Weaving these two gentle and effective trauma treatments together for healing childhood/complex trauma and dissociation.
In my EMDR basic training, my teacher repeatedly advised those of us working with clients who have childhood trauma/ cPTSD and dissociation to work with parts before going into any specific trauma processing. This preparation work with parts is to make sure that all parts are onboard with the EMDR processing, to hear their thoughts and concerns, and create safety for them before going into a memory.
To review, and if you want to read more I wrote about parts work here. Parts work, also called ego state therapy, inner child work, Internal Family Systems and more has been a core part of Psychotherapy from the jump. Different therapists have expanded upon those theories and created new and updated frameworks to use with clients. In parts work, we acknowledge that our psyche is made up of different parts, instead of a singular self. Some parts hold pain from the past and are called exiles, others keep those younger, feeling parts safe and are called protectors. At the center of these collection of parts is the Self, a core part that holds our most authentic and grounded self.
In therapy, we are always working with all of these parts. Frequently, protectors show up first. They have concerns about us feeling our feelings and processing trauma. Can we handle it? Will it be overwhelming? Will we fall apart if we do? How do we know we can trust you, the therapist? Protectors can show up in the work the same way they keep us safe in our day to day lives: through dissociation, avoidance, minimizing, and sometimes even survival coping like drinking, self harm and more. THIS is exactly why it is so paramount that these protectors are onboard with the work, or at the very least are down to take a step back and give it a try. Remember, these parts are trying to help us by keeping the work at a stalemate! They really believe they are keeping the wounded parts of us safe by not allowing the work to happen.
Recently in my own EMDR, right as I was releasing emotion and an exile of mine was finally being heard through the trauma processing, a protector stepped in and shut the whole thing down. This protector introjected into my moment of feeling and processing to remind me that what I was working on was nothing compared to the stories I have heard from others. "See it isn't so bad!" this protector shouted, jumping in front of my wounded parts who were crying and processing. I stopped crying. I stopped feeling.
In EMDR, we would call this a blocking belief. "Other people have it/ had it worse" is a belief that blocks the processing from happening. It's my defense of minimizing, which I have used my whole life, and it's a fierce protector of mine. I have been kept safe by this protector through some pretty bad situations, that I survived by believing, "it could be worse, other people have it worse". In many ways, the protector is right, someone is always suffering more. Just interpreting this as a blocking belief, and not seeing it as a part, limits the work. This is one of the many ways parts work is so necessary for the EMDR work to happen! Once my therapist and I named this blocking belief as a protector, then we could work with that part so she wouldn't jump in front of our work and my feelings, so I could finally have some lasting relief and fully process.
We all have parts, but we especially have them if we have experienced trauma during childhood. As we form our sense of self in those early years, through attachment and major developmental stages, we are particularly vulnerable to fragmentation of the self in order to survive. Something traumatic or wounding occurs, and we develop an exile. If this part holds what happened to us, then we can compartmentalize that away in order to still attach to our caregivers, do well in school, and build peer relationships. Protectors develop during this years to keep us alive and safe. Dissociation, drinking & drug use, avoidance, minimizing, people pleasing, over achieving, managing others through codependency, self harm, suicidal thinking and more are all ways to keep those feelings that exile holds at bay. Later in life, when we walk into therapy, wanting things to change, that is only possible if these protective parts are willing to let the work happen. They have kept these feeling parts safe for so long, it's not going to take just walking into the therapy office for them to step aside. While we may have signed up for EMDR, protectors didn't necessarily agree to it. They can step in front of the work through dissociation in a session, turning off the faucet of feelings, not showing up to sessions, and more.
As therapists, it is vital that we hear thoughts, concerns, and questions from these protectors. We also need to make sure exiles know this processing will happen safely, within their window of tolerance. They have kept these memories and feelings safe for so long, it can be terrifying for them to open that box. We may know that EMDR addresses these memories in a way that won't put them out of their window, but these exiles don't know that.
Trauma therapist Janina Fisher who uses both EMDR and parts work with her clients teaches a Safe Place Protocol for beginning this work. She has clients invite their parts to the safe place the client has created in EMDR, or creates a new place with them that is good for a meeting of the parts. Here, protectors, exiles, and anyone else can be fully heard in their feelings and concerns around therapy and trauma processing. This protocol is coupled with the BLS (Bilateral Stimulation) used in EMDR, either eye movements, tapping, or using buzzers. Janina teaches that this work is as important or maybe even more than the trauma processing aspect of EMDR. If the system of parts can feeling more cohesive, protectors feel unburdened from their post, and the client is feeling compassionate towards all parts, this can be just as transformative as closing our an EMDR target. It certainly leads to the work flowing more easily, clients staying present in the room, and coming back for sessions.
If more extreme protectors like drinking & drug use or suicidal thinking or behavior is showing up, getting that client to safety through skills groups like DBT and 12 step groups, medication, safety planning, and any higher level of care is necessary before going any further. This is still EMDR! The preparation phase can look different for each client depending on their needs.
It makes all the sense in the world to me to combine two of the most highly effective trauma treatments together in this way so we can work more holistically with our clients, or show up to our own healing with all parts welcome.
To learn more about using parts work & EMDR you can check out the following resources:
EMDR Toolbox by Jim Knipe
EMDRIA for trainings on joining these two modalities can be found here
Information on doing EMDR with me can be found here