I-gaze workshop 02-2018 handout - Barry Littbarrylitt.com/yahoo_site_admin/assets/docs/I-gaze... ·...

The I-Gaze Interweave for Attachment Repair in EMDR Therapy

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TheI–GazeInterweave

forAttachmentRepairinEMDRTherapy

Barry K. Litt, MFT EMDRIA Approved Consultant Human Dynamics Associates Concord, NH Barrylittmft.com

Today’sOutline:

Part1:TheDomainsofSelf

Part2:TheZoneofOptimalProcessing

Part3:SomaticInterweaves

Part4:TheI—GazeInterweave

TheDomainsofSelf

Implicationsfor:

Phase3(setup)

and

Phase4–5(desensitizationandinstallation)


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WorkingwithDomainsoftheSelf

Being vs. Nothingness

Merit

Safety

Litt, 2007b

DomainsoftheSelf,continued


Being vs. Nothing •  Self-Other Dialectic

•  Attachment Trauma

•  Depersonalization

Merit

Merit • Neurosis

Safety Safety •  Hypervigilance

Litt, 2007b

CognitiveCorrelatestoDomainsoftheSelf


Being vs. Nothingness •  I don’t exist’ •  I’m invisible •  I don’t matter

Merit

Safety

Safety •  I’m gonna die •  I’m not safe •  I’m trapped

Merit •  I’m not good enough •  I don’t measure up •  I’m responsible/ •  I’m helpless

Litt, 2007b


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ShockorDisbelief(a.k.a.peritraumaticdissociation)

•  Sometraumasseemedtobelockedinastateofpsychologicalshock–  Suddenonset–  Perpetratorbehaviorunexpectedoranomalous

•  Eventnotintegratedwithnarrativememory

–  Doesnotprocesswell;affectblocked–  ANPcannotaccepttheevent

•  Typicalclientpresentation:–  Iknowithappened,butIcan’tbelieveit

AssessingandTreatingShock/Disbelief*

DuringSetupPhase(Phase3):

1.  Have client cover one eye

2. Ask: Give me your gut response––can you believe it?

3. Get a SUD for “Disbelief”

4. Repeat with other eye

*Adapted from Cook & Bradshaw (2002)

AssessingandTreatingShock/Disbelief*

DuringSetupPhase(Phase3):

5.  Perform DAS with Lower SUD eye

6.  Continue DAS until SUD = 0

•  Yes, I really believe it happened

7.  Repeat with other eye

8.  Repeat with both eyes

9.  Resume Setup anew


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KeepitSimple…

Trauma Node

Standard Protocol

Resolution

The Royal Road to Resolution

KeepitSimple…unless

Trauma Node

Resolution Shock/ Disbelief

One-Eye Interweave New Setup

Resume Standard Protocol

TheBeingDomain


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Normalvs.PathologicalAloneness

•  ByMyself–  Amatteroftemporarynon-membership–  Astatus;notamentalconstruct–  Pleasantorunpleasant

•  Lonely–  Bored;noonetoplaywith

•  Aloneness–  TraumaticStateofexistentialisolation–  Acuteterrorand/orshame–  Belongingtonooneornogroup

Featuresofthe“Being”Domain

•  Behavior:Acting-out–  (Bettertobebadthantonotbeatall)– Relationalconflictandegostateconflictmaybe“tradingup”fromnotbeing

•  Cutting;substanceabuse;O-CD;etc.

•  Affect: shame, anxiety, panic, fear

•  Sensation: numbing, tonic immobility

•  Knowledge (NC): I’m alone, invisible…

(Nihilism)

TheNaturalProgressionofEmotionalExperience

Ar

ou

sa

l

Time


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ThePathologicalProgressionofEmotionalExperience

Ar

ou

sa

l

Time

Normal Progression is Arrested •  Distress Intolerance •  Overwhelming Shame •  Dissociation:

-  Numbing -  State Shift -  Fugue

SensationandKnowledge

BeauBergdahlInterviewFromSerial,PodcastDecember10,2015

WithpermissionfromThisAmericanLife

WorkingThroughtheBeingDomain

•  Ithink,thereforeIam -Descartes

•  InoticethatIfeel,thereforeIam -(Damasio,1999)

The Importance of Sensation:


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•  Dynamic Targets:

-Narcissistic partner

-Partner avoids/withdraws

-“As-if” relating

•  Event Targets -Rejection

-Abandonment, separation, loss

-Associations


Cognitions:

