sandra paulsen, ph.d. copy right all rights powerpoint...• if child can’t fight or flee, so...

Sandra Paulsen, Ph.D. Copy right all rights reserved

8/18/2015

[email protected] www.bainbridgepsychology.com 1

Bainbridge Institute for Integrative Psychology

Sandra Paulsen, PhD

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8/18/2015


Looking Through the Eyes

EMDR and Ego State Therapy Across the

Dissociative Continuum

Introductory Comments

• Phones & Bathrooms -- Breaks• Questions – Hold unless baffling

– No Cases Unless Done Early– 60 min per consult

•

My Learning Curve in 1991

• Trained Standard Protocol

• Case: Woman in Car Accident

• Case: Rape Victim

• Case: Gecko Phobia …






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• EMDR facilitator since 1991, certified consultant since 1995, advanced specialty workshop instructor since 1995

• Collaborating with Jack Watkins, Father of Ego State Therapy

• Completed 2 years training in somatic psychotherapy, SE and Somatic Transformation, with Sharon Stanley and may refer to somatic work in this workshop

For Complex Cases Need Three Additional Skills Sets… Plus EMDR

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Overview• Integrated Theoretical Framework

• ACT-AS-IF Phased Approach to Therapy With Complex Trauma Cases

• ARCHITECTS Phased Approach to EMDR Session With Complex Trauma Cases

• Video - I may move them around

Putnam

• Ego States

“States of consciousness –or ego states ---are discrete self organizing patterns of behavior differing along axes of affect, access to memory, attention and cognition, regulatory physiology and sense of self “ -- Frank Putnam

Normal Ego States






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Ego state disorders are the result of dissociated and affectively dysregulatedstates due to trauma or other experiences

--- Frank Putnam

Pathological Ego States

Theory – In Presence of Severe, Chronic Trauma and/or Neglect

• Adaptive Information Processing Theory –Shapiro

– Neural Networks holding frozen traumatic material

– Insufficient linkages to adaptive neural networks

– Inability to integrate identify, memory, time


• Dissociation Theory – Janet, Watkins, Kluft, Putnam, others

– Reliance on defense of dissociation for survival– Identification with the aggressor– Amnesia barriers – Inability to integrate identify, memory, time






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• Developmental Theory – Bowlby, Main, Siegel, Schore

– Failure to meet developmental milestones

– Failed attachment has neurobiological sequelaeincluding

– Failure to acquire affective regulation


• Polyvagal Theory – Porges

– Lack of exposure to Ventral Vagal State

– Thwarted Fight or Flight Response (Sympathetic Arousal)

– Living in a Chronic Freeze State (Dorsal VagalShut Down/As If Dead) with Intermittent Breaking Through of Sympathetic Arousal States

Intersubjectivity






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Theory: Origin of Intersubjectivity

Looking Through Each Others Eyes

I & Thou

RelationshipAttachment

Empathy

Porges – Polyvagal Theory

Ventral Vagal

When all is well

Social Engagement

Ego Strength

Resources






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But In The Presence Of Danger….

Sympathetic Arousal

Adrenaline Response for Strength for a Fight

Sympathetic Arousal

Adrenaline for Flight






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Dorsal Vagal

Immobilization

Prepare for Death

Frozen State

Alan N. Schore

• Implicit memory• Right hemisphere holds

– Trauma– Attachment experience– Dissociative states – especially Eps

Jaak Panksepp

• Experimental neuroscientist • Hardwired affective circuits• Three levels of brain processing






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Mammals Have Hardwired Affective Circuits … People, too

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Those emotions are there for a good reason

Like gauges on a dashboard, they give us information so we don’t drive our lives into a ditch

When people have malignant histories, they often clipped their dashboard wires, and haven’t had the healthy use of their emotions

Affective Brain

PANKSEPP & PAULSEN

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Panksepp Uses Caps

To show it isn’t just an emotion, but it’s a hardwired emotional circuit

His seminal tome reviewsthe science

A lay version out this year

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An Integrated Theory• If trauma is chronic severe inescapable

…and

• If child can’t fight or flee, so adrenaline and thwarted response is held in the body and brain…and

• If the client didn’t die but had to chronically submit, frozen, and helpless for years, in cycles of dorsal vagal shutdown . . .






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An Integrated Theory• All that fight flight freeze experience stored

as BASK elements in neural networks, with few associative links to other neural nets, and that

• Prevents integration of memory, learning, identity, perception and that

• Prevents achievement of developmental milestones . . .

