Trauma & Attachment Therapy

Bainbridge Book-Signing Party

Book Signing Party!

On Beautiful Bainbridge Island

June 14, 2-5PM

 

Sandra Paulsen, Ph.D & Robin Shapiro, MSW, LCSW will be there to sign and read excerpts of their 2009 books. We may have a special guest reader, Yaak Panksepp.
Bring your checkbook if you want to buy a book. Save shipping costs!

Location: 9054 Battle Point Dr. NE, Bainbridge, Island, WA 98110
At the log house in the woods of Sandra Paulsen, Ph. D and Tim Iistowanohpataakiiwa, MA. Weather permitting, there will be a campfire in the pasture with the horses.

From Seattle: Take the Bainbridge Ferry to wy 305, turn left at the third light--Sportsman's Road--and an immediate right on New Brooklyn. The next light is Miller Road, turn right, go two blocks, then left on Battle Point Drive. Follow the S curve to the very top of the hill. Turn tight at the big cedar mailbox at 9065 Battle Point Dr., and veer right at the fork in the driveway. If you pass Bainbridge Gardens on the left you have gone too far.

From Poulsbo: Take Hwy 305 across Agate Pass Bridge to the first light. Turn right on Miller Road and veer left. Go straight for several miles. Turn right just past Bainbridge Gardens, onto Battle Point Drive. Follow the S curve to the very top of the hill. Turn tight at the big cedar mailbox at 9065 Battle Point Dr., and veer right at the fork in the driveway.

Presented by Sandra Paulsen, Ph. D. and the Bainbridge Institute for Integrative Psychology.

For more information:
206-855-1133
sandra@paulsenphd.com
www.bainbridgepsychology.com

Is addiction a form of dissociation?

I read an article about how naltrexone, an opiate suppressant, curbs the urge to engage in kleptomania. I've had dissociative clients who have successfully used naloxone and naltraxone to vanquish their endogenous (internal) opiates, in order to be able to stay present and process traumatic events, instead of switching or spacing out completely. (See EMDR Processing w/ Dissociative Clients: Adjunctive Use of Opioid Antagonists by Ulrich Lanius, in EMDR Solutions: Pathways to Healing, 2005). I've also had success using ego state work with addicts, alcoholics, and people with compulsive/addictive behaviors. Here's my theory: Opiate Antagonists work on dissociation because much of dissociation is run by endogenous opiates. When addicts think of their drug or behavior of choice, they begin to enjoy their endogenous opiates. When they engage in their drug or behavior it gives them an even better high. The neural pathways to the repetitive addictive behavior become wide and strong, until they become ego states. When people in recovery talk about "my addict", they refer to this strong ego state. Integrate the ego state and help heal the addiction.

So how does this work? Have clients bring up the last time they were frantic to use, or the last time they did use. "Where do you feel that inside? What's the feeling? Float back to the first time you had that feeling. How old is that? What was happening then? Can you bring your adult back to that time/that kid? What do you need to tell that child? You're with her. You can fly her up to the present time. She's with you all the time, now, and you're with her. Can you tell her that now, as a competent adult, you can tolerate those enormous feelings? Can you show her how you have learned to soothe yourself without that drug/behavior? How's that kid doing now? (Do whatever it takes to calm her down.) And are you ready to hug her into you now and forever?"

There is usually a frantic little child and often an angry/protective teenage part. Sometimes there are several "parts" involved in different pieces of the addiction. It has worked on several clients.

A.J. Popky and Jim Knipe have protocols that seem to fit my opiate theory. Popky developed the Level of Urge to Use. Knipe spun off the Level of Urge to Avoid. In both of these you have the person imagine whatever triggers them to use a drug or to avoid a task and to feel how good it would feel to use or avoid. Then you do eye movements and watch the good feeling start to fade away. (DeTUR, an Urge Reduction Protocol for Addictions and Dysfunctional Behaviors by Popky, and Targeting Positive Affect to Clear the Pain of Unrequited Love, Codependence, Avoidance, and Procrastination-- both in EMDR Solutions: Pathways to Healing, 2005, Norton.) You target inappropriate positive affect in both cases. When the positive affect (the good endogenous drugs) fade, you target the distressing affect underneath, and the trigger stops being a trigger. I've done this many times, for many addicts. It works amazingly well.

