Thomas Zimmerman
Welcome everyone I’m here with Leslie Pertz, who’s one of my favorite people in the whole EMDR universe. So we’re here, we’re here to talk about doctor’s permission for EMDR therapy in a perinatal context. Welcome Leslie. Please introduce yourself. Please.
Leslie Pertz
Thanks Thomas for inviting me today. I am, as Tom said, I am Leslie Pertz. I’m currently in Ann Arbor, Michigan, which is about 30 minutes outside of Detroit and the bridge to Canada, which I remind myself of very often in these times. I am, as he said, I am a perinatal mental health specialist. I’m certified in perinatal mental health through Postpartum Support International, and I’m an EMDR Certified and Approved Consultant, and not too long ago, an EMDRIA Approved Trainer. So I’m really excited to talk about this today, because I will talk about doctor’s notes as it came up for me in the context of perinatal applications of EMDR. But this is really for anybody, any you know, whatever the condition is, whatever the question is, because it’s a it’s a question that I get asked as a consultant, and sometimes we see come up in the Facebook groups or on pages, people are asking, “What do I do with a client who has [fill in the blank condition]?” So as the question comes to someone who sees primarily in my work in private practice throughout the State of Michigan, because I’m mostly telehealth, I see about a third of people in person, but I see people who are all across the State of Michigan, and the question will come up every so often, of consultees… if this person is pregnant I was told in my training, we cannot do EMDR in pregnancy. And if you have ever watched or heard Mara Tesler Stein speak on this, and she has some videos, and she spoke at the EMDRIA conference a couple years back on this as a concept that those are old ideas and no longer valid. And we could have a whole entire discussion about why that’s no longer valid, but we need to have sometimes a question about, well, what if there’s this, what if it’s high risk pregnancy? What if it’s a twin pregnancy? What if she has preeclampsia? What if… there’s always the what ifs… and the first thing that I think about this question is how I felt reading Francine’s book, or the times that I’ve read Francine’s book, I sometimes, and bless her, I sometimes feel like she may have started writing the book out with some blurb about everybody thinks we’re all cuckoo banana pants, so don’t do anything that would make us, make anybody think that we’re more cuckoo banana pants than we already are. So she talks about in her book a lot, taking care, having caution, you know, kind of staying in your lane, but some of even the things that she said in her book really required a lot more expansion to kind of explain why she was saying those things, and I don’t think that she did that. So there’s several times in her book where she says, you know, use caution about this, or use caution or use care, but doesn’t say why use caution or use care. So I think over the last several decades, then well meaning trainers, well meaning clinicians take those pieces and think, well, we shouldn’t do this. And specifically, there’s a paragraph that those of us who get this question about doing EMDR and pregnancy point to. There’s one paragraph that says, with as with any medical condition, if somebody is pregnant, you should use caution with EMDR, and they took it as “Nope, we shouldn’t do this anymore.” So the question comes up then sometimes about what that caution looks like. Do we just not do it? Should we get a doctor’s note? How should we use caution or care with this person with any medical condition? And so, like I said, it’s not just pregnant people. It could be maybe this is a good question, or just even a conversation. What are some things that you’ve heard? I’ve heard a stroke, TBI, eye conditions. What are some of the things you’ve heard? Those are the big ones. Maybe, even things like cancer, but usually like brain and eye stuff. If there’s been brain or eye stuff, can we do EMDR?
Thomas Zimmerman
Seizures and neurological stuff too?
Leslie Pertz
Yeah, seizures, yep, yep, yep, yep, that’s a good one. So then it’s go get a doctor’s note, and I like to share… I had a couple of different epiphanies about getting a doctor’s note. I worked for a very large health system, maybe largely connected to the City of Ann Arbor, but I worked for this very large health system for a very long time, and so I had direct access to doctors. And I had a client one time who was on the heart transplant list. So she is on the heart transplant list, and came to me, and she was very eager to do EMDR. I want to do EMDR. I have A, B, C, D, E, F, G, traumas. I’m really excited to do EMDR. So myself, and this was just a few years ago, even my own self, I was like, I don’t know you’re on the heart transplant list. I don’t think that’d be safe. Now, I didn’t go to medical… I mean, I worked at a health system, but I didn’t go to medical school. I didn’t go to nursing school. I barely have had so much as a biology class since the ninth grade of high school. Don’t ask me how I got through undergrad and graduate school with nothing, with no organic sciences, but I did. So I was like, Oh, I don’t, I don’t think that will be safe. But I had access to her cardiologist, so I typed out a message to the cardiologist, and I said, Hey, cardiologist, hey, I had enough sense to go What if I, what if I do therapy with this person and their heart rate really increases to like, 150, 160, 170, what if she has huge spikes in cortisol, or, you know, whatever, stress hormones, what if she has all this stuff? And the doctor sent me a nice note back and said, “it’ll be fine, don’t worry about it.” And I was like, no, no, I still don’t think it’s going to be safe. No, no, I don’t like this. So I sent another message back. I’m like, like, really, are you sure? Like, she’s on the heart transplant list, and I really think this is not going to be a good idea. And bless this doctor, he sent a message back, and he said, “What do you think you’re doing in therapy and is worse than the damage she already has to her heart?” I was like, oh, okay, what do I think I’m doing in therapy that is worse than has already happened? And he said, and if you are able to reduce her anxiety and reduce the stress that she’s living with every single day, that’s probably going to be a good thing. And I was like, oh, okay, all right, this was all about my own fear. This didn’t have anything to do with this person. It was my fear and therapists, you know, don’t