•  NC:Idon’texist;I’minvisible;I’malone;I

don’tmatter;I’mnotenough/toomuch

•  PC: I am; I have myself; I exist even if…


•  Somaticregulationmustbemaintained– Clientsoftenareoutsidethewindowoftolerance

– Sensoryintegritynecessaryforprocessing– EMDRaugmentedwithsomatictechniques

•  Ensurethatclientsaremostlyembodiedatclosure


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•  Anxietymaypresentasaphobiaofunderlyingshame

•  Successfulprocessingmay“tradeup” fromnumbingorfeartoshame

•  ShamereactionscanbemappedbyNathanson’s(1992)CompassofShame

Nathanson’s(1992)CompassofShame

Withdraw

Attack Other Attack Self

Avoid

Self Absorbed Paranoid

TheMalignantShameSpiral


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WorkingThroughtheBeingDomainSpecificprotocolsfordoingattachmenttherapy:

•  AffectiveCircuitRestructuring(Paulsen,O’Shea,Lanius,2014)

•  Attachment-FocusedEMDR(Parnell,2013)•  ImaginalNurturing(Steele,2007)•  I–GazeProtocol(Litt,2016)

SuccessfulResolutionoftheBeingDomainEntails:

•  Increaseddistresstolerancevisavisinsecureattachmentsignalsfromsignificantothers–  EMDRwithTraumaFocus

–  Discontinuationofacting-outbehavior•  Acceptanceofexistentialaloneness

–  Mourning

•  Developmentoffearnedsecureattachment(startingwiththetherapist)–  Trustbuilding –SelfTrust

•  DevelopmentofObjectConstancy(acceptanceoftheSelfObject)–  AttachmentfocusedEMDR;egostatenurturing

TheMeritDomain


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WorkingthroughtheMeritDomain

• Mourning work: loss of idealized objects

• Transformation of shame yields compassion for self and others

•  Typical NCs are expressions of comparative worth defined by the family, community, culture:

‒ Avoid PCs that reify the same paradigm

‒ PCs should express existential worth:

‒ I’m okay; I am

SuccessfulResolutionoftheMeritDomain

•  Resolution entails acceptance of:

-  Existential worth: I am

-  Shifting from an adjective to a verb

- Existential Powerlessness: I’m powerless (and that’s okay)

• Shame narratives do not gain traction: the trait becomes a state

•  Increased distress tolerance = less avoidance

TheTootsiePopPhenomenon

WhenDomainsCollide:Beingvs.Merit


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Merit Domain: •  Anxiety, obessions, perfectionism,

•  Phobia of the Chewey Chocolatey Center

Being Domain: •  Attachment Trauma •  Aloneness •  Depersonalization

ClinicalPresentationoftheTootsiePop

•  Presentingproblemanddominantsymptomsareanxious,obsessive,and/orperfectionistic

•  Mayhavestable(ifunsatisfactory)relationships•  Catastrophicendpointisbeingalone•  Responsepreventionstimulatesdepersonalization(BeingDomainsymptoms)

WorkingwithTootsiePops

•  TheBeingDomain—nottheMeritDomain—drivestheanxiety

•  Clientmustsetasidetheanxietynarrativeanddropintothefelt-sense*ofaloneness– Thismaybeapreverbalmemory

•  *Itisfromthisstatethatattachmentworksproceeds


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TheSafetyDomain

Featuresofthe“Safety”Domain

•  Behavior:avoidance,hypervigilance

•  Affect: anxiety, panic, fear

•  Sensation: autonomic hypoarousal

•  Knowledge (NC): I’m gonna die, I’m not

safe…

WorkingthroughtheSafetyDomain

•  Therapistandclientworktogethertomaintainsomecontroloverfight/flightresponse

•  Controlled and organized activation of fight/flight motor behavior during desensitization phase

•  Client attention to present condition of body while remembering threat event: temporal safety


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TemporalSafety

•  Vision-TouchSynaesthesia:theRubberHandIllusion(BotvinickandCohen,1998)

•  Attentiontoreal-timesensorycuesvs.rememberedoranticipatedstates

•  Temporalsafetyasassociativevs.“safeplace”(dissociative)

SuccessfulResolutionoftheSafetyDomain

•  Acceptanceofroleofchanceineverydaylife(vs.magicalthinking)

•  Attentiontotemporalsafety– PC:I’mokayrightnow

•  Resettingautonomicnervoussystemtoincreasedparasympathetictone

Part2

TheZoneofOptimalArousal


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TheZoneofOptimalArousal

StabilityandSafetyinPhase4

Involvesthemanipulationoftwocrucialvariablesforreprocessing:

