Understanding

Trauma and
Effective Trauma
Treatment
Kristan Warnick, MS, CMHC

• Healing Pathways Therapy Center -

Owner
• Trauma Informed Care Network of
Utah - Founder
 Health and Resilience Symposium:
Growing a Trauma Informed Community
October 15, 2014
A free educational Violence, Abuse and other Toxic Stressors across the Lifespan
Afree
training foreducational
community
WELCOME: THE TIME IS NOW FOR A TRAUMA-INFORMED CARE COMMUNITY
training
leaders formembers
and community Susie Wiet, MD (Chair) Assistant Professor (adjunct faculty), Psychiatry, at the University of Utah
leaders and members School of Medicine; Director of Psychiatric Services at Odyssey House of Utah, Founder of the
educational steering committee for this symposium.
MORNING SECTION: NATIONAL BOARD MEMBERS OF THE ACADEMY ON VIOLENCE AND ABUSE (AVA)
or community THE ADVERSE CHILDHOOD EXPERIENCE STUDY (ACES): IMPLICATIONS OF LONG-TERM EFFECTS
d members on AGENDA Randy Alexander, MD, PhD Clinical Professor, Pediatrics, at the University of Florida, College of
erm effects of 8am-4:30pm Medicine, Medical Director of Florida’s Child Protection Team, Chief of Division of Child Protection
cross the life and Forensic Pediatrics, President-Elect of the AVA
nd why it is
7:30University
AM
of Utah NEUROBIOLOGICAL CHANGES FROM TOXIC STRESS
tive for the REGISTRATION
Goodwill Humanitarian Building
Brooks Keeshin, MD Assistant Professor, Pediatrics Division of Child, Protection and Family Health
at the University of Utah School of Medicine, board member of the Academy on Violence and
ty to become 8 395
AMSouth 1500 East, SLC UT
Abuse.
the warning WELCOME INTER PARTNER VIOLENCE: A NECESSITY TO IDENTIFY
d intervene. Kathy Franchek-Roa, MD Assistant Professor, Pediatrics, University Of Utah School of Medicine,
8:10-11:15
AGENDA AM Chair of the Utah Domestic Violence Coalition Health Care Workgroup, Chair of the University of
M7:30-8:00
ORNING SESSION Utah Health Care Domestic Violence Task Force.
11:15 AM – 12:15 EDUCATING THE COMMUNITY: HEALTH IMPACT OF VIOLENCE AND ABUSE
Registration
Dave Corwin, MD Professor and Director of Forensic Services, Pediatrics Department at the
PM University of Utah School of Medicine, President, AVA; Secretary American Professional Society on
LUNCH PROVIDED
8:00--2:00 the Abuse of Children
AFTERNOON SESSION: LOCAL EXPERTS, SURVIVORS AND AGENCIES
12:15
Keynote Plenary Sessions
PM STARTING IN CHILDHOOD
AFTERNOON SESSION Brian Miller, PhD (The Children’s Center) Director of The Safety Net Program for Families with
1:00--4:15 Young Children
4:20 PM Carol Anderson, Med (Utah State Office of Education) Education Specialist, Behavioral
WAfternoon
RAP-UP AND
Plenary Sessions Supports/Mental Health Needs
ADULTS BEAR THE LONG-TERM COSTS
EVALUATION
4:15 to 4:30 Steve Allen, PhD (Veterans Affairs Medical Center) Post-Traumatic Stress Disorder Clinical Team
Wrap up & Evaluation Director
Kristan Warnick, CMHC (Healing Pathways Counseling, founder) Founder of the Trauma-Informed
Care Network of Utah
(Attendance is Free ) PANEL DISCUSSION: TRAUMA IN THE COMMUNITY AND PREVENTION
LOCATION: UNIVERSITY Trina Taylor (Executive Director) Prevent Child Abuse – Utah
Kami Peterson MS RN CBPN-IC (Public Health Nursing Bureau Manager, Family Health
OF UTAH Services) Salt Lake County Health Department
GOODWILL Renee Olesen, MD (pediatrician) American Academy of Pediatrics-Utah Chapter
Mark Manazer, PhD (Chief Operating Officer) Volunteers of America of Utah
HUMANITARIAN PANEL DISCUSSION: SURVIVORS OF TRAUMA AND LONG-TERM RECOVERY
BUILDING Four panelists discuss their journey through community services and systems as a victim of trauma
and/or violence
395 S 1500E PANEL DISCUSSION: AGENCIES INTEGRATING PRINCIPLES OF A TRAUMA INFORMED COMMUNITY
HTTP://WWW.MAPQUEST.COM/MAPS?
Nanon Talley, LPC (State Training Manager) Utah Division of Child and Family Services
ADDRESS=395+S+1500+E&CITY=SALT+
LAKE+CITY&STATE=UT&ZIPCODE=8411 Lisa Arbogast, MEd, JD (Coordinator of Law and Policy, Special Ed) Utah Board of Education
2&REDIRECT=TRUE David Sundwall, MD (Professor of Public Health) University of Utah School of Medicine, Division of
COLLEGE OF SOCIAL WORK Public Health, former director of the Utah Department of Health
Doug Thomas, LCSW (Director) Utah Division of Substance Abuse and Mental Health
TBA: Utah Department of Workforce Services
COMMUNITY PARTNERSHIPS
Understanding Trauma
 What is trauma? Definition
 Psychological trauma is a type of
damage to the psyche that occurs as a
result of a severely distressing event.
Trauma, which means "wound" in Greek, is
often the result of an overwhelming
amount of stress that exceeds one's ability
to cope or integrate the emotions
involved with that experience. - Wikipedia
What is Trauma?

