EMDR Treatment With

Juvenile Delinquent Populations

CJC 2004

Jay D. Fellers, LCSW

What is EMDR?
EMDR-- Eye Movement Desensitization and Reprocessing
is a psychological method for treating emotional difficulties that
are caused by disturbing life experiences, ranging from
traumatic events such as combat stress, assaults and natural
disasters, to upsetting childhood events.

EMDR is also being used to alleviate performance anxiety and

to enhance the functioning of people at work, on the playing
field, and in the performing arts.

EMDR is a complex method that brings together elements from

well-established clinical theoretical orientations including
psychodynamic, cognitive, behavioral, and client-centered
treatments. For many clients, EMDR provides more rapid relief
from emotional distress than conventional therapies.
 EMDR

Looking Through Hemispheres

An Introductory Video
Dr. Francine Shapiro
Dr. Bessel van der Kolk
David Grand, CSW
 EMDR: An Accelerated Information
Processing Model

Within everyone is a physiological information processing

system, that processes experiences to an adaptive state.

Under normal circumstances, this information processing may

occur during thinking, talking, expressive/artistic activities,
and/or dreaming.

Information is stored in Memory Networksimages, thoughts,

feelings, physical sensations.

Memory Networks are organized around the earliest related

event.
 EMDR: An Accelerated Information
Processing Model

Traumatization has been described as a disruption of the

inherent information processing system that normally leads
to integration and adaptive resolution following upsetting
experiences (van der Kolk & Fisler, 1995)

In trauma, however, a malfunction of this natural

information processing system occurs such that the
experience of the trauma remains frozen, manifesting in
persistent intrusive thoughts, negative emotions and self-
referenced beliefs, and unpleasant body sensations.
Components of Traumatic Memory

TRIGGERS

PICTURES EMOTIONS

TRAUMA

SENSATIONS BELIEFS
EMDR: An Accelerated Information
Processing Model (cont.)

EMDR specifically targets traumatic material and appears to

restart this stalled information processing in a focused manner,
facilitating the resolution of the traumatic memories through the
activation of neurophysiological networks in which appropriate
and positive information is stored.
What Happens during EMDR?

A traumatic memory and associated

cognitions, emotions, and somatic distress
are identified.

The client is engaged in bilateral stimulation

while experiencing various aspects of the
memory.

The clinician stops the bilateral stimulation at

regular intervals to ensure that the client is
processing adequately.
8
What Happens during EMDR?

The client processes information about the

negative experience, bringing it to an
"adaptive resolution."

The "three-pronged approach" addresses:

1) earlier life experience.
2) present-day stressors.
3) desired thoughts and actions for the future.

EMDR treatment may last from 1-3 sessions

to 1 year or longer for complex problems.
Why Do Clients Seem to
Respond Well to EMDR?
EMDR is a client-centered approach that allows the clinician to
facilitate the mobilization of a client's own inherent healing
mechanism which stimulates an innate information processing
system in the brain.

The EMDR model acknowledges the physiological component

in emotional difficulties. The EMDR protocol directly targets
these physical sensations, along with negative beliefs,
emotional states, and other disturbing symptoms.
 Why and how does EMDR work?
Hypothesized Mechanisms

Many hypotheses have been put forth to

explain the possible mechanism of
change related to EMDR, but a
definitive explanation has not been
confirmed.
EMDR: Hypothesized Mechanisms

One hypothesis was proposed by

Harvard Medical School sleep
researcher Robert Stickgold, Ph.D. at
the 1998 EMDRIA Annual Conference:
EMDR: Hypothesized Mechanisms

EMDR facilitates the processing of

traumatic memory by activating brain
systems normally activated during REM
sleep.
EMDR: Hypothesized Mechanisms

Bessel van der Kolk, M.D. of Boston

University School of Medicine states (Boston
Globe, 1998):

In a recent EMDR study, in collaboration with

the New England Deaconess/Beth Israel
Neuroimaging Laboratory, brain scans were
used to measure how brain activity changes
after effective treatment.
EMDR: SPECT IMAGESPTSD
(Amen, 2003)

No Treatment-- EMDR & St. Johns Wort

Increased Cingulate, Basil Overall Improved Activity
Ganglia, & Limbic Activity
EMDR: SPECT IMAGESPTSD
(Amen, 2003)

No Treatment-- EMDR & St. Johns Wort

Increased Cingulate, Basil Overall Improved Activity
Ganglia, & Limbic Activity
What is the Research
Indicating the Efficacy of EMDR?
 Research Demonstrating the
Efficacy of EMDR

EMDR is an empirically valid treatment

for civilian post traumatic stress disorder
recognized by the American
Psychological Association.