we all kind of walk around just waiting for, like, to be served by papers from some scary attorney or the the letter from my state board that says my license is going to get taken away. We practice really defensively, and there may be no reason for this. So another one, I had was a client, and this was a perinatal client. She herself was a maternal fetal medicine physician, and she herself was pregnant, and this was even before I met Mara. So this was quite some time ago. It was the cardiologist that really made me see the light, but the my own client, who herself, herself, was an MFM. I started talking with her, Oh, we’ve been doing EMDR all this time, but I don’t you know it’s kind of contraindicated, I’m not really sure, and here’s the reasons why. And she just looked at me, and she tucked her head like this, and she said, “Well, that’s a weird thing to say. That’s a weird thing to say that we shouldn’t do therapy while somebody is pregnant.” And I was like, Oh, that was like, the first maybe idea that we don’t have to get doctor’s permission. The last piece, and this was after, then I’ve already seen the light, but the last piece, I saw this on a Facebook post one time, and then I asked for permission to use this. And this comes from a midwife, a certified… I don’t know what the P means, but a certified midwife, and really got me started thinking that withdrawing or withholding, with withdrawing and withholding good care that we know EMDR is from people might be violence if we think we know better than somebody else and we withdraw or withhold good care, that could potentially be violence. So I will read this out to you, but also it’s here for you. “To whom it may concern. My patient, fill in the blank, date of birth, fill in the blank, has been receiving midwifery care during her pregnancy. She recently told me that she needed a letter for a teeth cleaning at your office. As a sovereign adult who knows what is right and best for herself and her baby, I’ve instructed her that she does not need me granting her permission for such a normal task, while I understand that this has been the customary of care in our medical field to release us from liability, I assure you that if we as healthcare providers start questioning these standard tasks that just tick boxes and participate in health care, where we leave adults in charge of full body autonomy, our broken medical system and hence, every unhealthy population will start making better choices for themselves and their families, because they will realize taking responsibility for their health care is essential. I don’t say this out of confrontation, just a reexamining in thought, where we ask an adult to get permission from someone else for something that has to do with their body. If you have any questions, I would lovingly accept a phone call.” That was an education, right there.
Thomas Zimmerman
That is an education and related to the point, is this even for our clients, or is this for us? Is this because we can’t tolerate even the tiniest risk that we’re going to be the last person to touch a vase before it breaks right? It’s like, we just, yeah, yeah.
Leslie Pertz
I mean, I’ve heard, I’ve seen that, and I’ve responded to that, sometimes on Facebook posts or comments with pregnant people. Well, what if I do EMDR and she they have a miscarriage? I don’t know. That’s never happened to me. Well, it actually has happened to me. I have done EMDR with people and a miscarriage has happened. I have never had it where someone assumes that I’m the one who made that happen, right? And so if that does happen, well, then we manage that and we process that. And that doesn’t mean I demand that people go with that the very next session, but I hold my clients, and I take care of the client in front of me. So really, from the time that I started EMDR, till today, I really changed my whole mindset about what trainers say, recognizing as a trainer that I’m still learning and growing, and it’s not like I’m, you know, bringing directives and nor was Francine. We’re not bringing directives from the top of the mountain that say this is the right way for you to practice, but we are fallible human beings that can keep learning and growing, and the therapeutic relationship is the most important part. And I don’t do my therapeutic relationship by committee, and I don’t need somebody else’s permission to do the good work that I know is going to help people heal. So it’s just some things to think about, and if there’s some things that you’re afraid about, EMDR, gosh, there’s a whole world of consultants out there that can help talk about these concepts with you so that we can do good work for our clients. Because I just love that idea of that, that cardiologist that I don’t know if you knew the darndest thing about EMDR, but if we can help our clients nervous systems regulate better, that’s probably going to be better for them, no matter the medical condition. Now this is all to be said too, that it’s not that I’m jamming EMDR across to every single client that you know, the fast bilaterals. What am I… We’re always talking about, right? I’m not demanding desensitization Phases Four through Six with every single client, every single time, right? When things happen, I still use my good clinical gut. The client comes to me and says that they had eye surgery two days ago. I might go, Hmm, how did your eyes feel? You think maybe we should do some tapping today? And there’s all kinds of different considerations that I can adjust and change, but I use my good clinical gut.
Thomas Zimmerman
No,
Yeah, it makes sense. It makes sense. So, yeah, good. Thank you. Anything else to kind of, what’s the, what’s the, the top layer of this, this little cake, what’s our, let’s, let’s put something on the top of, maybe summarize everything in a sentence or two, so that…
Leslie Pertz
You did not need a prescription from a doctor to go and do good EMDR.
Thomas Zimmerman
Yeah, yeah. You don’t need permission from someone else to do your job, and to work, and for you and your client to do, to do good work. Yeah. Awesome.
Leslie Pertz
Thanks. So I appreciate you inviting me to have this conversation because it’s a topic that I feel really passionate about.
Thomas Zimmerman
Good Leslie, where can people in the EMDR world reach you? How can you consultation with you?
Leslie Pertz
You can find me at LesliePertz.com. LesliePertz.com
Thomas Zimmerman
Excellent. Thank you.
Leslie Pertz
Thank you. Have a great day.
Thomas Zimmerman
All right, bye, bye. You.
365 Questions About EMDR With Complex Trauma 