Trauma is a lasting psychic wound that does

not easily resolve on it’s own - Not all bad
experiences lead to trauma and not all
trauma comes from experiences that are
seemingly traumatic.
How to Identify Trauma
 Observation/Interviews
 Clientdisclosure
 DSM-V Diagnosis
 Questionnaires – about trauma and
trauma symptoms
 EMDR protocol is diagnostic
Observations/Interviews
 Clients are stuck in negative thoughts, emotions,
body sensations
 Clients don’t respond to traditional talk therapy
 Teaching skills and awareness doesn’t seem to be
enough
 They understand intellectually but can’t move
past it emotionally
 They are emotionally flooded or numbed out
 Dissociative symptoms
 Other?
PTSD DSM-V Diagnosis
Some Key Changes in DSM-V
 moved from the class of anxiety disorders into a
new class of "trauma and stressor-related
disorders.”
 require exposure to a traumatic or stressful event
as a diagnostic criterion. The rationale for the
creation of this new class is based upon clinical
recognition of variable expressions of distress as a
result of traumatic experience.
 A clinical subtype "with dissociative symptoms"
was added
 Separate diagnostic criteria are included for
children ages 6 years or younger
Some debate about
whether the DSM-V definition
is too wide or too narrow

Problems with the post-traumatic stress disorder diagnosis

and its future in DSM–V Gerald M. Rosen, PhD, Robert L.
Spitzer, MD, Paul R. McHugh, MD
http://bjp.rcpsych.org/content/192/1/3.long
Criterion A: stressor - The person was exposed to: death,
threatened death, actual or threatened serious injury, or
actual or threatened sexual violence, as follows: (one
required)

 Direct exposure.
 Witnessing, in person.
 Indirectly, by learning that a close relative or close friend
was exposed to trauma. If the event involved actual or
threatened death, it must have been violent or accidental.
 Repeated or extreme indirect exposure to aversive details
of the event(s), usually in the course of professional duties
(e.g., first responders, collecting body parts; professionals
repeatedly exposed to details of child abuse). This does not
include indirect non-professional exposure through
electronic media, television, movies, or pictures.
Criterion B: intrusion symptoms - The traumatic
event is persistently re-experienced in the
following way(s):
 Recurrent, involuntary, and intrusive memories. Note:
Children older than six may express this symptom in
repetitive play.
 Traumatic nightmares. Note: Children may have frightening
dreams without content related to the trauma(s).
 Dissociative reactions (e.g., flashbacks) which may occur
on a continuum from brief episodes to complete loss of
consciousness. Note: Children may reenact the event in
play.
 Intense or prolonged distress after exposure to traumatic
reminders.
 Marked physiologic reactivity after exposure to trauma-
related stimuli.
Criterion C: avoidance - Persistent effortful
avoidance of distressing trauma-related
stimuli after the event

 Trauma-related thoughts or feelings.

