Eye Movement Desensitization and Reprocessing (EMDR) and Dialectical Behavior Therapy (DBT) are two ways that I treat people who have suffered from traumatic events so that they can live in the present, create a life worth living, and feel comfortable in their own skin.

    A traumatic event is one that is deeply disturbing and distressing, and this can be subjective (it can vary from person to person). Traumatic events can leave people feeling like they have no skin -- even a small event makes them feel vulnerable and can hurt them. In such a state it can be very hard to feel like you're in charge of how you feel and think.  Everything can be taken as a threat to your safety or well-being. This can make it hard to enjoy life or function wel.

Some people become very depressed or anxious in response to the troubling event. They may keep re-experiencing the trauma by having

• nightmares,
•  flashbacks, 
• intrusive thoughts about the event, or 
• become obsessed with the thought that it will occur again. 

(For a checklist of PTSD symptoms, please go to the "Quizzes and Questionnaires" tab on the menu and go to "Could you have PTSD symptoms?")

Trauma can also leave people with problems getting along with others -- at work, in social environments, with friends, and with family. A person may

• have trouble knowing how to stand up for themselves in a conflict;
• have unrealistic expectations of themselves or others in the relationship
• believe that other people are out to get them, even when everything is ok. 
•  become suicidal or self-injurious
• want to harm their bodies to cope with the intense internal pain they experience
• take drugs or alcohol to numb their pain or "feel alive"
• do other things compulsively (in an out-of-control way) to distract themselves from how they feel (like shopping, eating, working, sex, etc.)
• If this is happening for you, I hope that you get help immediately. This is serious and needs to be addressed right away!

 One way to understand the lasting effects of trauma is that you've been wounded in a spot that has only partially healed, and each time you are reminded somehow of that traumatic event, it's like hitting that partially healed wound and re-opening that sore spot. Until you have the skills and resolution to make that wound heal completely, it's going to hurt like hell when someone bumps into it, accidentially or intentionally.

 Some people are fortunate and have a resilience that they bring to life's events. They might have had someone they could ask for help when the traumatic event occurred; or they could have believed that it was not a personal event -- that everyone has a cha nce to be treated poorly at some point in life. They might have believed also that they would not feel this horribly forever -- it's a temporary condition and will become resolved with time. Those are all healthy ways to approach stressful and upsetting events, but not everyone had the fortune of believing that way or having supportive people around when they were traumatized.

In cases where a person did not have a healthy way to respond or someone safe to go to, it can help to have a caring professional to help them build skills to handle the events (DBT) and to help them move through the distressing event so they can put it to rest and live in the present (EMDR). These two types of therapy are described below.

        EMDR was developed by Dr. Francine Shapiro to help people who have survived traumatic events to recover more quickly and thoroughly than with regular psychotherapy. The EMDR International Association describes EMDR as a “physiologically based therapy that helps a person see disturbing material in a new and less distressing way.” EMDR seems to directly affect brain functioning. Nonetheless, how it works exactly is not known.

It’s believed that EMDR is similar to what happens during dream or REM (rapid eye movement) sleep. When we are very upset, our brains do not function normally, so that disturbing events can become “frozen in time.” When we remember that event it can feel as bad as the first time it happened because the images and sensory information attached to the memory have not changed. This lack of processing the memory can affect how we relate to the world, and can limit our ability to enjoy life.

Before using EMDR, it's important for the therapist to see whether a client has dissociation (explained below) and other conditions that would make it more risky to do EMDR. A person may need to develop some coping skills to handle their out-of-control behaviors before stirring things up with EMDR. If you have a heart condition, epilepsy or are pregnant, EMDR is not a good idea.

However, If it seems like a person is appropriate for EMDR treatment, we develop a safe place and person for the client to rely upon when things get rough internally. I will ask you to think about events that still make you hurt emotionally and make you think bad things about yourself. As you recall all the sensory, emotional and cognitive elements of the event, I guide you through a set of eye movements back and forth that often leads to a new experience and understanding of the original event. Your feelings about it may seem to become unglued from the event and you may feel detached from it. Processing the event can bring up intense feelings. Generally by the end of the session, you feel less upset by the event and see it differently.

Everyone has a different experience of EMDR; it's a fluid process and the client doesn't need to worry about doing it "wrong."

EMDR can work for

• traumatic events, 
• anxiety disorders, 
• stress reduction, 
• complicated grief, and 
• phobias. 

I have helped people dealing with moving from a long-term home to a new apartment, get over fears of airplanes, and assisted artists in removing self-talk that blocked their creativity, to name just some of the applications. I am a certified EMDR therapist by EMDRIA (an international organization for EMDR) and use it regularly in practice. Clients have been very satisfied with the freedom they've gained from disturbing memories.
       
    DBT was developed by Dr. Marsha Linehan for people who tend toward self-injurious behavior and suicide attempts. Self-injurious means purposely harming your body in order to relieve the internal pain you experience. this could take the form of

• cutting, 
• burning, 
• scratching, 
• hitting
• bruising
• biting
• picking one's skin
• or other forms of self-mutilation. 

Some people who engage in this type of behavior suffer from dissociation -- they have had traumatic events that were too powerful to withstand and have "left" their bodies mentally and emotionally. While this helped them withstand the traumatic event at the time, it now makes it hard for them to inhabit their bodies comfortably. They sometimes cut or self-injure to end the numbness they feel and to re-inhabit their bodies.

It can also be a way to try to take control of their harmful experience, but it is not a healthy way to be in their bodies. The idea behind DBT is that people sometimes lack coping skills to handle distressing situations and that this lack of skill creates significant problems; thus, by teaching coping skills, people can create a life worth living and find more functional ways of handling stressors.  

There are four main skill sets to learn with DBT: core mindfulness; emotional regulation; interpersonal effectiveness; and distress tolerance.

•  Core mindfulness teaches people to observe what's going on inside without attaching any particular significance to it. By doing this, one is able to get a certain distance from their thoughts so they can evaluate the accuracy and usefulness of what they're thinking and experiencing. Through core mindfulness a person can develop Wise Mind, which is a state of mind where one is informed by one's emotions but not govenered exclusively by them; but they are also not cut off from emotions. With Wise Mind a person can observe what's going on inside, put words to it, and participate with one's experience without getting carried away by it. 
• The other skill sets, Emotional Regulation and Interpersonal Effectiveness, teach people how to handle their emotions and relationships with other people effectively and successfully. The goal is that they can make better decisions about relationships and how to handle their feelings.  Sometimes trauma survivors have trouble with this because they have drastic reactions and impulsive decisions driven by past hurts. 
• Distress tolerance helps people get through extremely unpleasant or intense psychological experiences through accepting the experience and developing a certain calm reserve in the face of crises. It is one of the most valuable skill sets but also more abstract than the rest, and when people practice these skills regularly and mindfully, they are often able to avoid going to the hospital and stay in the community. 

It can be very rewarding to work with people using these skills because they can work for people who use them in their day-to-day lives, and I've seen them help people stay out of the hospital and gain more personal power to face their distress. These skills can be helpful for substance abuse as well, as people tend to act impulsively and compulsively in many ways (including substance abuse) when they lack the skills to handle painful feeling and thinking.

If you would be interested in developing these skills for yourself and are sick of letting past wounds push you around, I'd love to hear from you! Just call 661-233-6771.