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What happens after successful EMDR?

Post Traumatic Growth becomes ‘Network Growth’

David BlorePhD student

School of Health and Population Sciences

College of Medical and Dental Sciences, University of Birmingham, England

10th EMDR Europe Conference, Beurs van Berlage, Amsterdam 2009

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Observation

• Because clients are discharged when ‘symptom free’, EMDR clinicians rarely get to see what actually happens in the weeks, months and even years following the installation of positive cognitions…

• …this is hardly surprising given the understandable objective of healthcare to reduce the suffering of negative symptomatology… but this has given rise to a ‘lop-sided’ view… recognised over 50 years ago…

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Maslow’s criticism of the ‘negative only’ view of mental health:

“The science of psychology has been far more successful on the negative than on the positive side. It has revealed to us much about man’s shortcomings, his illness, his sins, but little about his potentialities, his virtues, his achievable aspirations, or his full psychological height. It is as if psychology has voluntarily restricted itself to only half its rightful jurisdiction, and that, the darker, meaner half.”

(Maslow 1954 p.354)

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Research questions

• What is the lived experience of clients who have been in a traumatic experience, subsequently undergone a course of EMDR and experienced ‘positive’ outcomes?

• How did they get there?

• What can be learnt about the role of EMDR in that process?

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Methodology

• Phenomenological investigation of Road Traffic Crash victims, who had reported ‘positive’ outcomes subsequent to receiving EMDR

• Snowball recruitment of participants via treating EMDR clinician resulted in n=12 interviews of “experiential experts”

• An Interpretative Phenomenological Analysis (IPA) framework for data analysis to facilitate the generation of hypotheses

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Results

• 1589 Second hermeneutic ‘summary phrases’

• Generating 19 ‘Sub themes’

• Clustering into: – 2 ‘Super-ordinate’ themes and – 1 ‘Over-arching theme’

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Alison Christine David Fiona Isabelle John Mike Nicola Olga Pat Robert Tim TOTAL

NAVIGATIONAL STRUGGLEASSUMPTIVE WORLD pre RTA 3 4 1 2 2 2 1 2 0 1 1 1 20

PERI-RTA STRUGGLE WITH ASSUMPTIVE WORLD 11 5 12 14 5 3 4 6 4 18 6 7 95

SPIRITUALITY TO RESOLVE STRUGGLE 9 10 2 0 2 0 3 1 0 3 0 5 35HANKERING (struggle to maintain assumptive w orld) 4 12 4 2 4 3 8 0 0 3 1 8 49

SECONDARY TRAUMATIC EXPERIENCES & IATROGENESIS 13 15 16 19 5 6 6 5 9 15 4 19 132

STRUGGLE TO COPE WITH NEGATIVE OUTCOMES 9 24 11 5 3 5 5 7 9 8 4 9 99

STRUGGLE FOR CONTROL OF READJUSTMENT 18 20 7 7 2 4 11 6 5 10 2 6 98

FIGURATIVE LANGUAGE USE 64 95 25 24 9 18 22 7 9 15 14 18 320

NETWORK GROWTHINVISIBLE

HINDSIGHTING (retrospective w isdom) 35 31 14 13 3 8 6 9 6 15 11 16 167PROSPECTIVE WISDOM 26 59 21 23 12 8 8 6 11 13 5 23 215PARADOXICAL WISDOM 7 6 2 2 4 3 0 0 2 3 1 3 33

VISIBLEDEVELOPMENT OF SUCCESS HEURISTIC 12 12 5 3 0 2 2 0 1 3 3 7 50

ENHANCEMENT OF SOCIAL DEVELOPMENT 6 6 3 9 0 0 0 2 1 2 13 2 44

ENHANCEMENT OF PERSONAL DEVELOPMENT 5 20 6 4 1 3 0 2 4 5 4 5 59

APPRECIATION OF LIFE 3 3 2 2 3 4 0 3 8 4 5 5 42

SPIRITUAL & PHILOSOPHICAL DEVELOPMENT 4 22 0 4 0 0 0 2 0 5 1 9 47

EXPRESSION OF POSITIVE EMOTIONS 12 9 0 3 3 0 1 6 2 3 4 6 49

GROWTH ASPIRATIONS 1 12 3 2 2 1 1 1 2 2 3 5 35

TOTAL 242 365 134 138 60 70 78 65 73 128 82 154 1589

Collated findings grouped by super-ordinate theme

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Why ‘Navigational Struggle’ ?

