The episodes that follow this one provide options that can help your clients moderate the amount of distress that comes into awareness by adjusting how the client interacts with the memory. If your impression is that it’s best to stay out of the way and let things go where they go, you are right. But sometimes with clients with really complex trauma that’s not a good idea. We can appreciate that a toddler needs to bump around the living room, even if that means some occasional bumps and upset. That’s probably the best way for them to learn how to navigate the world effectively, safely, and confidently. Conceptually and generally, that feels true. Some toddlers, if you turn your back on them for one second, will walk straight off a cliff or will literally burn your house down. The world contains those also. You need to know the nervous system that is in front of you.
Other podcasts will address strategies to help you work in tolerable territories. This grouping of podcasts is about how to promote the client staying inside their window of tolerance by making small adjustments to how they interact with the memory. I often use the boat and the fish metaphor, with the boat being the fund of the client’s right-now adaptive information and the fish being the memory you are trying to land in the boat. Imagine the client is in an eight-foot canoe and is hooked to a five-foot fish. That memory is theoretically landable using the adaptive information that is accessible, but how you interact with that memory matters. It’s not just the total size of the memory, it’s how you reel it in. If you stand on the seat of the canoe and just yank and yank, you are likely to flip over. It’s not just the size of the memory. Are the pieces you are activating coming in tolerable and noticeable chunks? That is a highly relevant question with clients with severe trauma for these reasons:
- Clients metabolize the distress that comes into awareness by present-based noticing. Often, the closer that they get to flooded, the more likely they are to be out of present awareness and the more likely that are to be in the memory.
- The body starting to take an intolerable state often causes a parts battle related to the management of that pending body-based catastrophe. It’s hard for parts of you to take an open, mindful, and noticing stance when you feel on fire.
- The distress that comes into awareness needs to come within the client’s window of tolerance. Clients with complex trauma, because of their allostatic load, typically don’t have a big window of tolerance. It is not unsual for my client’s baseline to be 8/10 or even 8.5/10 when starting a reprocessing session. They may have paper-thin windows of tolerance, even after weeks or months of resourcing and frontloading. It’s often tolerable healing that may start to make the window of tolerance wider.
- Remember that we aren’t just noticing distress. Beneath the surface, the client’s nervous system is metabolizing the old stuck information into existing adaptive information already held somewhere in the client’s system. What happens to the parts of the brain that hold that rational information when we get flooded? The parts that know that you were just a child, that children are not responsible for what grown-ups do to them, and that that shame isn’t yours? They become less accessible the closer you get to flooded. The closer the client is to flooding, often the smaller and farther away the boat becomes. This decreases the chance that any of that noticing will be productive.
All of this is to say that when working with clients with complex trauma, we need to work in tolerable territories and in tolerable ways. That information is not new to you. The idea that complex trauma doesn’t want to come out in tolerable chunks is also not new to you. These episodes are strategies to help promote distressing content coming into awareness in smaller, more tolerable, and ultimately more productive ways. As we will see, the hardest and least efficient way to do EMDR therapy with clients with complex trauma is in ways that are not tolerable. Here are some options you can use when they are clinically and reasonably justified. Several of them have the advantage of Francine Shapiro recommended resources in their own right for clients with complex trauma.
365 Questions About EMDR With Complex Trauma 