I've watched clients and people in my private life turn into unrecognizable demons, sociopaths, and screaming or pleading children while in thrall to their addictions. The dissociation/opiate theory explains these behavioral shifts. Please comment and give me your opinion about this theory.

EMDR Solutions II, for Depression, Eating Disorders, Performance and More

Yesterday I held my new book in my hands. It's hard for me to make meaning of 14 months of work being encapsulated in a 1 1/2 pound book. As I paged through it, I recalled the process of writing; my appreciation of the content of other people's chapters; editing squabbles; waiting, waiting, waiting for late chapters or late edits to show up in my emails; and my immense relief at each ending. The first ending was when my chapters were complete (EMDR with Depression, with OCPD, with Medical Trauma, with Multiple Chemical Sensitivities.) The next ending was when all the chapters were finally in. The next ending was after the first and second edits, by me then by my writer-mother, when I emailed all the chapters in. And last ending was after the re-editing by writers and then again by me.

One of the perks of editing a compilation is that I get to learn the material, really well. I never read a chapter 4 times before I did these books. There are 7 chapters about eating disorders. I am suddenly well-versed. I knew what to do, and successfully did it, when a fledgling anorexic client walked in the door. I know much more about working with early childhood trauma, performance issues, and targeting intrusive images. And I knew next to nothing about Positive Psychology and Coaching. Now I have a clue!

This book is about 200 pages longer than the last, and has units of related material: 5 chapters on depression, 7 on different aspects of eating disorders from affect tolerance to desensitizing desire, 5 on complex trauma, 3 chapters on Medically Based Trauma, and stand-alone chapters on performance enhancement, coaching, positive psychology, sex offenders, and religion/spiritually attuned clients. It's a better book than Solutions I. More depth, more heft. (Though it's not "bigger", because the pages are thinner.) It's even prettier than #1.

Tomorrow, I'm off to Los Angeles for the UCLA-sponsored Trauma Conference. I want to hear about the cutting edge affect theory heralded in the materials, so that I might jump start my next book: Trauma Treatments Sourcebook. I plan to blog about what I learn at the conference. Stay tuned.

If you're in Seattle mid-April, come to the book signing for book # 2. If you're in Seattle in spring of 2011, come to the signing for #3, if all goes well. I'll let you know the dates, as I know them.

The book comes out at the end of March. It's sold over 800 advance copies. I'm amazed.

Phantom Itching Cured With EMDR

    A long time client came back to see me. She'd been ill and after weeks in bed, depression had colonized her, again. She mentioned, " that it's stupid, but what was really bothering me is this itch on the back of my head." She'd been to the doctor, who found nothing wrong with her scalp, used dandruff shampoo and cortisone cream, to no avail. I explained to her that her itch could be like phantom limb pain. I'd read Atul Guwande's New Yorker article http://www.newyorker.com/reporting/2008/06/30/080630fa_fact_gawande?currentPage=all about intractable itching. Guwande said that researchers found that when a nerve cell that could report itching dies, the brain starts sending signals that itching is occurring. Since nothing is actually happening to the skin, there's no way to shut it off. It mentioned cases of people causing damage to themselves scratching. One poor woman actually scratched through her scalp and then her skull and did brain damage to herself in her sleep, and was hospitalized, in restraints.

    I explained that this kind of itching sounded like phantom limb pain--the brain sending pain signals out, about body parts that aren't there anymore, and that EMDR can sometimes eradicate the pain. Let's do it! We did.

    I had her focus on the day the itching started, and then the sensation itself. We did the standard EMDR protocol set-up, and I handed her the bilateral hand buzzers. The itch started moving around on her head, a good sign. She cleared emotions about it, and kept feeling it transform and move. As it faded, I suggested she talk to her brain about the itch, based on the article: "Brain, you think I've got lice or fleas over there. I don't. There's nothing there. Stop telling me there is! There's no vermin!" She laughed and told her brain to stop. I had her visualize the scalp she had--whitish pink and healthy. By that time, the itch factor had gone from a 6 out of 10 to a 2. An email yesterday, 5 days later, let me know that the itch had gone completely away.

