The Prevalence of Trauma
EMDR (Eye Movement Desensitization and Reprocessing) has become the treatment of choice for dealing with PTSD (Post-traumatic Stress Disorder) as a result of controlled studies on returning war veterans conducted under the supervision of Francis Shapiro, the creator of EMDR. A scientist by training, Ms. Shapiro wanted to demonstrate the efficacy of the technique by putting it to a statistical test. The results, repeatedly replicated by others, have made EMDR one of the few psychotherapeutic treatments to be validated in controlled experiments, and not just by anecdotal evidence.
When one uses the word “trauma,” the general public tends to think in terms of overwhelming experiences sustained in military combat, in a natural disaster, or through physical or sexual abuse, and EMDR has proven effective in dealing with this kind of trauma. Yet nearly everyone has experienced what I call “small t trauma,” meaning any experience that overwhelms one’s capacity to process it normally. Not surprisingly, such “small t” trauma frequently occurs in childhood, since children are more easily overwhelmed by strongly emotional experiences. Such trauma may occur as a result of witnessing a violent dispute between parents, being bullied, being teased beyond endurance, being humiliated, or suffering a grievous loss.
The most commonly occurring mental health issues, such as depression, anxiety, or relationship problems, often have their roots in earlier trauma. Addressing only the symptoms of these issues leaves the underlying trauma unprocessed, which means that the negative self-beliefs that generally accompany trauma continue to have a deleterious impact on the individual’s sense of self-esteem and his or her ability to form and sustain intimate relationships. Addressing the underlying trauma using EMDR can resolve both the presenting issue and its root causes.
It is often difficult to support this claim with a full clinical report since instead of completing a full treatment plan, clients frequently cease coming to appointments once their presenting complaints have been reduced to what they consider a tolerable level. The accounts that follow describe the treatment of half a dozen of my clients who continued treatment until all of their underlying traumatic experiences had been either processed or reduced to a disturbance level below the general threshold for EMDR (SUD < 5). I have changed the names of the clients and suppressed identifying details of their experiences.
Calvin H. came to see me in order to deal with anxiety arising from a medical diagnosis. The Beck Anxiety Inventory at intake registered 21 or moderate. In this case, the client had no childhood trauma to report. The most significant previous trauma came from his divorce, in which his long-held belief that he could fix anything ran up against a situation that he could not fix, leading to a feeling of failure. Addressing this earlier traumatic experience using EMDR allowed the client to then process the current anxiety successfully, and go on to deal with his medical treatment without fear.
George F. also experienced anxiety, as well as panic attacks during driving, to the point that he was scarcely able to drive at all, and never on major highways. I dealt with the driving phobia using a standard desensitization technique associated with cognitive-behavioral therapy. I then gave the client the option of addressing the root causes of his fears and he decided to pursue this option. George’s underlying issues included childhood abuse and bullying, as well as trauma associated with the treatment of a physical injury. Following the EMDR protocol, we identified a negative cognition (NC) associated with each traumatic experience, as well as a positive cognition (PC) that the client would like to believe once the processing had been completed. For George these cognitions included: NC: I am shameful (PC: I am honorable); NC: I am inadequate (PC: I am capable); NC: I am a disappointment (PC: I am okay as I am); NC: I cannot trust anyone (PC: I can choose whom to trust); NC: I cannot stand it (PC: I can handle it); NC: I’m in danger (PC: It’s over; I’m safe now). After the completion of our treatment, George reported that in addition to being to drive anywhere without stress, he had now succeeded in carrying out a major project that he never could have undertaken before.
Rebecca S. also came reporting anxiety, with a Beck Anxiety Inventory at intake registering 19, or moderate. Her anxious feelings brought such tension in her jaw that she constantly ground her teeth at night, requiring the aid of a mouth guard to prevent injury to her teeth. Rebecca’s concomitant issues included a lack of boundaries and lack of self-esteem. Her traumatic experiences went all the way back to childhood, including conflict between and mistreatment by alcoholic parents and bullying by her siblings. Rebecca’s negative cognitions reflect the nature of her experiences, with predictable effects on her sense of self-worth. NC: I’m a bad person (PC: I’m a good, loving person); NC: I am powerless [or helpless] (PC: I am strong) [Each of these negative self-beliefs occurred repeatedly.] NC: I did something wrong (PC: I did the best I could); NC: I am not in control (PC: I am now in control); NC: I’m not good enough (PC: I’m okay as I am); NC: I should have done something (PC: I did the best I could); NC: I am in danger (PC: It’s over; I’m safe now). In addition to processing disturbing experiences, we set up rules for dealing with intrusive family members. Where Rebecca began by describing herself as a “doormat,” she developed procedures enabling her to insist on being treated with respect.
Wendy P. suffered debilitating depression, with a Beck Depression Inventory level of 38, or extreme, at intake. Her catalogue of disturbing experiences was the worst that I have encountered as a psychotherapist. Her issues included childhood physical abuse, gang rape, a cheating husband, and the break-up of her marriage. Predictably, a small number of negative self-beliefs kept recurring as we addressed Wendy’s horrendous list of traumatic experiences: NC: I cannot trust anyone (PC: I can choose whom to trust); NC: I am insignificant (PC: I am significant); NC: I should have known better (PC: I do the best I can); NC: I cannot stand it (PC: I can handle it); NC: I am permanently damaged (PC: I can be healthy). Wendy’s present circumstances remain unenviably bleak, but she now experiences a sense of inner strength enabling her to address them effectively. For the first time she felt able to take on the maintenance of a house that had gotten completely out of control and to see the positive aspects of leaving a stressful and abusive employment situation.
Melanie R. also experienced depression, particularly as she faced her lack of success in establishing healthy relationships. (The Beck Depression Inventory Level at intake was 27, or moderate.) Her list of most disturbing memories included her father’s abuse of her mother, her mother’s physical abuse of Melanie, and several abusive relationships in which Melanie had been involved. Melanie’s negative self-beliefs reflect a very low sense of self-esteem: I cannot succeed; I am shameful; I’m a bad person; I deserve only bad things; I am worthless. In addition to processing each of Melanie’s disturbing memories we also employed thought-stopping techniques to prevent her negative beliefs from infecting her day-to-day life, thoughts such as “I’ll never amount to anything,” “I can’t do anything right,” or “I always fail.” I find thought-stopping techniques and replacing negative beliefs with positive affirmations to be truly effective only when the client creates believable alternative statements. A client suffering from low self-esteem will likely reject conventional platitudes, thereby diminishing the value of the technique. So to contradict “I can’t do anything right,” Melanie came up with “I do some things right,” as an initial statement.
Kate T. consulted me over problems of trust in a relationship. In my experience, relationship issues can be traced to early trauma just as much as problems involving depression or anxiety. Kate’s disturbing memories included witnessing fights between her parents, childhood sexual abuse, physical abuse by a sibling, and a suicide note written by her mother, although not acted upon. The negative self-beliefs generated by these unprocessed memories clearly had a deleterious effect on Kate’s ability to make and sustain intimate relationships: I cannot trust my judgment; I am a bad person; I am ugly ; I am in danger; I am worthless; I am powerless; I am permanently damaged; I am insignificant. Kate’s recovery of mental health could be seen in her processing of her mother’s suicide note, in which in the course of EMDR sets she understood that she could not protect her mother from her own sadness. At our final appointment, Kate reported that she “had her own life now,” as opposed to being the pawn of others.
Trauma, whether of the “capital T” or the “small t” variety, exerts a profound influence on one’s sense of self, on one’s view of the world, and on one’s attitude toward others, in short, on the core beliefs whose quality helps to define one’s mental health.
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