EMDR in the treatment of clients with developmental trauma and dissociation: case conceptualisation and treatment
The treatment of clients with developmental trauma and dissociation – children and adults alike – might pose some challenges to the processing of traumatic memories (Shapiro, 2001).
Different adaptations and recommendations have been suggested, such as the progressive approach to work through the phobias maintaining dissociation (Gonzalez & Mosquera, 2012), and procedures to reverse internal processes and defences that were originally the result of the pervasive nature of chronic interpersonal trauma, such as avoidance, shame or idealization of attachment figures (Knipe, 2015). While special interest has been given to increase the efficacy and safety of trauma processing using EMDR with this population, less attention seems to be given to the peculiar nature of the information that clinicians need to gather during history taking, including a thorough assessment of dissociation and dissociative self-states (Twombly, 2005, Waters, 2016), or the quality and extent of the preparation for trauma processing. These two first steps are essential for case conceptualization and later success of EMDR treatment, and developmental trauma and dissociation require information and preparation that might not be necessary when treating simple PTSD.
A thorough assessment of dissociative self-states and ways to engage these self-states in the early phases of treatment will be discussed, as well as psychoeducation tools for the client and surrounding external systems (caretakers, partners, etc.). Examples on how to work with clients afraid of memories, reluctant to acknowledge or to discuss their problems, will be presented.
Videos will support this presentation and specific recommendations for increasing the feelings of safety with therapist and therapeutic setting, will be discussed.
Gonzalez, A. & Mosquera, D. (2012). EMDR y Disociación. El abordaje progresivo. Madrid, Ediciones Pléyades, S.A.
Knipe, J. (2015). EMDR Toolbox. Theory and Treatment of Complex PTSD and Dissociation. New York, Springer Publishing.
Porges, S. (2011). The Polyvagal Theory. Neurophysiological Foundations of Emotions, Attachment, Communication and Self-Regulation. New York, W.W. Norton & Co.
Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing. Basic principles, Protocols and Procedures. New York, The Guilford Press.
Twombly, J. (2005) EMDR for clients with Dissociative Identity Disorder, DDNOS and Ego States. In Shapiro, R., (Ed.) EMDR Solutions. Pathways to Healing. New York, W.W. Norton & Co., (pp. 88-120)
Waters, F. (2016). Healing the Fractured Child. Diagnosis and Treatment of Youth with Dissociation. New York, Springer Publishing.
Sandra Baita is a clinical psychologist graduated at the University of Buenos Aires, with postgraduate studies in Childhood Clinical Psychology, and an EMDR Certified Therapist and Approved Consultant. Dr.Baita has worked for 15 years at government agencies in the City of Buenos Aires, as a staff member of Domestic Violence Programs, with special focus on child abuse. She was a Professor at the Department on Postgraduate and Postdoctoral Studies of the School of Psychology at the University of Buenos Aires, and invited Professor at the National University of La Pampa (Argentina), Catholic University of Salta (Argentina), Latinamerican University on Social Sciences (FLACSO- Uruguay), and Universidad de La Sabana (Bogotá, Colombia). She has offered lectures, conferences and trainings on child sexual abuse, and complex trauma and dissociation in children and adolescents in Argentina, Bolivia, Chile, Ecuador, Paraguay, Perú, Uruguay, Spain, The Netherlands and the United States.
She has authored several papers and book chapters in Argentina, Italy, Spain and the United States, the book Rompecabezas. Una guía introductoria al trauma y la disociación en la infancia. (Puzzle. An introductory guide to childhood trauma and dissociation), and co-authored the book Abuso Sexual Infantil. Cuestiones relevantes para su tratamiento en la Justicia (Child Sexual Abuse.Relevant Issues for Judges and Prosecutors), a joint project of UNICEF and The Supreme Court of Justice of Uruguay. A Fellow Member of the International Society for the Study of Trauma and Dissociation (ISSTD), she has served on its Board of Directors and is a member of the Child and Adolescent Committee of this Society. Dr.Baita has received in 2012 ISSTD Distinguished Achievement Award for her contributions to the study of trauma and dissociation in Spanish speaking countries. She is currently on private practice in Buenos Aires, Argentina.