An Integrated Theory• Moreover, failed parenting, and absence of

healthy intersubjectivity in infancy results in failed attachments so that

• The inner landscape supplies all coping strategies, relationships, fantasy, denial, and more, so…

A dissociative disorder is born

Basic Concepts in Dissociation

• Many more concepts in the 3rd Edition of the ISST&D Treatment Guidelines with contributions from many people including Paulsen, Fine, Gelinas from EMDR

• Rest of today pretty practical • Focus on key concepts and techniques that

are most important •






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Neuroscience Implications For Us

• Because trauma is held in right hemisphere• And talk therapy is based on left hemisphere• Need methods to access right hemisphere

– Ego state– Somatic therapy– Early trauma protocol

Imaginary Friend

Normal capacity

Survival strategy

Continuous Made

Dichotomous






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Phases of Treatment

From EMDR Perspective

Various Assessment

Devices






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DES is Quickest

Has False Negatives

Red Flags: Do

Not Proceed

With EMDR

Red Flag

Poor Positive Affect

Tolerance

Can’t Do Safe Place






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Kluft’s

Dimensions of

Therapeutic Movement

Red Flag:Won’t

Follow Rules of Therapy

Red Flag:

Swirling Vortex






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Briny Sea of Affect

Dysregulation

Good Sign

Positive Affect

Tolerance

Somatic Sensation Tolerance

• Are they able to answer questions like,

“When you think about your safe place, what do you notice in your body?”

“Where in your body do you notice it?”

If they can’t tolerate soma sensations, then they have a lot of resourcing to do, need to get their wires “hooked up” before doing EMDR






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Can’t Do EMDR If Wires Clipped

• EMDR will loop if client can’t tolerate body sensation

• Dissociative clients are all about, “It happened to her, not me” so at its core it is about not being present to the body

• The body isn’t safe and is too painful physically and emotionally to occupy

• Treatment of dissociation is about making body a safe place to live

Lots of Nuances Over 2 Days

• But here’s the highest level• The summary of every thing we’ll cover can

be boiled down to this,…..

EST & EMDR in a Nutshell

Low DES & Good Affect and Soma

Tolerance &Regulation

Go Ahead With EMDR






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If Not Affect & Soma Tolerant

• The preparation is what we’ll be talking about for the morning

If Pain is Greater

Than Ego Strength, Have to

Resource First






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Per Watkins,

Add Resonance And They Can

Tolerate Abreactive

Work

Overview of Containment

Hypnosis

Closure Steps

Resources

Somatic Work

Utilizing Amnesia

Resonance

Boundaries

Education

Tactical IntegrationistPer Catherine Fine:

Utilizing the dissociation

Working behind the amnesia barrier

Titrating affect intensity (dilution of affect)






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Working Behind Amnesia Barrier

in DID

Just Switching Instead of Talking Through Initially

Talking Through


Hypnosis

Closure Steps

Resources

Somatic Work

Utilizing Amnesia

Resonance

Boundaries

Education






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Resonance

Empathically Attuned

External Witness

First Honoring Relationship

A Neutral Stance About What Happened

A Resonant Stance About Their Feelings

…and Curiosity


Hypnosis

Closure Steps

Resources

Somatic Work

Utilizing Amnesia

Resonance

Boundaries

Education






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Early Attachment

Failures

Critical to Have

Boundaries

Boundaries

No, But I’ll Be Your Therapist And I’ll Keep You Safe In The Structure Of

This Work






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Boundaries

Imaginal or…

Felt Sense


Hypnosis

Closure Steps

Resources

Somatic Work

Utilizing Amnesia

Resonance

Boundaries

Education

Educate About

Normal Functions of

Emotions

“No Shame”






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Thwarted Fight/Flight = Symptoms

Educate About Sympathetic Arousal

Dorsal Vagal

Response

ImmobilityShut Down

FrozenPrepare for Death

Dissociated“Mummified”

Ventral Vagal

Any Thing Life Enhancing,

Resourcing:

Cole Slaw RecipeHorses

ArtGrandBabies

BeachSafe Place

God






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Hypnosis

Closure Steps

Resources

Somatic Work

Utilizing Amnesia

Resonance

Boundaries

Education

Various Hypnotic

Suggestions

Hypnosis

DownRegulation

Practiced Skill






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Hypnosis -> RDI

• Imaginal resourcing• Enhanced with vividness• Future imaging • Caution! With DID likely get interference from

perpetrator introjects saying: – Not safe to be strong and resourced– I’ll punish you for being strong and resourced– Other threats or fears – Have to work to defang the introjects

Ego State Therapy – Watkins & Watkins

My favorite ….Dissociative Table– George Fraser – formalized and

developed– David Caul – first mentioned – Helen Watkins – utilized a variant – Paulsen for EMDR – since 1991– Widely used now in EMDR practice

Easy Set Up

I’d like you to imagine a pleasant conference room….