 Trauma-related external reminders (e.g.,
people, places, conversations, activities,
objects, or situations).
Criterion D: negative alterations in cognitions and
mood - Negative alterations in cognitions and mood
that began or worsened after the traumatic event:
 Inability to recall key features of the traumatic event (usually
dissociative amnesia; not due to head injury, alcohol, or drugs).
 Persistent (and often distorted) negative beliefs and expectations
about oneself or the world (e.g., "I am bad," "The world is
completely dangerous").
 Persistent distorted blame of self or others for causing the traumatic
event or for resulting consequences.
 Persistent negative trauma-related emotions (e.g., fear, horror,
anger, guilt, or shame).
 Markedly diminished interest in (pre-traumatic) significant activities.
 Feeling alienated from others (e.g., detachment or estrangement).
 Constricted affect: persistent inability to experience positive
emotions.
Criterion E: alterations in arousal and reactivity -
Trauma-related alterations in arousal and reactivity that
began or worsened after the traumatic event

 Irritable
or aggressive behavior
 Self-destructive or reckless behavior
 Hypervigilance
 Exaggerated startle response
 Problems in concentration
 Sleep disturbance
Specify if: With dissociative
symptoms.
 Depersonalization: experience of being
an outside observer of or detached from
oneself (e.g., feeling as if "this is not
happening to me" or one were in a
dream).
 Derealization: experience of unreality,
distance, or distortion (e.g., "things are not
real").
Full diagnosis is not met until at least six
months after the trauma(s), although onset of
symptoms may occur immediately.
We should not wait to treat, as research has shown that immediate
trauma work can help alleviate symptoms
EMDR Humanitarian Assistance Programs (HAP) http://www.emdrhap.org

 An assessment of the impact of direct volunteer services provided after the terrorism
attacks in New York City demonstrated the effectiveness of both immediate and
delayed EMDR treatment (Silver et al., 2005).

 Clinicians trained by HAP treated victims of the Marmara, Turkey earthquake in tent
cities, and demonstrated that 92.7% of a representative sample of 1,500 of those
with PTSD lost the diagnosis after an average of five 90-minute EMDR sessions, with a
reduction in symptoms in the remaining participants (Konuk et al., 2006).

 Hurricane in Mexico - EMDR group treatment protocol was developed (Jarero et al.,
1999) that has now been used worldwide with great success. Rapid treatment
effects have been demonstrated after 1-4 sessions in interventions throughout Latin
America, in Italy, and in the Palestinian territories (Adruiz et al., 2009; Fernandez,
Gallinari, & Lorenzetti, 2004; Jarero et al., 2006, 2010; Zaghrout-Hodali et al., 2008).
Broader Definitions of Trauma
Big T Trauma – classic DSM-IV diagnosis, ACES,
obvious traumatic experiences, sometimes these are
resolved quickly

Example
 Client who was a hospice nurse
 came home in the afternoon to hear her daughter
dying on the couch, making the “death rattle”.
 healthy functioning woman previously, had panic
and anxiety and couldn’t go home at that time in
the afternoon for months afterwards.
 Took 3 sessions to resolve
Little T Trauma or “Subtle Trauma”
Any other type of event which exceeds our capacity
to cope, and can be stored as trauma. Examples
can include divorce, job loss, an abrupt move, really
anything that overwhelms us.
http://blogs.psychcentral.com/after-trauma/2014/02/the-big-deal-with-
little-t-traumas/

Example:
 13-year-old nephew
 intense physical and emotional reactions to popcorn,
 sat far away from it in the movie theater, very agitated if
someone is eating popcorn near him.
 One EMDR session – traced back to father getting mad at
him for not completing homework and pushed his face in
the popcorn bowl. My niece told me on Sunday he still
doesn’t love popcorn but can stand being around it =).
Dr. Francine Shapiro
Defines two types of trauma—“big T” trauma and “little t”
trauma. “Big T” trauma refers to what we commonly think
of as trauma like war or natural disaster, “little t” trauma
refers to incidents such as getting teased as a child or
getting rejected by your first love. Most people experience
“little t” trauma some time in their lives. People who live
with and love someone emotionally abusive experience
“little t trauma” on a daily basis. The experience of put
downs, criticisms or whatever form emotional abuse takes,
not only wears down self-esteem but also impacts the
nervous system. Memories of the abuse can elicit negative
feelings, tense physical sensations along with negative
thoughts about yourself long after the abuse has occurred.

http://www.goodtherapy.org/blog/trauma-emotional-abuse/
Other Trauma Types
Chronic Trauma – ongoing repeated trauma such as
an alcoholic abusive father. Internalized feelings of
anxiety, fear, unworthiness. Messages of “I’m not safe.”

