Defense and phobia in complex-traumatized clients - Defense and affect restructuring with EMDR therapy (Leeds)

Defense and phobia in complex-traumatized clients - Defense and affect restructuring with EMDR therapy

Survivors of persistent neglect and abuse develop insecure and disorganized attachment systems leading to an increased vulnerability to adult psychiatric problems including disorders of structural dissociation (DID, OSDD, DESNOS and PTSD) as well as personality disorders. The standard EMDR protocol for PTSD may not be suitable in the early stages of therapy for many of these individuals. However, a number of modified EMDR procedures can be helpful throughout their therapy, not only for simple ego strengthening – such as with Resource Development and Installation – but for a variety of therapeutic tasks which include: to increase presentification, capacities for basic self-care, and mentalization; to develop affect tolerance and management skills; to restructure defenses; and to improve interpersonal relationships.

In addition to “external phobias” and triggers, a number of “internal” phobias affect survivors of persistent early neglect and abuse. These include affect phobias, phobias of attachment, phobias for trauma derived mental actions, and phobias for structurally dissociated parts of the personality. Modified EMDR procedures can be applied to these internal phobias to assist patients in repairing developmentally frozen self-capacities.

These “internal” phobias may also be described as psychodynamic or dissociative defenses or as ego state conflicts. When patients present with “internal” phobias, they will often fail to progress or have adverse reactions with standard EMDR procedural interventions. EMDR therapy can still be effective when clinicians have the conceptual knowledge and perceptual skills to recognize these patients’ defenses, and when they can make use of a flexible set of advanced EMDR procedural stills for responding.

EMDR trained clinicians must also confront their own affect phobias and psychodynamic conflicts as they experience a range of responses to their work with patients including countertransference and vicarious traumatization that can disrupt their ability to make use of their conceptual, perceptual and procedural knowledge and skills.

This presentation provides an introduction to concepts and procedures derived from Short-Term Dynamic Psychotherapy (STDP: McCullough, 1997, 2003) and the Theory of Structural Dissociation of the Personality (TSDP: van der Hart, Nijenhuis & Steele, 2006) and identifies procedures from Knipe (1999, 2003, 2005, 2008, 2009, 2010a, 2010b, 2010c), Mosquera (2010, 2011), Mosquera and Vazquez (2010), Gonzalez and Mosquera (2012), and Leeds (2001) which clinicians can employ for defense and affect restructuring with cases involving “internal” phobias. We will also consider how clinicians can be sensitive to and mitigate the potential impact of their own affect phobias in their clinical work.

Learning Objectives

1. Participants will be able to describe causes of disrupted EMDR reprocessing that therapists may encounter in complex clinical cases with secondary structural dissociation or personality disorders.

2. Participants will be able to provide a concise definition of affect phobia.

3. Participants will be able to name the main stages of defense and affect restructuring developed by McCullough (1997, 2003) and to describe alternative EMDR procedures for accomplishing these steps into their clinical work.

4. Participants will be able to make thoughtful clinical decisions about when to apply and when not to apply Resource Development and Installation procedures versus when to apply EMDR procedures for defense restructuring versus when to apply the Standard EMDR procedural steps.

5. Participants will be able to integrate clinical interventions for developing affect tolerance capacities in their EMDR clinical work with clients including positive affect tolerance.

6. Participants will be able to differentiate personal from complementary countertransference and to make use of strategies to manage these clinical situations.