Got it? Take a look inside and tell me

what, if anything, you see






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Inner Conflict Among States

Dissociative Table:

Access to Inner

Dynamics

Add Tools As You Need Them … Resources the Client






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Hypnosis

Closure Steps

Resources

Somatic Work

Utilizing Amnesia

Resonance

Boundaries

Education

Containment

Of Disturbing Material Until the

Time is Right

Affect Regulation

Learned Skill






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Conditioned Response Closure

Closure - Tuck In Ego States

Paradox

Don’t Skip This!!


Hypnosis

Closure Steps

Resources

Somatic Work

Utilizing Amnesia

Resonance

Boundaries

Education






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Deputize – Resource Team

Ventral Vagal

Deputize – Resource Team

Ventral Vagal

Spiritual Resources:

Ventral Vagal






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Therapeutic Alliance

Framed byTherapist’s

Ventral VagalExpectancy


Hypnosis

Closure Steps

Resources

Somatic Work

Utilizing Amnesia

Resonance

Boundaries

Education

Empathy

• The basis of the work, of ALL work• The therapeutic relationship itself• With bodily attunement • The holding environment• The energetic cocoon• Even radical intuitive attunement ….. • Activation of ventral vagal nervous

system through relationship






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The Relationship Context

• Intersubjectivity• I and thou• Attachment• Love• The origin of self

If attachment fails

Developmental trauma results in dorsal vagalshutdown as well as does shock trauma

Empathy

Not just watching and listening, but resonating, and attuning, hearing the story in the enactments






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Somatic Or Any Resourcing

• Evoke and strengthen client’s capacity to be in a ventral vagal state

• With safety and a sense of well-being in the therapeutic relationship, transformation is possible

• Want to make body awareness comfortable• We invite client to identify something ….

After a while

• You won’t have to resource them so frequently

• They’ll just be resourced• And be able to tolerate trauma work better• They will live in ventral vagal more often

spontaneously • DID will begin to be able to occupy the body

Summary-Resourcing

Establish and strengthen inner resources So they can reliably move to their ventral vagal

nervous systemSo later they can titrate between trauma vortex

and a resourceThe building block of somatic work






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SummaryContainment & Stabilization

QuietingBeginning of trustDistancing from affectNot forever, but until the time is rightParts in cooperationPacing the workReady to approach the disturbance

Overview of Trauma Accessing

• Work with encysted neural nets - ego states • Manage reenactments & flashbacks• Bring double binds into consciousness • Orient x 3• Find other solutions for problem behaviors• Work with introjects and other pushed away or

cranky parts• Resource somatically • Nurture imaginally






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Why Not Just Do EMDR?

Well, because . . . . . . They are defended.

Why Not Just Do EMDR?•Protective parts will stop the work – looping

•Insufficient ego strength to tolerate affect

•Unable to maintain dual attention awareness

•Parts of self not on board, won’t know you

•Parts haven’t consented to the work . . .

Why Not Just Do EMDR?•Parts may experience as a reenactment of trauma

•Can be re-traumatizing

•Might confuse you with the perpetrator in the memory






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States Can Be Ego or ObjectCathected –

This is Important!!!. . . Though obtuse

In ego state theory (Federn, 1950), mental states are understood to be imbued with either ego energy (I hurt) or object energy (she hurts)

Working Ego And Object States Build Intersubjectivity

When a state is imbued with ego energy, the state is experienced as a felt sense, first person, “I” and may be said to be “looking through the eyes”

-Paulsen

Also called “ego cathected”-Watkins


When a state is imbued with object energy, the state is experienced as he, she or it, and is seen at a distance, is “over there.” Is in conscious mind, but the felt sense is disowned or dissociated. A natural protective function of our system.






