Helping the Predictive Brain Update Bad Memories
Turns out, the story that we’ve been telling ourselves about the neurobiology of trauma doesn’t make sense anymore based on what we have learned the past twenty-five years about brain evolution, function, structure, memory reconsolidation, neuroplasticity, and the predictive brain. How we understand perception of our external world and internal worlds and has changed profoundly. There is growing consensus around the core idea that our nervous system is predicting and constructing our reality for us. And while this has some really disturbing implications related to things like our felt sense of free will and our illusion of objective observation, it has potentially remarkable implications for how humans might heal. Predictive processing might be able to do what no other theory of mind has: explain how we construct reality and possibly even our own selves. Central to this understanding is the role that prediction error plays at all levels of abstraction. And for the purposes of what I’m talking about now, the vast majority of predictions and prediction errors occur outside of direct consciousness and awareness. Prediction errors are central to perception, memory formation, learning, movement of all types, and every experience imaginable. We can think of consciousness, awareness, experience, and our own identities as floating on top of our predictive system the way a foam mat floats in a pool.
When Complex Clients Insist on Doing EMDR Processing Immediately
Clients often urgently need to heal. Their lives are probably unmanageable and they may have significant relational, occupational, or functional stressors that need urgent attention. We can align with that urgency. However, urgency is not a substitute for preparation. If you have a complexly traumatized nervous system, your recovery is not going to be brief and the needed preparation probably isn’t going to be short. Your relief of the current stressors may not come in the short term, when those stressors are the direct result of your allostatic load.
EMDR therapy is different than our regular coping and survival strategies. It is not culturally intuitive. It asks you to sit in the states that you may have spent much of your life organizing against or put a needle in your arm to avoid. It requires a window of tolerance. EMDR therapy starts a fire in your nervous system and when that fire starts to get better, I encourage you to put more logs on it. You have to have the capacity to be set on fire, but not consumed by it. To do this work safely with complex trauma, EMDR typically requires careful preparation and execution. Client urgency replaces none of that need for preparation and care in execution.
I have told clients that they can fire me, but I’m not doing EMDR reprocessing with them if they clearly are not prepared to do the core things that EMDR therapy requires. That isn’t going to go well for them and the consequences of that would be on me. Because I knew better. I’m happy to do some parts work or some Flash with clients who are prepared to work in those ways, but I’m just not going to do EMDR therapy because of the client’s insistency and urgency when I can clearly see that is a horrible idea.
Full text of this podcast is at the EMDR Podcast and EMDR365.com
EMDR Therapy shifts how you think about yourself and the world related to the memory we are working on. Why does it do this? Because that’s a lot of what healing is. Healing shifts how you think about yourself and the world, as well as lots of other things. Wounding is experiential learning and vast regions of our nervous system are organized around meaning-making in the foreground, midground, and background. Healing is also experiential learning. Broadly, in EMDR therapy and other transformational trauma therapies, it is not that difficult to help clients shift an individual memory and the cognitions associated with it.
Sometimes consultees will ask why a particular cognition that clients have worked on across multiple sessions isn’t showing up in how they broadly believe about themselves and how they actually live. The consultee may say, we have successfully worked on three different memories around the belief, “What I need doesn’t matter,” and they still don’t believe it broadly about themselves. How much wounding has this client had, where the take-home message was that cognition? Hundreds of experiences? Thousands? Tens of thousands of individual experiences that redundantly placed and reinforced that reality of the world? Saliently learned information in the service of survival isn’t meant to be shifted easily. That wouldn’t be evolutionarily wise. A parent who has the capacity to treat you as though your needs don’t matter will do that consistently. There are 154,000 hours in childhood and those hours may contain an enormous amount of salient, somatic, and deeply redundantly-placed learning.
It is entirely possible that you can work on a handful of memories with some clients with complex trauma and the broad belief about themselves may start to soften. That is remarkable. But for many, processing a handful of memories isn’t nearly enough disconfirmation to shift a whole cosmology. Three hours isn’t enough to offset the bedrock reality of 154,000 hours. But keep at it. And by that, I don’t mean endlessly hammering away at that individual cognition until it is fully resolved. In fact, to make good progress with it you may need the client to work in adjacent memory contexts and other categories of learning for a while. Return it. Check in on it. And the first clues probably aren’t going to be the client coming to session and telling you that they have arrived and the positive belief suddenly feeling true. You may see the emergence of a new belief in small things. You may hear the client reporting, almost offhand, that they set and defended a boundary with someone who has never respected theirs. When broad change happens with complex trauma, it often happens slowly, because the learning that we are trying to change isn’t small and limited, it is global and cosmological and has been reinforced across many developmental eras.
