Getting a full Picture - EMDR Conceptualization Tip

A a clinician: Starting with a timeline of events can help you determine where the client has been and what negative beliefs are impeding their happiness and fullness of life. 

We want to find what is a maladaptive response to things that happen in life and help them become more adaptive. This is what helps people to function well. Sort of 'updating the circuits' if you will. EMDR can help you update them after you find them. 

The following is based on my experiences as a clinician. 

Start with a question like: "What is the earliest memory you have?"  An example may be something like: "I went to the hospital because I fell off the bed. I had a broken clavicle. It happened when I was 3 years old. I remember my mom being upset and it hurt a lot and I had to have my arm strapped down. I hated it. I wanted them to let my arm out but they wouldn't. My parents fought about it and it got pretty nasty. They were both mad all the time." 

This type of answer will tell you as the clinician to look for the 'I'm not safe' 'I am trapped' and/or 'I am vulnerable' negative belief, there may be other beliefs like 'I'm not important,' 'I am invisible', or 'I am not worthy',  because of the fighting going on that as a 3 year old the person believes is about him/her. 

This client could have problems with relationships, hospitals/doctors, having someone grab their arm or feeling trapped when in certain physical positions, they may have dreams about falling off of things and have general feelings of low self worth. 

Continue to get event after event and you will begin to see themes for them. You may find several times when they tried to do something and it wasn't well received or they had a couple of bad job experiences. Cluster those events as negative belief systems. 
 
Our worth is dictated to us by how our first relationships treat us. At 3 years old, it is a time when we are learning our separateness from our parents and our ability to do things. It is Erikson's 3rd stage, called Initiative vs. Guilt. We are drawn in this stage to look for things we can do on our own, start something (and finishing with help) and feel good about it. When we are told no repeatedly for trying to do things, or unable to do so, we often feel bad about ourselves.

So, this seemingly small incident can make us download one or more negative belief into our neuro-pathways. All negative beliefs make us desperately want find reasons they are not true. However, our brains see more of when that negative belief IS true. Things we see validates that negative belief, over and over again through our life. It makes it difficult to rid ourselves of that negative belief and we respond to it maladaptively over and over again. A reaction if you will to keep ourselves safe. Our brains don't know the difference between a physical danger and an emotional danger.

So, when that same person has an argument with someone they love, the old networks fire off and we have the same reactivity as when we were young. They may have a shut down, fighting or avoidance response related to all this old content that comes rushing back to them when 'triggered' to remember these things. 

This is a simplistic view, but from the age of 3 to 30, one can have several of these types of reactions and 'triggers' which makes it more and more likely that the next thing that happens to them will have the same response. These responses are maladaptive now, but they were adaptive when the person was 3 years old. It is like, the brain finds what works and sort of etches it in and uses the same response over and over again because it worked once. It is like gambling... that rush with the win prompts the next bet. 

Our job as the clinician is to find the negative belief that hurts their ability to respond adaptively and help them update that neuropathway. 

Positives experiences are things the brain doesn't spend as much time on cataloging because we are wired for health and safety, so we find the negatives first!

Getting a second positive timeline of events can help to build resiliency and show the person they have good things in their lives.  When you do both at the same time, you can reduce the activation of negative emotion substantially and not let the person leave your office with too much emotion. Keeping them in the window of tolerance. 

Have them tell you about happy events that give them positive memories and feelings. Have them bring up the positive emotion, find it in their body and assign a positive belief to that specific memory or event. Then have them tap in (tapping their heels or hands on knees, alternatingly for a count of 6 or so, don't actually count) or meditate with breathing on the positives that those memories give them. This can substantially help them to function better during your treatment and help them feel more in control of their emotions during treatment. 

There is much more to this, but these are two basic things you can use to help guide your therapy, (making a plan) and prepare them for therapy.

Hope to see you in Consultation!