Example –
 young man in his 30’s unable to form healthy intimate
relationships
 angry mentally ill father
 a string of step-mothers throughout his
developmental years
 Trauma work off and on for more than a year,
developmentally delayed in relationships but making
steady hopeful progress
Complex Trauma
Prolonged exposure to repetitive or severe events such
as child abuse, is likely to cause the most severe and
lasting effects. This often is a combination of several
different types of trauma
.
Example:
 Woman in her 40’s struggling with severe depression,
anxiety, poor attachment, suicidal ideation, self-
harm
 Sexual, physical, emotional abuse from father,
neglect from mother, molestation by father, then by
several neighbors who she went to for help
 In treatment for years, requires a lot of stabilization in
the present, slow going on trauma work, but making
progress over time, will continue to be delayed in her
ability to attach and form intimate relationships
Traumas of Attachment
Many types of abuse/trauma can cause attachment issues but this also includes:

Childhood Neglect– a trauma of grief and loss, Traumatization can also occur
from neglect, which is the absence of essential physical or emotional care,
soothing and restorative experiences from significant others, particularly in
children - http://www.isst-d.org

Example –
 severely depressed female client whose father was numbed out from his WWII
experience and mother who coped by working hard.
 quiet, compliant oldest daughter who got very little affection, attention,
praise, and learned to self-soothe with food
 very low self esteem, poor self-efficacy, struggles to initiate activities,
relationships, try new things. Complains of feeling bored and empty – time
weighs heavily.
 Very slow progress, but slowly making headway in awareness, letting go of
negative beliefs, connecting to more positive thoughts, emotions, behaviors
Adult Attachment Injuries
Emotionally Focused Therapy – Sue Johnson Johnson, S.M.,
Makinen, J. & Millikin, J. (2001) Attachment Injuries in Couples
Relationships: A New Perspective on Impasses in Couple
Therapy. Journal of Marital and Family Therapy, 27, 145-156.

Example
 Couples client - wife was in labor in the hospital and the
husband went and played golf with friends.
 primed by childhood neglect to feely highly abandoned at
the time of attachment injury
 Has anxiety response when she thinks about this and it
affects her ability to feel safe and be intimate with her
husband.
 Can improve with individual trauma work and couples
attachment injury work
Identifying Trauma through
Formal Measures
 Adverse Childhood Experience Questionnaire
(ACES)
 Life Event Checklist
 Trauma Checklist Adult
 Trauma Symptom Inventory (TSI) - Briere, 1996 -
global measure of trauma sequelae; items are not
keyed to a specific traumatic event
 Trauma Symptom Checklist – 40 (Briere & Runtz,
1989)
 Child and Adolescent Trauma Measures – A
Review - http://www.ncswtraumaed.org/wp-
content/uploads/2011/07/Child-and-Adolescent-Trauma-Measures_A-Review-
with-Measures.pdf
Negative side effects of
unresolved trauma
 See ACES study http://acestoohigh.com/got-your-
ace-score/
 A variety of health issues
 Chronic Pain
 Autoimmune – High Adrenaline - Adrenal Fatigue -
Cortisol Response - Inflammatory Response
 Anxiety
 Depression
 Non-responders to regular talk therapy
 Panic attacks, phobias
More negative side effects of
unresolved trauma
 Relationship dysfunction
 Addictions
 Personality disorders
 Other mental health disorders

