Susan Kravitz and Katy Murray, the wonderfully effective stewards of the Southwest Washington Regional meeting, organized a training for EMDR therapists in Olympia, at which they played an audiotape of Andrew Leeds teaching about enhancing positive affect. (2007, Learning to Feel Good About Positive Emotions, from the 2007 EMDRIA conference worshop on the Positive Affect Tolerance Protocol) This is what I came away with:

People who were poorly attached to their parents, who didn't get appropriate mirroring of their joy and excitement, may grow up to be unable to tolerate the positive affects of happiness, joy, and excitement. They may have been punished for showing too much exuberance (a depressed child is a quiet child). Or there may have been so much abuse and/or mayhem around them that they learned that "if it's good now, it will turn bad soon."

When you do regular EMDR processing with these folks, you may clear the distressing events, but the relief that we see with other kinds of clients ends up distressing these dismissive attachment folks. If you try to do Resource Installation, having them remember a good or strong time, they fall apart, avoid it, or dissociate, because they don't have the neural hardware to tolerate and assimilate the joyful feeling. They have trouble taking in the good feeling of a compliment. (I've noticed that compliments are ego-dystonic for my complex trauma clients who live in deep shame.)

Leeds and his colleagues came up with a few ways to start building in the appropriate hardware. One is available to any kind of therapist, or anyone reading this blog:

  1. When you receive a compliment, maintain eye contact with the give and take a deep breath into your chest and diaphragm.
  2. Breathe the compliment into the area around your heart.
  3. Continuing the eye contact say, "Thank you. I appreciate you saying that."

Practice this in the session. Have the client give you a compliment, twice, warning him or her that you will turn it down the first time, then accept it. Then give them a compliment and have them take it in say the words. Assign responding to compliments for the next week, (or the rest of their lives) and reporting to you about it.

The next part is for EMDR therapists:

Target moments of positive affect, using a slightly modified Standard Protocol: the Positive Affect and Integration Protocol.

Ask the client for "a recent moment of poorly tolerated shared positive feeling".

There are a few changes in the protocol:

  1. The target is a 'feeling state' from a recent experience (not an old memory).
  2. It's the discrete behavioral state shared positive emotion, not the event itself.
  3. You're going for a small change, only lowering the SUD 2-3 levels, and not for a 0 SUD, so only 3 to 5 sets of eye movements are used.
  4. If the client comes up with a positive cognition, and no negative cognition: good! Then skip the negative cognition. Again, you're only going for a small change in the VoC, the validity of cognition.
  5. You might want to change the SUD scale to a negative/positive scale.  Completely Distressed is negative 10, completely joyful is positive 10.
  6. If distressing memories arise, acknowledge them for future processing, but don't work them: go back to the original target of shared positive affect.
  7. The closure phase may be longer and may use your entire toolbox of calming and containing exercises, until the client is "tucked in" and ready to go out into the world.

Of course, it was much more complicated, with descriptions of how people develop dismissing insecure attachment, case histories, and some practica. Leeds said that he saw big changes in his clients' ability to tolerate their positive affect in five or six sessions. I'm looking forward to trying it with my complex trauma clients.

Other ways to build positive affect tolerance, laughing with clients. Sharing their good feelings in obvious ways: mirror smiling and eye contact. Show delight in their delight and talk about it (ala Diana Fosha): "What was it like for you when we laughed together?"  "What was it like for you when you noticed that I noticed your happiness today?"