The fact that EMDR therapy can help shift such deeply held beliefs at all is a testament to how transformational trauma therapies can create learning experiences whose lessons can ripple through the client’s internal cosmos. The fact that sizeable chunks of this work can be done in dozens of hours and offset hundreds of thousands of hours of learning is remarkable.
...We need to be advocates when someone is trying to gaslight us about what complex trauma is and how easily people should be able to recover from it. We need to challenge when we hear EMDR being described as an ultra-brief approach to psychotherapy when most of this world’s wounding is of the complex type.
The world took its time with us when it set about wounding us. Healing is going to take its own time. We should understand and advocate that.
A summary of why attachment wound targets in EMDR therapy are a uniquely difficult place to start.
The full text of this episode is available on the EMDR Podcast here: https://emdrpodcast.com/2023/12/13/lettingthingsgo/ The script for the videotape approach mentioned in the podcast is here: https://emdrthirdweekend.com/posts/videotape-approach-script-with-complex-trauma-phases-three-and-four
A child's toy metaphor for the need to adjust your interventions to the nervous system you are working with.
When a SUDS of One, Two, or Three May Not be Ecological
You are technically correct, quoting Dr. Shapiro in EMDR Therapy when you say that a SUDs of one can be ecological if it “sounds right.” Shapiro's example of an Uncle who died. Shapiro worked with really healthy people and what’s in a one with her clients may be different than what’s in a one or a two with clients with really complex trauma. With really healthy people, you can go to installation if the SUDs is a one if it “sounds right” and the debris will likely get cleared up in Phases Five and Six. You may be tempted to say that because I’m working with a complex client, a two is pretty good. Especially if we are starting at an eight to ten SUDs. And it is. Yes, we don’t want to make the perfect the enemy of the good. However, a lot can be hiding in that one or two with a client with complex trauma. If I had $5 every time the client said that the SUDs was a one, two, or three and it wasn’t going to go lower and it immediately went lower once they noticed it, I’d be able to go on a nice vacation. Out of the country. It’s simply good practice to identify what makes it that one, two, or three and ask the client to notice it a few rounds. And you know what happens, 97%+ of the time? It goes lower within a few sets of the client saying that it isn’t going to go lower. And yes, there are ways to do this respectfully what the client says to you, but also lets them fully and adaptively resolve that memory. Really good things happen when clients fully and adaptive resolve memories. Generalization occurs. Installation isn’t junky. Body scan isn’t leaving debris. A one or a two may also be an ember that may ignite other things between sessions. Don’t want to run the marathon and then sit in the lawn chair within sight of the finish line. If we can, finish it. Get your time. Get that race in the books. Whatever it is that makes it a one, two, or three, or whatever it is that makes the Validity of Cognition a five or six, notice that and it is highly to movie in a positive direction… unless it’s about something in the future or about other things from the past. That’s not your target. We’re in the business of resolving memories, not whole themes all at once and we don’t work in the past and the future at the same time. We have the future prong and future template for that. What is it that makes it a two? Notice that. If it doesn’t go lower, that’s okay. But it’s also okay to notice whatever that two is a few rounds before you assume that it’s good enough for this client on this day.
You May Do the Least Reprocessing with the Clients Who Need it the Most
Full text of this episode is at:
https://emdrpodcast.com/2023/11/29/parts-work-is-central-to-emdr-therapy/
• The Impulse to Want to Avoid Causing Harm
• Working with Trauma is Like Working with Lava
• Confessions about Difficult Sessions
• Most Basic Training Programs Can’t Train You to Work Effectively with Severely Complex Trauma in EMDR, You Will Need to Learn the Nuances of this On Your Own, But There is an Enormous Amount of Help Out There
• Normalizing Mistakes and Missteps
• The Real Risks of Not Doing Trauma Work with Clients
• We are the Only Professionals on the Planet that Can Do This… Whose Job it is to Do This
• It’s Like Everything Else… You Learn to Do This by Doing This
• The Really Good News About EMDR Therapy: It Breaks in a Very Limited Number of Places
• When Clients Struggle, There is Information in that Struggle
• You can Dip Your Toe into Every Phase of EMDR Therapy
• You will Develop More Trust in the Process
• You will Get Better at Intuiting when the Client is Stuck and Strategically and Effectively Intervening
• Not Everyone is Prepared to Do EMDR Therapy Right Now: We Can Help them Prepare
There is so much to say here. Broad overview. Each point could easily be a chapter. Very little of this is mine, the metaphors are mine, but this is a collection ways of seeing that are helpful for me in understanding where clients get stuck in reprocessing, why, and what might be helpful in getting them unstuck, and what we subsequently do with that information. When clients encounter difficulties in any phase of EMDR Therapy, that isn’t failure and it isn’t evidence that you have done something wrong. It’s important information about the client’s nervous system and means of survival. That information needs to come so that we can use the lessons in it in the service of the client’s recovery.
