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Bainbridge Institute for Integrative Psychology
Sandra Paulsen, PhD
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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
Theory – In Presence of Severe, Chronic Trauma and/or Neglect
• 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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Theory – In Presence of Severe, Chronic Trauma and/or Neglect
• Developmental Theory – Bowlby, Main, Siegel, Schore
– Failure to meet developmental milestones
– Failed attachment has neurobiological sequelaeincluding
– Failure to acquire affective regulation
Theory – In Presence of Severe, Chronic Trauma and/or Neglect
• 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
8/18/2015 32
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
Overview of Containment
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
Overview of Containment
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
Overview of Containment
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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Overview of Containment
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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Overview of Containment
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!!
Overview of Containment
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
Overview of Containment
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
Working Ego And Object States Build Intersubjectivity
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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Working Ego And Object States Build Intersubjectivity
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”
Working Ego And Object States Build Intersubjectivity
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.
Working Ego And Object States Build Intersubjectivity
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”
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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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
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
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
A Few Basic Ego State Tactics
Utilize the Dissociation
Appreciate the Parts,
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
A Few Basic Ego State Tactics
Utilize the Dissociation
Appreciate the Parts,
Honchos First
Orient Often x3Listen to the Story in the
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
Appreciate the Parts,
Honchos First
Orient Often x3Listen to the Story in the
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…
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