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Also called “object cathected.” When used as a primary coping style, may result in a dissociative disorder.

“what does that state look like” NOT “feel like or think like”


In ego state therapy, Watkins described how to integrate parts of self that had been disowned or dissociated by giving them a voice, or imbuing them with ego energy.


In that hypnosis tradition, adding object energy to a state is a distancing maneuver, to titrate affective intensity, and make affective states more tolerable






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Working Ego & Object States Builds Intersubjectivity

Using object energy in this way seems to increase client objectivity about the helpful purpose of each state, including those previously dissociated and disowned

This increases compassion for self as an innocent child, and increases ability to tolerate affect during EMDR and inlife in general

Working Ego & Object States Builds Intersubjectivity

In ego state therapy, sometimes we give a voice to a state and sometimes we deliberately remove that ego energy by looking AT a state, without having the client feel it.

A Few Basic Ego State Tactics

Utilize the Dissociation

Appreciate the Parts,

Honchos First

Work the Honchos First

Listen to the Story in the

Reenactments

Pace the Work






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Common Mistake

• Jump in to do EMDR prematurely• Or try to pull up traumatic memories• Or try to force integration prematurely• Or to do too much trauma work

So remember……

Kluft’s Axiom

“The slower you go, the faster

you get there”




Honchos First



Reenactments

Pace the Work






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Conflicts Dissociated

EMDR Loops If Associative

Linkages Occur Between Neural

Networks Without

Readiness

Utilizing theDissociation

We Continue to Work Behind

Amnesia Curtain

Work Conflicts& Double Binds

in theConference Room

If Can’t Tolerate Do One at a Time

Or Do Later






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Sparing the “Front Part of Self”

until later when material has been

worked and detoxified

aka “dilution of affect”

“Tupperware Kids”

Neuro-networks

Holding Unresolved

BASK Material

Emotional Flashbacks

Let It Be Held Apart in Sequestered

Neural Networks

Acknowledge But Don’t Spill Traumatic Material Until Ready to Clean It Up






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Close

Each and Every Ego

State Session

End Ventral Vagal




Honchos First



Reenactments

Pace the Work

Parts Out of Awareness Tell Their Story

Reenactment As Information






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Reenactments of the Trauma

Manifest as either:- Internal behaviors between

parts of self - External behaviors

- In relationship with us- In relationship with others

Consider Your Problem Client…

• Think of their most problematic and bewildering behavior

• Consider the hypothesis that that behavior is the only means a child ego state has to tell the story of what happened to them, either literally or symbolically

• Consider the hypothesis that “hypochondriacal” symptoms are the body trying to telling the story about infant days

Re-enactments

• Take many forms• Tell us about early trauma and other things

about family dynamics • Think of it as an emotional-relational

flashback• No picture as it is not in explicit memory so it

just leaks into present time, the office, their relationships, the therapy






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Enactments

• The Story Telling Itself• Only voice infant has to tell its story• Body keeps the score• Enactments Tell the Story • Patient who is sadistic with therapist….• Patient who leaves you tongue tied• Patient who you are double bound with….

First Rule Out …

• Is it your own material being triggered – counter transference

• Is it about truth in present moment • Or. …is it the story telling itself? • “I’m wondering if someone tortured you…”• “I’m wondering if you weren’t free to speak…” • “I’m wondering if you were stuck no matter

what you did”

Nuance as StoryIn the relationship field: • In the unspoken behavior• In the relationship dynamics• In the non-verbal communication

If energy sensitive, it’s in the Energy Field • In the energy in the room• In the pictures that come into your mind…• In the way the static changes on the phone or in

the room






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Self Loathing:

IntrojectedPoints of

View

Conflict Between

Dorsal VagalShutdown & Sympathetic

Arousal

Introject

Pre-emptive Strike

Brings Under Some Control

Preserves Attachment

also ….






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Introject

Looking ThroughPerpetrator’s Eyes

Identification with the Aggressor’s Power

Introject is NOT….

• Synonymous with “alter” or “ego state” • It is a special type of alter or ego state• It is the taking in of an external person• We are supposed to have them

Perpetration Lives On Inside

Perpetrator is Important

Child Isn’t






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Find Another Way to Accomplish the Same Thing

ReliefPunishmentReenactment of S/I Memory

Reenactment

Transference

Educate About Emotional Flashbacks

Projection






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ProjectiveIdentification




Honchos First

Orient Often x3Listen to the Story in the

Reenactments

Pace the Work

Orienting

Early and Often






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To place & time…

It’s the 21st

Century and we are in (our town)

Orienting to Person

Orientation to Person

Whose Hands Are

Those






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Orientation to Person

Whose Eyes Are You Looking

Through?