We train you to stay out of the way, but if a client is stuck, your obligation is to try to help them get unstuck. EMDR Therapy with a client with complex trauma is a complicated task. We’ll explore some of the reasons why and how you might intervene when someone is struggling.
How do you know when someone is stuck when they have really complex trauma? Sometimes it is ambiguous. Because they are often connecting something big with a small amount of adaptive information, the metabolization can be slow. Questions to ask. Clients can be stuck in high anxiety near panic that won’t shift, clients can be stuck in a shutdown response (100 amp breaker), they can be stuck in the big existential loneliness of childhood (particularly if working on an attachment wound), they can be stuck trying to figure something out that is existential, or they can be stuck noticing on channels that just aren’t productive right now (thoughts, memory, etc), where things aren’t moving and shifting and changing.
Defining looping.
When someone is stuck, they are probably stuck in a perspective. Office shortcut metaphor. Interweaves help clients change their perspective.
Ideally, when we intervene, our interventions should match where the client is stuck. We shouldn’t just randomly throw something out. Car metaphor.
They are not sure what their role in this dance is.
Blocking beliefs. Hopefully, you will pick up on these in your Phase Two. Phase Two is the canary in the coal mine for blocking beliefs. What is a blocking belief and why is it a problem?
Too big of a target too soon.
The target memory is an attachment wound. Why attachment wounds are about everything. What might you do. Long resonance after sessions is common when not working with attachment resources.
If the core of EMDR Therapy is activate a piece of difficult stuck information, notice what comes, while the brain gets a left-right stimulation, let’s evaluate potential stuck places.
Activate: Are they activating in ways that are tolerable? Is the activation from the memory or from an agenda? Are they allowing too much memory content to connect too soon. We need memory content to come, but we need it to come at digestible rates.
Notice. Noticing is the bright yellow line in the center of the EMDR road. Is the client noticing? Does the client know how to notice? We may need to be very clear about what noticing means. The difference between being aware and noticing clearly.
Left-Right Stimulation. Always a possibility that switching bilateral may be helpful.
Stuck in guilt, shame, blame, or responsibility. Appropriate and not developmentally appropriate types. Assessing for adaptive information, clues in Phase Three.
How is your relationship with your client? The relationship is a key component in what is effective in EMDR Therapy. How is your client’s parts relationship with you and your parts? Did you ask consent to work on this memory, attempt to address concerns, and listen to a concerned part when that part has an agenda different than yours? If you didn’t, their parts are likely already aware of this quality in you. Working with a system always easier than pretending that you are not working with a system.
Many new EMDR therapists misunderstand where the magic is in EMDR Therapy. Trainings and training practicum experiences often send the impression that simply following the script is likely to result in memory resolution with the vast majority of clients. EMDR can be seen as a kind of magic wand that allows us to go up to almost any person and “dink” their memory. Some trainees may be left with the impression that most of the magic in EMDR Therapy is in the bilateral alone. While this is a key part, I describe it elsewhere as one of the three wheels of the EMDR tricycle. It takes all three wheels. Otherwise drummers would be the healthiest people on the planet. And, they are not.
EMDR Therapy is a combination of activation, noticing, and left-right stimulation, but what is happening in EMDR is perfectly described in the Adaptive Information Processing model. This combination of elements helps connect old stuck information into right-now existing adaptive information… if you have enough of it. And Shapiro is very clear that if you do not have enough of the needed adaptive information for the target that you are connected to, there is nothing in the Eight-Phase Protocol that is going to generate the missing information. I have used the metaphor of a boat fishing in an ocean. The boat is the needed adaptive information and the fish you are hooked onto is the memory. You can’t land a bigger fish than your boat. You don’t simply get a bigger boat because you are hooked to a big fish. You have the boat you launched with today.
Again, the magic of EMDR Therapy is that you can metabolize almost any old stuck information into existing adaptive information and we do this by using the Eight-Phase Protocol. Inside that understanding contains the logic and the worldview to account for when this therapy doesn’t work. Many of the episodes in this podcast focus on this core understanding of the Adaptive Information Processing model. It explains almost everything beautiful in working with clients who have adaptive information the size of a cruise ship and almost everything challenging in working with clients whose adaptive information is the size of a leaky intertube. This understanding explains why parts work is an important element in what we do as trauma therapists. It explains why we need to support adaptive information about what it means to have been born human. And, why our resources need to involve more than a few core mindfulness skills when working with clients with pervasively traumatized nervous systems. This understanding is the foundation, I think, to doing EMDR Therapy really well with clients with complex trauma—who have been saturated with the tasks of surviving, rather than bumping against the world and learning who they are, what they’re worth, and how they deserve to be treated.
A shocking amount of talk online about EMDR and grief goes against everything we know about both. This episode highlights effective ways to use EMDR with grief-saturated targets.