 “Bipolar trauma disorder” – Colin Ross - http://www.rossinst.com

Internationally renowned clinician, researcher, author and lecturer in
the field of dissociation and trauma-related disorders. He is the
founder and President of the Colin A. Ross Institute for Psychological
Trauma. Calls himself a former psychiatrist. I’m guessing he would also
say Borderline Trauma Disorder.
 Example: client was primed by death of her father as a preteen,
then several incidents of molestation as a teenager, was
diagnosed and put on med cocktail in college, subsequent adult
rape. We did her trauma work and she no longer fits bipolar
diagnosis. Off most of her previous meds.
How Trauma is Stored
Limbic system – stores memories in form of negative
thoughts, images, sensations (sight, sound, smell,
body sensations)
The Theory Behind EMDR and the
Adaptive Information Processing Model
 Humans have a physiologically-based information processing system - compared to
other body systems, such as digestion in which the body extracts nutrients for health
and survival.
 Memories are linked in networks that contain related thoughts, images, emotions,
and sensations
 When a traumatic or very negative event occurs, information processing may be
incomplete, perhaps because strong negative feelings or dissociation interfere with
information processing. This prevents the forging of connections with more adaptive
information that is held in other memory networks.
 The memory is then dysfunctionally stored without appropriate associative
connections and with many elements still unprocessed.
 When the individual thinks about the trauma, or when the memory is triggered by
similar situations, the person may feel like she is reliving it, or may experience strong
emotions and physical sensations.
 Information processing is thought to occur when the targeted memory is linked with
other more adaptive information. Learning then takes place, and the experience is
stored with appropriate emotions, able to appropriately guide the person in the
future.

Solomon, R.M., & Shapiro, F. (2008).

https://www.emdr.com/general-information/what-is-emdr/theory.html
Other Thoughts about Neurological
Processes in Trauma
 Disconnect from frontal lobe and limbic system –
brain imaging has shown weaker links in traumatized
individuals that actually strengthens as trauma
resolution progresses
 Right brain – emotional is disconnected from left
brain – logical. EMDR helps coordinate left and right
brain allowing logic override emotion.
 Disintegration – vs – integration – trauma resolution
creates adaptive neurological connections/links –
the brain integrates the old information with new
information and says A-ha and then can let go of the
old trauma material
 Trauma processing techniques such as EMDR put
brain in healing state or theta state where this
integration can happen
 Understanding Trauma Management/Containment
– vs –
Trauma Resolution/Release/Healing

 Many therapies involve coping rather than

healing
 Both of these are important in the process of
trauma resolution but it’s helpful for clients
and clinicians to understand which is which.
This alleviates frustration when coping
techniques to not “cure” the problem
 Many clinicians and clients today still believe
that trauma or PTSD can only be managed
rather than cured.
What can I do if I am a trauma-informed
therapist but not formally trauma trained?
A lot !!!!
 Ask the questions – don’t be scared to bring it up, trust that you can help
them contain emotion if they get triggered.
 Administer ACES or similar questionnaires about traumatic events or symptoms
or trauma symptoms
 Ask “When is the first time or worst time you felt that way? – Quick diagnostic
to see if current thoughts, feelings, emotions might tie into something from
their past
 Teach trauma containment techniques – make sure clients understand that
these are skills to manage the trauma symptoms before or during trauma
treatment, but that these won’t necessarily resolve the trauma, otherwise it
can be frustrating and discouraging for them
 Consider taking courses in a formal trauma treatment modality – good
investment - marketable, will expand your client base, will help you better
formulate and understand many if not most of your cases even if you don’t
practice the modality, research shows EMDR therapists have higher job
satisfaction, less burn out.
Trauma Management Techniques

 Psycho-education/awareness about trauma

 Healthy coping skills
 Resources – develop social support, self-care,
hobbies, spirituality, build on success
experiences
 Help clients identify and recognize triggers
 Affect regulation
 Relaxation techniques
 Mindfulness
Trauma Management Techniques
cont…
 DBT skills– mindfulness, affect regulation, relationship skills
 Try to avoid dissociation in session – leads to re-
traumatization – keep one foot in the present – Are you
here with me?
 Container Exercises
 Grounding Exercises
 Know your limits – for both trauma informed and trauma
trained therapists
 Referrals to trauma trained therapists with appropriate
skills/specialization to meet clients needs
 Before, during, and after trauma treatment clients will need
to learn new skills such as assertiveness, communication,
healthy risk-taking, etc.
EMDR Informed
Techniques
• Self Help Techniques
• Appropriate for clients and
clinicians
• Don’t need to be EMDR
trained to use these
 Effective Trauma Treatment
Research-Based Trauma Modalities