EMDR received an A/B rating from the

International Society for Traumatic
Stress Studies (ISTSS).
 Research: Efficacy of EMDR for
Civilian PTSD

Marcus, Marquis, & Sakai (1997) study:

Results showed Kaiser HMO projected

to save $2.8 million annually using
EMDR for PTSD.
 Research: Efficacy of EMDR for
Civilian PTSD

Three of four studies comparing EMDR

and CBT showed EMDR to be more
efficient (Ironson, Freud, Strauss, &
Williams, 2002; Lee, Gavriel,
Drummond, Richards, & Greenwald,
2002)
EMDR Research: Panic Disorder & Phobias

Goldstein & Feske (1994)

Choking phobias (De Jongh, & ten Broeke, 1999)

Simple phobias (De Jongh, ten Broeke, &

Renssen,1999)

Blood and injection phobias (Kleinknecht, 1993)

Other EMDR Research

Symptoms arising after a natural

catastrophe (Grainger, Levin, Allen-Byrd,
Doctor, & Lee, 1997)

Test Anxiety (Mayfield & Melnyk, 2000)

Crisis Intervention (Solomon, 1998)

EMDR Research Re: Conduct Disorder

EMDR Treatment for Children With

Treatment Resistant Disaster-Related
Distress (Chemolab & Nakashima, 1996)

Enhancement of Victim Empathy Along

With Reduction in Anxiety & Increase of
Positive Cognition of Sex Offenders After
Treatment With EMDR (Datta & Wallace,
1996)

EMDR For Boys With Conduct Problems

(Soberman, Greenwald, & Rule, 2000)
EMDR & Conduct Disorder (cont.)

Trauma & Conduct Disorder (Puffer,

Greenwald, & Elrod, 1998)

The Role Of Trauma in Conduct Disorder

(Greenwald, 2000)

A Trauma-Focussed Individual Therapy

Approach for Adolescents With Conduct
Disorder (Greenwald, 2002)

MASTR Therapy for Adolescents with

Conduct Problems (Greenwald, 2002)
EMDR Research Re: Substance Abuse

EMDR Treatment Protocol Based on a

Psychodynamic Model of Chemical
Dependency (Omaha, 1997)

DETUR: A New Approach to Working With

Addictions (Popky, 1998)

EMDR Chemical Dependency Treatment

Manual (Vogelmann-Sine, Sine, Smyth, &
Popky, 1998)
EMDR Research

There is much research in progress.

See Efficacy of EMDR, updated yearly by

the EMDR Institute.

www.emdr.com
www.emdria.org
www.emdrhap.org
www.andrewleeds.net
The Eight Phases of EMDR Treatment

1. Client History and Treatment Planning

2. Client Preparation
3. Assessment
4. Desensitization
5. Installation
6. Body Scan
7. Closure
8. Reevaluation
Client History and Treatment Planning

Intergenerational Genogram

Negative Cognition Inventory

Assess Level of Dissociation

Substance Abuse Assessment

Client Preparation

Establish Trust

Stabilization & Safety

MotivationExternal vs. Internal;

Precognition, Cognition, Determination,
Action, Motivation

Resource DevelopmentCognitive,
Affective, Self-Soothing (Safe Place)
The Core of EMDR Treatment

ASSESSMENT PHASE

DESENSITIZATI0N PHASE

INSTALLATI0N PHASE

SOMATIC
The Core of EMDR Treatment
ASSESSMENT PHASE
Presenting Issue
Picture
Negative Cognition (NC) and Positive Cognition (PC)
Validity of Cognition (VOC)
Emotions/Feelings
Subjective Units of Distress (SUDS)
Location of Body Sensation

DESENSITIZATI0N PHASE
Potential Responses: Pictorial Processing, Cognitive Processing, Emotional
Processing, Sensory Processing
Associative Links and Feeder Memories
Informational Plateaus: Responsibility, Safety, and Choices

INSTALLATI0N PHASE
Integration of Positive Cognition with Targeted Information and VOC Check

SOMATIC OR BODY SCAN

Brief Therapy Inside Out Video

EMDR: Working Through Grief

Dr. Francine Shapiro
with
Jon Carlson, Psy.D., Ed.D.
Diane Kjos, Ph.D.
Childhood Trauma Case Example
Client
A 17 year old male struggling with negative conclusions about himself resulting
from being physically abused by his stepmother, witnessing domestic violence,
biological mothers substance abuse.
Presenting Problems: Marijuana dependence, delinquent behavior, truancy,
poor peer choices, conflict avoidance, hypervigilence, guilt, self-hatred, mistrust
of others, and a sense of hopelessness and helplessness.
Negative Cognitions: I am weak. I need to get high to deal with the pressure.
Positive Cognitions: I can get through anything. I can deal with it without
getting high.

Assessment Components
Picture: Stepmother pulling him out of his bed and whipping himage 5
Negative Cognition: I'm weak.
Positive Cognition: I can get through anything.
VOC=4
Emotions/Feelings: Fear, sadness, anxiety, hopelessness
SUDS=8
Location of Body Sensation: Tension in the neck and shoulders, knots in
stomach, palpitations in chest.
Childhood Trauma Case Example (cont.)