• Orienting helpful for many things including self mutilation

• Parts think they are external, that the abuse is happening now

• Up to us to keep orienting them to person place and time




Honchos First


Reenactments

Pace the Work






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Grand Illusion:

Not Me

Ego States Frozen at

Unmet Developmental

Milestones

Dorsal VagalShutdown

Appreciate EVERY Part

• No Exorcisms• Understand and appreciate the function• Some parts hold the rage• Some parts hold the attachment to the perp• Some parts hold BASK elements• Some parts hold blocking beliefs






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Common Mistakes

• Work with helpless child parts first• Fail to look for or work with introjects, angry

parts or other “honchos” • We want to rescue helpless• Rather, task is to help them do their dynamics

differently• To work first with the honchos is to work with

the defenses and the resistance to change.

Headaches

Inner Conflicts

Approach-Avoidance

Therapist, Remember What and

Whom This Is!

A Neural Network Stuck in Time






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Their Most Monstrous State

…

A Child State in a Fierce Role

Thwarted Sympathetic

Arousal

We Don’t Get Rid of Parts

We Appreciate Their Adaptive Function

Most Monstrous Pushed Away Parts Usually:

- Introject of Perp, - Anger - Shame






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I’m NOT in the business of getting rid

of parts

Maybe get more Up-to-date job descriptions….

I’ll Help Her Understand Your

Legitimate Concerns

Just Think What She Could Do!

Compassion Moves

Monstrous Parts Off Their

Spots






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Compassion for Their

Burden Too

They are Tired

Energy Bound for Half a Century

Gently Confronting Introjects

• Are you sure it serves you to stay loyal to a dead person?

• Maybe its time to be loyal to the body you live in and the life you are living?

• You had to be loyal to survive• I’m so glad you’ve held the (perp) energy• Somebody had to do it• I’ll help the others appreciate your great

burden & thankless task

Nurturing Imagery..

• For some DID clients• Once the honchos (introjects and other

controlling states) are on board with the therapy, and have moved off their spots,

• One can provide reparative attachment work by providing in imagination

• “what you needed, the way you needed it to be”-O’Shea






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Ventral Vagal

Reparative Nurturing

Installations

What Would You Have Needed

What Would Your Parent Have Needed

Ventral Vagal

In the Mind and in the Room, Providing Social Engagement

Attachment healing

What the Brain Has Been Waiting For All These Years

Remediating Relationships Among Ego

States

Transforming Object

Relations






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Your Inner Conference Room

• Very brief• Not in dyads because very deep, very

clinical, very fast• Rather just take a moment ….

– Recent incomplete project or problem– Imagine inner conference room– Look at parts you see there– Ask each for a brief comment-- Closure

Summary Ego State IntroUtilize the

Dissociation


Honchos First


Reenactments

Pace the Work

• Very powerful• “X Ray to the Soul”






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If Somatically Trained, IntroduceTrauma Processing Gently

Tracking without BLS

Evoked Oscillation

Traumatic

Material

Resource

It’s less disturbing

now

How would it be to just check

back in with the memory…

Evoked Oscillation: Moving Between Disturbance & Resource

Evoking Oscillation

Trauma Vortex

Resource State

Just “nibble around the edges” of the trauma vortex….and return to the resourced state






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Siegel, 1999

Hyper-arousal(Sympathetic Arousal)

Hypo-arousal (Dorsal Vagal)

Optimal Arousal Zone(Ventral Vagal)

Close

Each and Every Ego

State Session

End Ventral Vagal






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Tactical Integrationist

Without Titration --Overwhelm

Fractionation – Manageable






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•Fully Resourced Over Time

•Can Tolerate Affect & Body Much More Reliably

•More Ready for EMDR

About to Describe EMDR Session

• There may be many years of EMDR for DID• The first many EMDR’s are done behind the

amnesia barrier (if there is one)• The host is spared until the memories have

been detoxified• Then when fold in the front part/host, the

work is much easier• This enables the patient to stay stable

Phases of the EMDR

Session for DID Client






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A-Accessthe system

R=Refine

the preestablished target – it may select

you

C=Consent

Refresh your consent including

roles






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H/I= Hypnosis or Imagery

to accelerate or deccelerate

Give a Voice to a Mute Part

If Too Young orSilenced by Threats or Violence or

Shame

T=TITRATION

One of Many Memory Patterns

(Behavior, Affect, Sensation, Knowledge

Braun)






