It is important for every prospective client to understand that EMDR is not for everyone. This article will explain some of the situations when EMDR may not be appropriate.
It is possible that disturbing emotions can arise either during or after an EMDR treatment so any potential client must have the resources (internal and external) necessary to help them cope with any high levels of disturbance that might arise from processing the old traumatic memories or dysfunctional information. In a previous article we talked about the safe place as being one such resource, but other resources could be things like a supportive family member or friend, the ability to physically calm oneself using deep breathing, having a relaxing physical treatment such as massage or acupuncture, finding something that encourages laughter, or simply having a few days off work to have the time to deal with the emotions without the usual daily pressures. When a client first comes in, it is important to take some time to talk through what resources might be available and help to provide some if necessary.
Each EMDR session will be different, and the specific unconscious responses that come up are unique for every client. Emotional responses or physical sensations that were present at the time of the original traumatic event can arise during processing, and these of course can be distressing. Processing continues to happen to a lesser extent after the EMDR treatment, so clients have to be aware that disturbances can also happen outside of the treatment room.
It is advised for clients to think about someone who they can go to for support, such as a friend or family member, in case of disturbance between the sessions. In addition, EMDR treatment is not advised if a client is in the middle of family, career or financial crises, as the additional stress could simply be too much to handle.
On a physical level, EMDR treatment would not be advised if a woman was pregnant. In addition, great care would have to be taken if someone had a serious physical health problem, such as a weak heart. If there are physical problems with the eyes, such as eye muscle weakness or a tendency towards eye pain then eye movements would not be used during processing. However, other forms of bilateral stimulation such as alternate tapping of the hands, or alternating sounds would still be appropriate. If there is a history of epilepsy, it is still fine to use EMDR with caution.
Clients with substance abuse issues are advised to have the appropriate support in place, such as a 12 step program, or to do treatments within a residential rehabilitation centre where support is readily available. The stimulation of disturbing material can exacerbate cravings as well as potentially reducing them. The rapid eye movements of EMDR can lead to agitation, so again sounds or tapping can often give a better response.
EMDR is also contra-indicated if strong psychotic symptoms or dissociative disorders are present, or a weak sense of self, or also low motivation levels for this kind of therapy. It is important for there to be a good rapport between the client and therapist, which can only happen if the client has a powerful motivation for positive change. In return, an effective therapist provides the client with an atmosphere of safety, flexibility, transparency, empathy and unconditional positive regard.
Tuesday, September 30th, 2014
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