TRIGGERS
Getting ready for school
Conflict
Female anger

PICTURES EMOTIONS
Stepmother pulling Fear, sadness, anxiety,
him out of his bed and Traumatic Memory hopelessness
whipping himage 5 Age 5
Physical Abuse by
Step-mother

SENSATIONS BELIEFS
I am weak. I need to get
Tension in neck and shoulders high to deal with the
Knots in stomach pressure.
Palpitations in chest
Childhood Trauma Case Example

Possible Information
Processing Shifts:

Responsibility

Safety

Choices
Childhood Trauma Case Example (cont.)
Possible Information Processing Shifts Related to Concepts of
Responsibility, Safety, and Choices:

Responsibility:

I was too young to defend myself.

Dad never stopped her.

Safety:

Ill never have to live with her again.

Im not weak anymore.

Choices:

I dont need to pity myself.

I wont use this anymore as an excuse.

Substance Abuse Case Example
Client
A 17 year old male struggling with negative conclusions about himself resulting
from being physically abused by his stepmother, witnessing domestic violence,
biological mothers substance abuse.
Presenting Problems: Marijuana dependence, delinquent behavior, truancy,
poor peer choices, conflict avoidance, hypervigilence, guilt, self-hatred, mistrust
of others, and a sense of hopelessness and helplessness.
Negative Cognitions: I am weak. I need to get high to deal with the pressure.
Positive Cognitions: I can get through anything. I can deal with it without
getting high.

Assessment Components
Picture: Biological mother calling him asking for moneyfor drugs?
Negative Cognition: I need to get high to deal with the pressure.
Positive Cognition: I can deal with it without getting high.
VOC=5
Emotions/Feelings: Fear, sadness, anxiety, hopelessness
SUDS=6;
Urge to use=6
Location of Body Sensation: Pain in lower back
Substance Abuse Case Example (cont.)

TRIGGERS
Mother calling
Female need

PICTURES EMOTIONS
Mother calling him in Upsetting, disappointing,
AM, on way to borrow
Substance Abuse
Confusion, frustration,
money Trigger: Pressure, temptation
Role Reversal &
Substance Abuse by
Mother

SENSATIONS BELIEFS
I am weak. I need to get
Pain In Lower Back high to deal with the
pressure.
URGE TO USE
Substance Abuse Case Example (cont.)
Possible Information Processing Shifts Related to Concepts of
Responsibility, Safety, and Choices:

Responsibility:

Im doing what Im afraid shes doing.

I use this as an excuse to get high.

Safety:

I dont have to feel pressured

Im not weak anymore.

Choices:

I dont have to take her call.

I can tell her no.

Resource Development Installation

Identify Characteristics or Qualities Needed to Deal with Problem

Identify Existing Examples of Quality

Own Examplesfeelings & body sensation

Others Reports of Own Qualityfeelings & body sensation

Known Others Qualityfeelings & body sensation

Others (Fact or Fiction) Qualityfeelings & body sensation

Symbol (i.e. Animal) of Qualityfeelings & body sensation

Reinforce each example with 3 Short Sets of Bilateral Stimulation

Anchor Cue Word of Quality

Install Future Templates

Substance Abuse RDI Example

Client
A 15 year old male struggling moderate family conflict, peer pressure.
Presenting Problems: Marijuana dependence, delinquent behavior,
truancy, poor peer choices, conflict avoidance, and a sense of
hopelessness and helplessness.
Negative Cognitions: I am easily tempted.
Positive Cognitions: I have self control.

Identify Characteristics or Qualities Needed to Deal with Problem

Picture: Peers talking about using drugs. He thinks about skipping

class and getting high.

Qualities Needed: Self Control, Thinking About Consequences

Before Acting, Staying Focused on Goals, Choosing Right From Wrong,
Keeping Busy.
Substance Abuse RDI Example (cont.)

Identify Existing Examples of Quality

Friend tries to get him to smoke, says no without thinkingproud,

good feeling in chest

Peer asks him to ditch class with him, says nofeels good,
shoulders relaxed

Admires another friend, refuses to get highadmires, gut

Skateboarder peer doesnt usegood feeling, warm behind ears

Jesus, tempted a lot, never gave ingood feeling, chest

Substance Abuse RDI Example (cont.)

Reinforce each example with 3 Short Sets of Bilateral

Stimulation (less if negative content arises)

Anchor with Self-Control

Install Future Templates re: Peers talking about using drugs,

thinking about skipping class and getting high, using anchor &
recalling inner resources, imagining doing something different.
Note emotions and body sensations, reinforce with short set of
bilateral stimulation.
Homework

Between-Session Work InherentProcessing Continues

Noticing what comes up (thoughts, memories, feelings, body

sensations, dreams, nightmares, conflicts, etc.)

Remembering the Big 3thoughts, feelings, body sensations

Noticing spontaneous positive changes

Remembering to Use Self-Soothing Techniques i.e. Safe Place

EMDR Websites

www.emdr.com

www.emdria.org

www.emdrhap.org

www.andrewleeds.net