 Effective trauma resolution therapies should work

with trauma material stored in the limbic system
 Talk therapy often only accesses frontal lobe so
more experiential, holistic, symbolic, multisensory
methods tend to be more effective based on this
model
 Art Therapy, TF-CBT, EMDR, NLP, Play Therapy,
Exposure Therapy, Energy work, Emotional
Freedom Technique, Body work (chiropractic,
massage, cranio-sacral)
 Some of these tend to be seen as “alternative”
without substantial research basis, but research
support is growing in many of these areas.
Veterans Administration
Recommendations
 Cognitive Behavioral Therapy (CBT), such as
Cognitive Processing Therapy (CPT)
 Prolonged Exposure Therapy (PE)
 Eye Movement Desensitization and
Reprocessing (EMDR)
 Medications called Selective Serotonin
Reuptake Inhibitors (SSRIs)

http://www.ptsd.va.gov/public/treatment/therapy-
med/treatment-ptsd.asp
Therapy – vs - Medication
While there is no clearly defined “preferred” approach to
manage PTSD, each of these guidelines supports the use
of trauma-focused psychological interventions for adults
with PTSD, and all recognize at least some benefit of
pharmacologic treatments for PTSD. Indeed, some
guidelines identify trauma-focused psychological
treatments over pharmacological treatments as a
preferred first step and view medications as an adjunct or
a next-line treatment.
Jeffereys M. Clinician's Guide to Medications for PTSD. Washington, DC: United States Department of
Veterans Affairs; 2011. Available at: http://www.ptsd.va.gov/professional/pages/clinicians-guide-to-
medications-for-ptsd.asp.
NICE Guidelines. Available at: http://guidance.nice.org.uk/ (CG26). Accessed December 12, 2011.
Other Recommendations:
Cognitive-behavioral therapy such as cognitive restructuring,
cognitive processing therapy, exposure-based therapies, and
coping skills therapy (including stress inoculation therapy);
psychodynamic therapy; eye movement desensitization and
reprocessing (EMDR); interpersonal therapy; group therapy;
hypnosis/hypnotherapy; eclectic psychotherapy; and
brainwave neurofeedback. These therapies are designed to
minimize the intrusion, avoidance, and hyperarousal
symptoms of PTSD by some combination of re-experiencing
and working through trauma-related memories and emotions
and teaching better methods of managing trauma-related
stressors.

Institute of Medicine. Treatment of PTSD: assessment of the

evidence. Washington, DC: National Academies Press, 2008.
What is EMDR?
 An eight-phase treatment
 Eye movements (or other bilateral stimulation) are
used during one part of the session.
 After the clinician has determined which memory to
target first, he asks the client to hold different aspects
of that event or thought in mind and to use his eyes
to track the therapist's hand as it moves back and
forth across the client's field of vision.
 As this happens, for reasons believed to be
connected with the biological mechanisms involved
in Rapid Eye Movement (REM) sleep, internal
associations arise and the clients begin to process
the memory and disturbing feelings.

https://www.emdr.com/faqs.html
How Effective is EMDR?
 Twenty positive controlled outcome studies have been
done on EMDR.
 Some of the studies show that 84%-90% of single-trauma
victims no longer have post-traumatic stress disorder after
only three 90-minute sessions.
 Another study, funded by the HMO Kaiser Permanente,
found that 100% of the single-trauma victims and 77% of
multiple trauma victims no longer were diagnosed with
PTSD after only six 50-minute sessions.
 In another study, 77% of combat veterans were free of PTSD
in 12 sessions. There has been so much research on EMDR
that it is now recognized as an effective form of treatment
for trauma and other disturbing experiences by
organizations such as the American Psychiatric Association,
the World Health Organization and the Department of
Defense.
Phase 1:
 The therapist assesses the client's readiness and develops a
treatment plan.
 Client and therapist identify possible targets for EMDR
processing. These include distressing memories and current
situations that cause emotional distress. Other targets may
include related incidents in the past.
 Emphasis is placed on the development of specific skills
and behaviors that will be needed by the client in future
situations.
 Initial EMDR processing may be directed to childhood
events rather than to adult onset stressors or the identified
critical incident if the client had a problematic childhood.
 Clients generally gain insight on their situations, the
emotional distress resolves and they start to change their
behaviors.
Phase 2:
 The therapist ensures that the client has
several different ways of handling emotional
distress.
 The therapist may teach the client a variety of
imagery and stress reduction techniques the
client can use during and between sessions.
 A goal of EMDR is to produce rapid and
effective change while the client maintains
equilibrium during and between sessions.
Phases 3-6:
 A target is identified and processed. This involve the client identifying three
things: 1. The vivid visual image related to the memory 2. A negative belief about
self 3. Related emotions and body sensations.
 In addition, the client identifies a positive belief. The therapist helps the client rate
the positive belief as well as the intensity of the negative emotions. After this, the
client is instructed to focus on the image, negative thought, and body sensations
while simultaneously engaging in EMDR processing using sets of bilateral
stimulation. These sets may include eye movements, taps, or tones. At this point, the
EMDR client is instructed to just notice whatever spontaneously happens.
 After each set of stimulation, the clinician instructs the client to notice whatever
thought, feeling, image, memory, or sensation comes to mind. These repeated sets
with directed focused attention occur numerous times throughout the session. If the
client becomes distressed or has difficulty in progressing, the therapist follows
established procedures to help the client get back on track.
 When the client reports no distress related to the targeted memory, (s)he is asked to
think of the preferred positive belief that was identified at the beginning of the
session. At this time, the client may adjust the positive belief if necessary, and then
focus on it during the next set of distressing events.
Phase 7:
In this phase of closure, the therapist asks
the client to keep a log during the
week. The log should document any
related material that may arise. It serves to
remind the client of the self-calming
activities that were mastered in phase two.
Phase 8:
Consists of examining the progress made
thus far. The EMDR treatment processes all
related historical events, current incidents
that elicit distress, and future events that will
require different responses.
Conclusion
We can manage AND heal trauma. It is complex yet
rewarding work.
Posttraumatic phenomena and their permutations are rich in their tapestry and are
woven of thousands of threads whose fibers are spun from unique and sometimes
exotic, secretive, horrific, and forbidden sources of discovery.

