding. The first four chapters by Dan Siegel, Hesse/Main et. al, Allan Schore and Bessel van der Kolk speak to research about the interactive nature of attachment/brain growth, and the necessity for those interactions for we humans to learn to regulate affect, connect to others, grow empathy, and more. We just finished the last four chapters, which describe four different approaches to therapeutically moving the "small-t" traumas that created the disordered attachment. See January 14 & 28 posts for more detail.
Francine Shapiro writes about EMDR and its Adaptive Information Processing Model. She is the founder/discoverer of EMDR. Her rigor in pursuing research and holding EMDR therapists to researched interventions has given EMDR iron-clad credentials in the therapy world including acceptance by the APA, DOD, VA, and many other credentialling bodies and insurance companies. In her chapter Shapiro describes how EMDR works: "The goal of EMDR therapy is to forge new connections between the unprocessed memory and more adaptive information that is contained in other memory networks." (p. 199) and ". . . EMDR catalyzes a learning process and metabolizes the experiential contributors to clinical problems. (206) She presents a case of a "large t" trauma, resulting in Post Traumatic Stress Disorder, in an earthquake survivor, and the trauma’s ties to childhood themes of lack of safety and chaos. Then she tells of an amazing case, a 14-year-old guy with a "classic attachment disorder" who avoided eye contact, touch, and social contact. "EMDR was used to target the anger he felt toward his parents. During the session, he remembered. . . being dropped off at a day care center at 3 years old. There, he became terrified that his parents were never coming back. The experience of that day was locked into his system, and he kept people at a distance. Processing was rapid because Todd had a loving home and many other positive expereriences in multiple memory networks. As the negative experience was integrated, associative links were made to these other memories, and Todd became a loving and affectionate child." (210) If Todd had been neglected and abused for years, treatment would have taken much longer. After 13 years of practicing EMDR, I’ve cleared hundreds of attachment-related injuries in clients. I’ve seen people lose their "Axis II" diagnoses, and become able to connect, self-regulate, have boundaries, and come to positive affect (happiness), when they didn’t have it before.
Diane Fosha’s chapter is "Dyadic Regulation and Experiential Work with Emotion and Relatedness in Trauma and Disorganized Attachment". Fosha, a scary-good clinician developed accelerated experiential-dynamic psychotherapy (AEDP) marrying attachment/relational sensibility/techniques to Davanloo’s short-term dynamic psychotherapy. AEDP includes intentional use of the therapist and the therapist’s affect to move the client along, direct attack on defenses, and absolute containment at all times. I’ll talk about it more next month, when our group reads Fosha’s book, The Transforming Power of Affect. Let me give you the headings in her case example: Setting Up the Focus of the Work; Identification and Clarification of Defenses Against Affective Experience; Experiential Work to Deepen the Visceral Experience of the Categroical Emotion of Anger: The Emergence of Fear; The Breakthrough of Fear; Corrective Experience: Affirming the Patient and Taking Off the Pressure. (That’s one session!) In the next session: The Subsiding of the the Fear, the Operation of the Reflective Self Function, and Accessing of Emotional Resources; The Undoing of Dissociation: Adaptive Access to Anger; then Outcome. So Fosha helps clients go from Defense to Core Affect to Core State, masterfully. More next monthabout her.
Robert Neborsky’s chapter is A Clinical Model for the Comprehensive Treatment of Trauma Using an Affect Experiencing-Attachment Approach. He speaks of the difference between a recently traumatized person with good attachment, (distressed, but metabolizes the experience and moves on) and a person with poor attachment, in whom old defenses and old emotions are activated, and not regulated nor cleared. Neborsky, another student of Davaloo’s, states that short-term dynamic therapists believe that "the patient must experience his or her genuine feelings from the past in the present." (292) He adds his own component that "a patient leaves the intitial interview with a coherent narrative of the origin of his or her psychopathology." (293) He explains the STDP model, his additions and presents an edited transcript of 6 hours of therapy with insecure attachment. His full-bore attack on the client’s defenses was amazing, as was the connectedness he kept, throughout.
After reading Fosha’s and Neborsky’s chapters, I noticed that I was confronting my (non-DID) clients’ dissociative responses more directly and more clearly ferreting out the affect that underlied the dissociation. It worked wonderfully with four different people. (I wish I could say more on a public blog!) I noticed that Fosha and Neborsky get to the same place as EMDR does with their therapies. They go for the cognitions, the affect, the body feeling, and make people talk about it. I think that the "dual attention" in their work is the therapeutic relationship. EMDR ought to take place in the context of a good therapy relationship. It works better if it does. And I know a few people, intense relational holders, who sometimes drop the bilateral stimulation, they can "fosha" a client with their connection, and lead them through to what Francine Shapiro calls : "The basic goal of treatment, to acheive the most comprehensive effects possible, in the shortest period of time, while maintaining stability, within a balanced system. This goal is achieved when the distressing memories are processed and integrated withing adaptive memory networks, and when all past, present, and future aspects are addressed." (202) It’s nice that there are many paths to the river, all using affect, connectedness, and here-and-now orientation to get there.