In EMDR Therapy, the pathway for healing is that stuck information has to connect to right now adaptive information. The process that facilitates that linkage is the Eight Phase Protocol.
The Boat and the Whale Metaphor
The boat is the amount of the needed adaptive information that is have accessible right now. The fish that you want to hook and land is the trauma. You cannot land a fish bigger than your boat. However, you can get a bigger boat by catching smaller fish. You can also build a bigger boat through developing relationships—including the therapeutic relationship, through parts work, through resourcing, by expanding the window of tolerance, through psychoeducation [particularly psychoeducation about what it means to be born human], and through a wide assortment of other means.
Implications of this metaphor:
The Mount Everest Metaphor
Shapiro says that if we tackle the mountains of memory first, everything after that will feel like a small hill. And, she is right if you have adaptive information the size of mountains. Again, clients with complex trauma have very little adaptive information. You cannot metabolize a trauma the size of Mount Everest into adaptive information the size of a walnut. You simply can’t do it.
Also, if you’re not an Olympian, Mount Everest is a terrible place to start. The are over 200 dead bodies on Mount Everest right now because it’s too dangerous to remove them. And, if you need to tackle Mount Everest, you had better tackle some smaller hills then some smaller mountains first.
To be fair, Shapiro acknowledges that with complex trauma we do want to work with smaller and more recent memories first, but many people graduating from EMDR foundational trainings misunderstand the nature of the magic that is EMDR.
Understanding the Difference Between A Complexly Traumatized Nervous System and a Non-Pervasively Traumatized Nervous System Via the AIP Lens
In the AIP model, the difficult stuff has to connect with right-now existing adaptive information. One of the key things that we appreciate about complex trauma is the large size of the trauma and the typically small amount of adaptive information that the difficult stuff must connect with and metabolize into. Again, back to the boat metaphor. If client’s have adaptive information the size of a canoe, we really need to be careful about what they hook. You can’t land a fish bigger than your boat. Clients that are really healthy, but who have had some trauma have adaptive information the size of a cruise ship (the privilege in
The Field and the Municipal Dump Metaphor
There is another metaphor that I like here related to following memory content or maybe taking a restricted approach to memory content. Imagine a space about the size of large sports stadium. The field of this sports stadium is the entire lifespan of the client up until this point. Almost all of it is clear and open. But even as we survey the field, there are some piles of things. If this is the client’s system that we are working with, we want the client to just walk around the field and pick up things, sort them a little, and put them in a knapsack. We don’t want to micromanage that. The client can walk around, form connections, knapsack the needed things, and everything in that knapsack can be resolved. If we over intervene, we are interfering with the client’s work.
Imagine another stadium and this is the stadium of the complexly traumatized. Except instead of piles of things, it has been used for 46 years as a municipal dump. In fact, old garbage bags, mattresses, food disposal, packaging, are piled so high that the whole inside of the stadium is filled to the highest seats at the very top of the stadium. Now, we’re going to drop the client into the 37th yard line and put them 25 feet down, with a knapsack. Do you see the problem? Everything connects to everything else there. There is the impuse to try to knapsack it all, but there isn’t the means. And this is one of the things that is really unfair about being on the receiving end of other people’s stuff for decades. The mistake we make is that we consistently underestimate how much there is and the client can only carry what the client can carry.
What’s the Problem with Too Much Memory Content Coming In?
They very quickly get outside of their window of tolerance. If you want to have a big window of tolerance, start with having a really good life. Absent that, it’s a lot work. Other podcast episodes cover how the ways that we help clients develop a bigger window of tolerance often ask the client to sit with things that go (or feel like they go) directly against their survival strategies.
Deciding:
First, Time
Two, How are You Doing, Distress-Wise, With the Current Content
Is the Memory Adjacent or Feeder?
Conclusion
Regardless, when you do initial reprocessing, you are going to have information even if that information is clarifying about the narrowness of the client’s window of tolerance.
We can’t move it all at once. We can’t move everything that needs moved right here right now. Clients need to know this. One of the things that really sucks about being someone who is carrying all this stuff that was done to you is that we have to be both the jail to this stuff and the jailer. Memories don’t get paroled when a riot is happening. We have to work intentionally. And we start by starting. One piece, one purposeful and careful step, at a time.
Client and therapist agendas are frequent blocks in EMDR Therapy reprocessing.
Using age, space, and topography to find an individual representative memory related to a presenting issue, theme, current trigger or emotional state.
• Identify a negative cognition.
• What age do we need to work related to that theme and negative cognition?
• Home, school, or community?
• Where (what room) in that space do we need to work?
• Where in that room or space (what chair at the table) do we need to work?
• Put yourself in that space at that age and related to that theme and negative cognition, what is the first memory that comes?
• Target that in EMDR Therapy.