In a previous podcast, we explored what a blocking belief is in EMDR therapy. I want to itemize some options in working with blocks and identify some advantages and challenges in each approach, so that you can weigh the clinical picture of your individual client and make the best suggestions. First, I think that “suggestion” is the right word, because this work really needs to be collaborative. Blocks don’t exist accidentally. They have served and some may continue to show up in an attempt to serve very important coping and survival functions.
The classic guidance is to target the block as a concept or target the memories that serve as the foundation for the development and maintenance of the block. Without substantial experiential front-loading, it is likely that targeting the block as a concept isn’t going to be any more productive with clients with complex trauma than targeting any other theme of wounding as a whole. It’s probably an enormous territory with nearly countless memories that can serve as data points to justify and support it. Encouraging the client to rummage through much of that will require a very big boat of adaptive information, and remember that blocks generally exist because of significant deficits in right-now adaptive information.
The other most common piece of guidance is to target the individual memories that were central to the formation and maintenance of that belief. If that works, that’s fantastic. But remember, a block is a belief about the self that makes it difficult for the client to do EMDR therapy effectively. How can you target the central memories of the belief when the right-now existence of the belief blocks or complicates you from doing one of the core things needed to do EMDR therapy well? It feels like a chicken and egg dilemma. We may need to bring in things other than chicken and eggs to solve it. Also, these memories are not small. They may be the memories that most broke your clients in childhood. In short, they are not places where I like to start targeting with complex trauma anyway. What are some of our other options?
Sometimes we can do EMDR therapy in territories where the block does not exist and the adaptive information generated from that can be helpful for this. To repeat, sometimes working in territories adjacent to the block can be helpful in chipping away at the rigidity of the block. Obviously, this doesn’t work when the block shuts down a core element in EMDR therapy.
It can be helpful (sometimes essential) to scrutinize the block. One way I may chip away at the block is to look at how it has helped you survive. It has probably been helpful. We want to nod in appreciation of that. We also want to explore what has it cost you to survive in that way? What is it costing you now? What is it likely to cost you going forward? If you can’t find a cost or a significant motivation to change it, this work is going to be even slower.
Another way I may scrutinize the block is through psychoeducation. Psychoeducation has its limits, but the adaptive information has to get in there somehow. Sometimes we just need to put some facts on the table about what it means to have been born human (and born into need) and discretely back away.
Depending on the block, I’m really likely to ask the client to perspective take it. If the client really believes that they are bad, dispositionally bad, I may point out that I was born human and propose that they were too. Can you imagine going into the part of the hospital where babies are born? Can we sort those babies between those who deserve to be loved and those who are bad… those who deserve to get their needs met today and those who do not? In the exercise, clients will often say, “Tom, I know what you are doing.” It’s an experiential journey. You can do the same thing asking the client to perspective-take what they would tell a friend. Rarely single experiences are transformational but they can help widen the crack in the belief. Prospective-taking exercises provide an opportunity to point out that you weren’t born that way. So many blocks feel dispositional because they may originate in the land before language. I often say, “My guess is that we were born with the capacity to express with our whole voice and our whole body, when we were not okay. But to survive, we had to learn other things.” If this block was an adaptation to the realities of your then environment, in what ways is that environment not happening right here and right now?
It can sometimes be helpful to find and grow exceptions. In what ways are you already living in ways that violate the block? Find the cracks and put the client’s awareness briefly in the contradiction of it.
Parts work can be very helpful here. What percentage of you knows that the blocking belief isn’t true for other people? What percentage knows it isn’t true for the people you may care about? For you? Again, it’s how the block is held often that makes it so blocky, not so much that it is present to some degree. We’re exploring for exceptions to the block in your parts system and we will briefly put the client’s awareness there to try to grow it.
Exploring what would happen to you if you violated the block can sometimes free up some stuck points. What would happen to you, if you let yourself cry? “Tom, I would never stop crying.” I validate that, but I also let the client know that I have seen the inside of psychiatric hospitals and they are not filled with people who started crying in 1978 and couldn’t stop. We want to acknowledge the size of the fear, recognize that this work is not easy, but also hold information in the session that is true if the client can’t.
Parts work can allow parts of you to have new and disconfirming relational experiences with other parts of you that might build new possibilities out of what seems like nothing. Parts work can bring relational and attachment healing in its own right. Attachment figure resources are an expedited way to do parts work in some of the very territories of the client’s most profound deficits.
We may need to creatively leverage the therapeutic relationship to do some of this work. If the client can’t hold a positive belief about themselves, I may ask if I can hold that belief about them for just a few moments in my own nervous system. It’s a strange little intervention, but it can be powerful. I’m bringing into the room what they can’t have in their bodies right now and I’m genuinely getting in touch with whatever that positive belief we are trying to support is. For instance, I’m going to imagine the client as a child, and I’m going to get in touch with the belief and the somatic sense in my own body that as a child they deserved to get their needs met. I just did it. I just breathed that belief in and it did not hurt me in any way. And the client saw me do that. The client experienced me holding for a moment what they cannot. It’s not enough, but it was in the room… it was that close. And that’s something.
Some therapists send clients out into the world to have new relational experiences. I rarely do that with my clients with severe trauma, because they interact with the world and with other people through the lens of their already pervasively traumatized nervous systems and they are likely to have experiences that support the block, rather than disconfirm it. If your clients can, real-life experiential learning outside of sessions can be helpful.
There are so many forms of frontloading and tackling blocks, I want to ask CITs and Approved Consultant colleagues how they do it. When they reply, we’ll have those short podcasts here too.
365 Questions About EMDR With Complex Trauma 