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T=TITRATION

Fractionation (Kluft)

By Ego State

By channel

By age

Titration by Information Channel

Fractionation

Overwhelm if Too Many Neural Nets Co-Present and Looking

Through the Eyes






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Titrate Intensity

Down

One Part at a Time

Others Asleep or

Co-Conscious But Not

Co-Present (LTTE)

Observing Witness

& Fractionation

E=EMDR/BLS

(Insert Bilateral Stimulation Here)

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Modality?

• Auditory or tactile is gentler, because they CAN dissociate to titrate their own experience

• Eye movements you can see if they dissociate, because the eyes fixate

• May use visual and auditory or tactile, so they can close eyes if they need to

E=EMDR/BLS

Siegel, 1999

Hyper-arousal(Sympathetic Arousal)

Hypo-arousal (Dorsal Vagal)

Optimal Arousal Zone(Ventral Vagal)

E=EMDR/BLS

EMDR With DID WILL Loop!!

• Rule of thumb• Unavoidable• Best laid plans go south• Be prepared for the unexpected• Receive new info and parts with curiosity

and acceptance• Quit while you’re behind – it won’t be SUD 0

E=EMDR/BLS






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EMDR & DID = Looping

Part That Comes Up Next Isn’t

Doing So

Ask Why and Debug or Shutdown

E=EMDR/BLS

Ego State Interweaves• I’d like to speak directly to whatever part

comes up next – what’s your concern? • Listen to part’s concern and/or observe

switching and track energy, body• Hi! (If unfamiliar to you) do you know who I

am? Have you been here before? • If part doesn’t know you or what you are

doing, stop EMDR, explain and only continue with that part’s permission or close down

E=EMDR/BLS

Ego State Interweaves

Angry Protective Parts (Sympathetic Arousal States)

• If they are afraid of being out of a job, reassure them that there is a new job for them

• If they are afraid of doing harm to someone, assess safety and educate re slow leak, titrated release in EMDR and somatic work

E=EMDR/BLS






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Ego State Interweaves

If child part (dorsal vagal helplessness) • If they were told not to tell, orient them to

present time and reassure of safety (if safe)• If they are afraid of the pain, add a titration

method, or bring an additional resource• If they wanted to move to anger but can’t,

offer somatic micro-movements judiciously

E=EMDR/BLS

Somatic Interweaves

• Standard protocol – no bias toward somatic relative to cognitive, affective channels of information

• Somatic channel is one of ways to fractionate• But if processing loops (gets stuck) somatic

work can be part of a strategy to get it unstuck, that is, with a somatic interweave as one device in the armamentarium of interweaves

E=EMDR/BLS

Somatic Interweaves

• If simple looping, can ask, “what are you noticing in your body?”

• And….”go with that” • Consistent with standard protocol which

instructs to “change channel”

E=EMDR/BLS






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Somatic Interweaves

• If conflict not resolving, can ask them to hold one point of view in each hand, and feel the weight and texture of each one, to evoke oscillation between the two, and to uncouple the conflicted poles from each other

E=EMDR/BLS

Somatic Interweaves

• If looping and ONLY if looping on a fight/flight response

• As evident by:– client’s overt language about feeling angry– client’s wanting to hit or run, or – As observed in behavioral fidgeting of hands

during tracking ….or

E=EMDR/BLS

Somatic Interweaves

• If you are energy sensitive, may notice client’s unacknowledged material resonating in your body, so can inquire with curiosity,, “what’s that in the throat?” or, “is there discomfort in the chest?”

E=EMDR/BLS






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Somatic Interweave

• If they are looping on an inability to see themselves with compassion, can ask them to touch their arm with their other arm, the way a child should be touched, and notice the felt sense of it in the receiving arm, and the sending arm, oscillating between the two

• Can spend weeks on this, beginning to create fluid shifting in intersubjective awareness from I to thou

E=EMDR/BLS

Initiating Micro-Movements

• To release trapped sympathetic arousal• Not in sudden, dramatic movements which

would release nothing, merely an acting out• Gradual attenuated release

If Can’t Do Micro-Movements

If touch is contra-indicated, use imagination to create a felt sense of how it would be to have boundaries






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Never over do it, don’t want them to get overwhelmed in sympathetic

arousal, and then go into dorsal vagal shutdown

Or no choice but to pull out the BIG GUNS ….