1.  Absorption (or, Dual Attention)

2.  Autonomic Arousal

•  Fight-Flight

•  Freeze/Submit

•  Tonic Immobility

http://www.traumahealing.com/somaticexperiencing/index.html

Normal (Non-Traumatic)Variation

Autonomic Dysregulation due to Trauma

traumahealing.com/somaticexperiencing/index.html

Dominant ANS

Social Engagement (ventral vagal) -Parasympathetic

Primitive Parasympathetic


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depersonalized

Submission Tonic Immobility

abreaction

panic presence

absorption

Zone of Optimal Arousal for Processing

Hypoaroused Hyperaroused

Hyposaroused Sympathetic

presence

absorption depersonalized abreaction

panic Submission Tonic Immobility

Techniques to Decrease Absorption •  Distraction (e.g., breath cueing aloud) •  Present-time Orientation •  Variable Rhythm of DAS •  Somatic Cueing •  Olfactory Cueing •  Third Person Visual Perspective

Hypoaroused Sympathetic presence

absorption depersonalized abreaction

panic

Techniques:

• Closed eyes

• Push the NC

• Node isolation techniques

• Choosing new target

Submission Tonic Immobility

Techniques for Increasing Absorption •  Closing the Eyes

•  Steady Rhythm of DAS

•  Pushing the NC

•  Silent Breath Cueing

•  NC in Native Language

•  First Person Perspective

•  Postural Cueing


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Part3

SomaticInterweaves

SomaticInterweaves(Phases4—7)Goal:KeeptheClientsafelyembodiedfortraumaprocessing

Objectives:•  Organizethemotorresponse

•  Regulateautonomicactivation•  Regulatebreathing•  Maintainsomatosensoryawareness

AlwaysmaintainPresentTimeAwareness

SomaticInterweavesforAutonomicHyperarousal

Statesinclude:

•  Panic•  Rage•  Hyperventilating•  DesiretoAct-OutObjective:

•  Organizethemotorresponsetopromoteresolution

Methods(duringphase4)

•  RageDump•  MarchingFeet

•  FantasyAggression•  Slowmotorimpulse

•  Two-ArmPush–  With/withoutresistance–  Staticordynamicversion

• • States include: panic, rage, hyperventilating, desire to act- out aggression• Objective: organize the motor response so promote resolution• Method (during desensitization):� Rage Dump�

Marching Feet� Fantasy Aggression and slowly moving limbs� Two-Arm Pushing with/without resistance✔ Static version✔ Dynamic version


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•  Statesinclude:Freeze,tonicimmobility,depersonalization,submission

•  Objective:“reboot”theANS•  Method(Duringdesensitization)

Somatic Interweaves for Parasympathetic Hyperarousal

•  Kneading Toes •  Marching Feet •  Isometric Pushing

•  Two-Arm Pushing o  Without resistance o  With resistance

•  Cross-Crawl

Part4

TheI-GazeInterweave

Indications

•  Triggerisrelatedtoabandonment,aloneness,

estrangement,purposelessness

•  TraumabeingprocessedisintheBeing

DomainofSelfExperience(Litt,2008)

•  NC’sinclude:I’malone,I’minvisible,I’mnot

enough/toomuch,etc.


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Indications,continued

•  Maybeusedforshame––attachmenttrauma

perseornot

•  Eye-gazeisincompatiblewithmaintaining

shamestate

Indications,continued

•  Phase2considerations:

– Clientmusthavebuy-in

– Clientmusthaveconfidenceintherapist

– ClientmusthaveconfidenceinEMDR

– Clientmustbeabletotoleratecloseproximity

Contraindications

•  InadequatePreparation(Phase2)

•  Intoleranceforproximityoreye-contact

•  Unwillingnesstoexploreattachmenttrauma

(e.g.,insistenceonexternalizing)


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MutualEyeGazeasaResource

•  SocialEngagement(Porges,2009)

•  Oxytocinlevelsincrease(Nagasawa,etal,2012;Kimetal,2014).

•  “Mindsight,”socialcognition,andmirror

neurons(Baron-Cohen,2994;Rilling&Young,

2014)

Threatvs.Resource

•  Mutualeye-gazecantriggerthreat(Steuwe,Daniels,Frewen,Densmore,Pannasch,Beblo,Reiss,&Lanius(2014))

•  UseofBLS,Networkbalancing(Chamberlin,

2015),

•  anddualawareness:interoceptionvs.

exteroception

SetupProcedure

1.  Identifythetarget• Recent:abandonment,rejection,aloneness

• Past:childhoodneglect,abusewithabandonment;“still-face”caregiver

• Presentstate:noidentifiablememory,butthefelt-senseofaloneness


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I–GazeProtocol,continued

SetupProcedure:

2.  Identifytheeyewithgreatestconnectiontothefelt-senseofaloneness

–  Haveclientcovereacheyeseparatelyandreportaffect,sensation,cognition,andSUD

–  ChooseeyewithgreatestSUD**Unlessitistoofaroutsidethewindowoftolerance


SetupProcedure:

3.  SitKneetoKneewiththeclient*–  *orascloseasclientcantolerate

4.  Clientthinksabouttarget,focusesonfelt-sense,andstaresintotherapist’sdominanteye


SetupProcedure:

5.  Doanabsorptionsetwithhorizontaleyemovements

6.  Assessreactivityineachofthreezoneswithinthefieldofview

7.  Choosetheeye-zoneyouwillstartworkingwith


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WorkingwithEyeZones

Step4.AssessthereactivityforeachZone,includingSUD

Zone 4 Zone 5 Zone 6

SUD = 8 7 4


Processingprocedure(phase4):1.  Taponclient’skneesalternately*

–  *orhaveclientdobutterflyhugasneeded

2.  Paceclient’sbreathing3.  Maintainsteadygaze&thinknurturing,

complimentarythoughts

4.  Relaxyourface,letyourattachmentsystemdothework


Processingprocedure(phase4),continued5.  Continueprocedurefor1–2minutes

6.  Breakoffandbothbreathedeeply7.  Debriefexperiencewithclient8.  Compareclient’sreporttoyourown

subjectiveexperience


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Processingprocedure(phase4),continued9.  Assessprogress:ifitisgoingwell,

continue10. Iftheclientisnotprogressingaftertwo

sets,dooneormoreofthefollowinginterweaves:

–  Readmyeyeinterweave–  Healinglightinterweave–  Eye-zonedifferentialinterweave


TheReadMyEyeInterweave:Asyougazeintomyeye,readthemessagemyeyesendsyou– Twolongishsets,asbefore–  Bepreparedthatclientmaynotgetasignal,ormaymisinterpret–  Irecommendsetsof1–2minutesor

more–  Doatleasttwosetsofthisandassess


TheHealingLightInterweave:Asyougazeintomyeye,imagineyouseeahealinglightcomefrommyeyeintoyoursandgointoyourcore…

• Longishset,thenassess•  Installanypositivefelt-senseandtryonaPC:Ihavemyself,I’mokay


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TheEye-ZoneDifferentialInterweave:–  Askclienttorotatehis/herheadsoasto“peer”attherapist’seyethroughdifferentzones

–  Askclienttobecuriousaboutanyperceiveddifferences

–  Usethosedifferencestopendulate,titrate,orinstallasappropriate

Client rotates head to move through zones

Working with Eye-Zones

Therapist Client


Closure(Phase5–8):10.  Repeatprocedurewithbotheyesopen

•  Clientgazesintotherapist’sdominanteyeasbefore

11.  Clientrotatesheadtopeerthrougheachofthethreeeye-zones

12.  Therapistlooksintosameeye,blinks,looksintosecondeye


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Closure(Phase5–8):ImaginalNurturingInterweave

–  Haveclientimagineadultselfcomfortingchildself

–  Reverseroles:childperspectivecomfortedbyadultself

–  Installfelt-sense+PC“Ihavemyself”

I-GazeProtocolandthe

IntersubjectiveSpace

WhereTransferenceandCountertransferenceMerge

I–GazeProtocol:theIntersubjectiveSpace

•  Thisinterventiondirectlyaccessestheinternalworkingmodel(IWM)ofattachmentforboththerapistandclient

•  Clientreactionswillrevealhis/herIWM

•  Transferencedistortionsmayinclude:– Projectionofcontemptorangerontherapist–  Inabilitytoreadtherapist’sintention– Visualdistortions– Dissociation:blankingout;numbing


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•  Therapistmustbeabletoaccesshis/herownSecureIWM– Otherwise,fuggettabottit

•  Therapistwillfeelclient’sinsecureIWM:– Therapistgetsdistracted;cannotmaintaingaze

– Therapistseesfear,shame,rageonclient’sface

– ClientmaylookmuchyoungerTrustyourinternalreaction:it’sdiagnostic!


•  Therapistwillalsofeelflowofsecureattachmentwithclient– Gazingfeelsmorenatural,easy

– Therapistmaysensepulseofwarmth– Clientmayappearmorecalm,confident

•  Clientmayreportfeeling“solid,”grounded,calmer

•  ClientmayspontaneouslyendorsePC

We’re Done! ThankYou,

AndmaytheForcebewithyou!

I-gaze workshop 02-2018 handout - Barry Littbarrylitt.com/yahoo_site_admin/assets/docs/I-gaze... ·...

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