• Because the themes that make this category effectively describe the individual’s ‘battle’ to get from the traumatic event to some semblance of normality and the ‘route’ taken had to be ‘navigated’

ASSUMPTIVE WORLD pre RTAPERI-RTA STRUGGLE WITH ASSUMPTIVE WORLDSPIRITUALITY TO RESOLVE STRUGGLEHANKERING (struggle to maintain assumptive world)SECONDARY TRAUMATIC EXPERIENCES & IATROGENESISSTRUGGLE TO COPE WITH NEGATIVE OUTCOMESSTRUGGLE FOR CONTROL OF READJUSTMENT

The 'departure point''Losing sight' of 'familiar territory''Calling on higher resources' for helpWishing he/she hadn't departedAdverse 'road and weather conditions'Dealing with 'mechanical failures''Wrestling with the steering'

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Why ‘Network Growth’ ?• Because channels of associations (networks)

are expanding, or as Maslow would put it: “his potentialities, his virtues, his achievable aspirations and his full psychological height” are being achieved

EXPRESSION OF POSITIVE EMOTIONS

GROWTH ASPIRATIONS

INVISIBLE

VISIBLE

ENHANCEMENT OF SOCIAL DEVELOPMENT

ENHANCEMENT OF PERSONAL DEVELOPMENT

APPRECIATION OF LIFE

SPIRITUAL & PHILOSOPHICAL DEVELOPMENT

HINDSIGHTING (retrospective w isdom)

PROSPECTIVE WISDOM

PARADOXICAL WISDOM

DEVELOPMENT OF SUCCESS HEURISTIC

"The EMDR therapist planted the seed" an idea 'germinated', roots formed, and a

'shoot headed upwards'

The 'seedling broke the surface of the soil' a sturdy new 'plant' grew, in due course

'buds formed' and the 'plant flowered'. The 'plant' reached its full psychological height before producing the aspirational 'seeds' of

future growth

DEVELOPMENT 'BELOW GROUND'

DEVELOPMENT 'ABOVE GROUND'

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‘Figurative Language Use (FLU)’

• “Metaphor depends largely on encyclopaedic knowledge” (Griffiths 2006)

• Encyclopaedic knowledge = myriads of networks

• The individual who has been traumatised finds their existing networks unable to cope with the reality of what has happened (see Solomon 2004)

• To comprehend what has happened, the individual generates new networks (about 20% of FLU related directly to the RTC/ driving/roads etc.…)

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‘Figurative Language Use (FLU)’

• But isn’t that exactly what EMDR does…– Every time a traumatic memory is linked into an adaptive

network?– Every time a cognitive interweave works?– Every time the client describes an insight?– Every time the client uses a metaphor so as to

understand the traumatic event and its aftermath?

• “Metaphor is a neural phenomenon… Metaphor is a neural phenomenon… neurons that fire together wire togetherneurons that fire together wire together” (Lakoff

& Johnson 1980)

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Where to next?

• 8 Conceptual models of positive change (O’Leary et al 1998) were reviewed to see if they could describe the positive changes reported after EMDR – none fitted – most had helpful elements.

• A model is thus needed to adequately describe the lived experience of positive outcomes after EMDR for psychological trauma – preferably one that uses Adaptive Information Processing (AIP) as a foundation…

• The ‘Network Growth’ model ‘takes root’ here…

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Figurative

Language

Use

RTA

The ‘Network Growth’ model to explain positive The ‘Network Growth’ model to explain positive outcomes following EMDRoutcomes following EMDR

(Blore 2009)(Blore 2009)

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Conclusions and implications for EMDR practiceConclusions and implications for EMDR practice

EMDR treatment outcomes are considerably moreconsiderably more than merely a reduction in negative symptomatology or resolution of diagnostic entities

Assessment of positive assetspositive assets should be included as routine in history-taking

Secondary traumasSecondary traumas were frequently cited in the ‘navigational struggle’ after the road crash by those developing positive growth.

20% of metaphor use20% of metaphor use related to the trauma itself suggesting adaptive meaning-making as per AIP as per AIP model model and therefore growth started growth started withinwithin treatment treatment itself

PCs could be usefully viewed as ‘incrementalincremental’ in nature to facilitate further reassessment of the PC at the end of the first cycle of the installation phaseat the end of the first cycle of the installation phase. Installation should continue until this process is exhausted. This may result in the need for an ‘incomplete session’ protocol for Phase 5.

‘Post Traumatic Growth’ (PTG) is too restricting a labeltoo restricting a label to fully describe the lived experienced of positive outcomes following EMDR…instead ‘NetworkNetwork GrowthGrowth’ is proposed to describes the ‘invisibleinvisible’ (i.e. adaptive network expansion occurring during EMDR) and ‘visiblevisible’ (akin to the ‘visibility’ of PTG thereafter) processes involved in EMDR positive outcomes

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Thank you for listening

Past presentations relating to this research: www.davidblore.co.uk/news.php

E: david.blore@btinternet.com T: +44 7976 933096