Initiating Micro-Movements

Hearing the Narrative in the Enactments

• If mute, “Little One couldn’t talk,” • Or, “it wasn’t safe to talk,”• If choking, “there was choking involved?”• If rapid switching, “no matter which way you

went, you couldn’t win…”• Always, did I guess right or wrong?

If they are cruel to the therapist:

• There is cruelty in the air• I’m wondering if you were treated with great

cruelty…• They didn’t see your humanity• Or I’m so sorry they didn’t see your humanity• Little One wasn’t seen at all• She was alone then, but this time someone

is listening






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Summary EMDR & DID• Always do just a fraction• Always plan• Always expect and accommodate surprises• Always expect looping• Maintain dual attention awareness with

orienting procedures as needed • Resolve looping with ego state therapy and or

somatic interweaves • Hear the story in the non-verbals• ALL OF ‘EM

If Pace and Resources are Just Right

One Piece at a Time






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Continuity of Time, IdentityMemory, Perceptions

Spontaneous or Assisted Meaning Making

C=CLOSURE Meta-Cognitions

To Create Hope and To Wrap Up Incomplete

Sessions

(PS: DID EMDR sessions are always

incomplete sessions)






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C=CLOSURE Tucking in As Always

T=TRANQUILITY TECHNOLOGYTape, Telephone

S=Stabilize, Synthesize, Soothe Don’t Overdo, Consolidate

Once States Unfrozen

Milestones Can Be

Achieved






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Resourcing

Skills Building

Skills Building

Performance Enhancement

Protocol






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Parts working together toward same goals, serving same self, releasing attachment to perpetrators

With integration, barriers spontaneously thin…

Some States Fragmentary

BASK Elements

Some Are Ego Invested

Reabsorbing in Integration

Integration Ritual Spontaneous or By Brief Formal Process






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Future Templates & Follow Up

• Go into future with EMDR/BLS• Anything interfering with optimal future

performance will pop up• What they will do – wrap up therapy or

continue at increasing intervals • And length termination process to ensure

they are prepared for life after therapy

For Complex Cases Need Three Additional Skills Sets… Plus EMDR

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So that’s ego state therapy

• Applied to dissociative cases• Punctuated with somatic understandings• But let me tantalize you with one more set of

concepts….

Phases of Treatment

• Before we end want to introduce a radical revolutionary approach

• O’Shea built on methods from my workshop• She and I collaborating since 2006

– O’Shea & Paulsen 2007– O’Shea in Solutions II– Paulsen in Lanius, Paulsen & Corrigan

expanding procedure for complex cases

Nickel Version

• Two basic prep steps – 1 containment– 2 safe state

• Astounding new prep step works directly on sub-cortical hardwired circuits – Panksepps– 3 resetting circuits

• Clearing trauma by time frame (not target imagery) beginning from before birth

• Draw your attention to supporting theory…






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Temporal Integrationism

• Processing from beginning like• Three hole punch • Allow me to explain and to illustrate

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Understanding This Amazing Procedure

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When Attachment Goes Wrong, Circuits Can’t Flow

When Emotions Can’t Flow, Trauma Piles Up

If Self Can’t Develop, Defenses Stop Embodiment






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Periaqueductal Gray (PAG)

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Step 3 – Resetting Circuits

• Bilateral stimulation• Applied to each of the

panksepp circuits• Without an affective

load on them• Free to conduct

emotional data

• Perhaps cleared at the level of the PAG

• Prepares for step 4 processing by time frame….

Dissociated Early Experience

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Failure of : •Intersubjectivity •Attachment•Integrated affective circuits and state switching•Integration of identity, perception, memory• And it just piles up as time goes by, getting worse






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Step 4 - Because We Start Before the Unintegrated Experience Occurs

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Something interesting happens…..

Temporal Integrationism

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Questions?

• About any of the videos• Anything ego state

Bainbridge Institute for Integrative Psychology

Sandra Paulsen, PhD






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35 min ferry ride from Seattle…





sandra paulsen, ph.d. copy right all rights powerpoint...• if child can’t fight or flee, so...

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