Trauma work “on one end of the continuum…exacts an enormous toll on therapists,
draining their inner empathic resources…at the other end is a realization of the human
capacity for resilience and self-actualization, and the power of the human spirit to heal
itself.

…Clinical moments of dedication, inspiration, hoped for wisdom through education and
training alternate with private reflections of self-doubt, insecurity, despair, and fantasies
of escape from the heavy professional responsibility entailed in this task (Wilson and
Thomas, 1999).

Treating Psychological Trauma and PTSD. Edited by Wilson, J.P. Friedman, M.J., & Lindy, J.D. 2012
The Guilford Press, NY, NY.
References
 Aduriz, M.E., Bluthgen, C. & Knopfler, C. (2009). Helping child flood victims using group EMDR intervention in
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the Pirelli building airplane crash in Milan, Italy. Journal of Brief Therapy, 2, 129-136.
 Jarero, I., & Artigas, L. (2010). The EMDR integrative group treatment protocol: Application with adults during
ongoing geopolitical crisis. Journal of EMDR Practice and Research, 4, 148-155.
 Jarero, I., Artigas, L., & Hartung, J. (2006). EMDR integrative group treatment protocol: A post-disaster trauma
intervention for children and adults. Traumatology, 12, 121-129.
 Jarero, I., Artigas, L., López Cano, T., Mauer, M., & Alcalá, N. (1999, November). Children’s post traumatic stress
after natural disasters: Integrative treatment protocol. Poster presented at the annual meeting of the
International Society for Traumatic Stress Studies, Miami, FL.
 Johnson, S.M., Makinen, J. & Millikin, J. (2001) Attachment Injuries in Couples Relationships: A New Perspective on
Impasses in Couple Therapy. Journal of Marital and Family Therapy, 27, 145-156.
 Konuk, E., Knipe, J., Eke, I., Yuksek, H., Yurtsever, A., & Ostep, S. (2006). The effects of EMDR therapy on post-
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for psychologically traumatized individuals. Journal of Consulting and Clinical Psychology, 63, 928-937.
 Zaghrout-Hodali, M., Alissa, F. & Dodgson, P.W. (2008). Building resilience and dismantling fear: EMDR group
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TICN News/Upcoming Events:
 October 3rd TICN – Anastasia Pollock – Ego State
Therapy, Internal Family Systems
 November 14th TICN - Leslie Brown - Complex
trauma, DID, more EMDR, more ego state, and
polyvagal theory,
 Health and Resilience Symposium: Growing a
Trauma Informed Community – October 15th at U of U
 Academy on Violence and Abuse - Conference on
October 16-18 -
http://www.avahealth.org/events/2014_members_meeting/
 Critical Issues Conference – October 23-25th – trauma
focus
 EMDR training offered to non-profit therapists (20-30
hours per week in non-profit setting) in December
through U of U Social Work Program and Rape
Recovery Center