Tinker, R & Wilson, S. 2005.The Phantom Limb Pain Protocol in R. Shapiro, EMDR Solutions: Pathways to Healing. Norton.

EMDR and Depression poster

I applied to the EMDR International Conference to lead a 3-hour workshop on Treating Depression with EMDR. I wrote four chapters about it in the new book, EMDR Solutions II, for Depression, Eating Disorders, Performance, & More. Instead of a workshop, I was invited to do a poster. I know how to write. I know how to talk. I never had to put four chapters in an understandable form that fills an 8 foot X 4 foot poster and can be seen at 5 yards away. It took about 20 hours, including half-learning a new program (Power Point), formatting nightmares (why did the text size keep changing?), and pruning all my case examples, wit, and nuance from the basic information. It’s still too crowded, but understandable. If you want to see the content of the poster on EMDR and Trauma-Based Depression, Mood-Disorders, and Attachment-Based Depression go here:

Download DepressionPoster-1.pdf

Here are the other chapters. They’re in to Norton, the last laggards have sent in the “artwork” for their charts. And Norton’s copy editor is ready to find 1,000 errors that I missed in 3 edits, and still won’t find them all.

Unit I: TREATING Depression

1.Introduction to Assessment and Treatment of Depression, Robin Shapiro

2.Trauma-Based Depression, Robin Shapiro

3.Endogenous Depression and Mood Disorders, Robin Shapiro

4.“Shame is my Safe Place”: Adaptive Information Processing methods of resolving chronic shame-based depression, Jim Knipe

5.Attachment-Based Depression: Healing the “Hunkered-Down”, Robin Shapiro

UNIT II: TREATING EATING DISORDERS

6.The Why of Eating Disorders, Andrew Seubert

7.Integrating Eating Disorders Treatment into the Early Phases of the EMDR Protocol, Janis Scholom

8.The Neurobiology of Eating Disorders, Affect Regulation Skills, and EMDR in the Treatment of Eating Disorders, Linda J. Cooke & Celia Grand

9.Treating Bulimia Nervosa with EMDR, DaLene Forester

10.Image is Everything: The EMDR Protocol in the Treatment of Body Dysmorphia and Poor Body Image, DaLene Forester

11.Addressing Retraumatization and Relapse When Using EMDR with Eating Disorder Patients, Janet McGee

12.Desensitizing Desire: Non-Verbal Memory and Body Sensations In the EMDR Treatment of Eating Disorders, Catherine Lidov

13.The Case of Mistaken Identity: Ego States and Eating Disorders, Andrew Seubert & Judy Lightstone

UNIT III: PERFORMANCE, COACHING, AND POSITIVE PSYCHOLOGY

14.EMDR and Performance, David Grand

15.EMDR and Positive Psychology, Ann Marie McKelvey

16.EMDR and Coaching, Ann Marie McKelvey

UNIT IV: Solutions for Complex Trauma

17.EMDR Friendly Preparation Methods for Adults and Children, Katie O’Shea

18.The EMDR Early Trauma Protocol, Katie O’Shea

19.Towards an Embodied Self: Integrating EMDR with Somatic and Ego State Interventions, Sandra Paulsen & Ulrich Lanius

20.Direct Targeting of Intrusive Images: A Tale of Three Soldiers, Elizabeth Massiah

21.Attachment, Affect Tolerance, and Avoidance Targets in Obsessive Compulsive Personality Disorder, Robin Shapiro

UNIT V: TREATING MEDICALLY-BASED TRAUMA

22.Clearing Medical Trauma, Robin Shapiro

23.Treating Birth Related Post Traumatic Stress, Katherine Davis

24.Treating Multiple Chemical Sensitivities with EMDR, Robin Shapiro 

UNIT VI: MORE EMDR SOLUTIONS

25.EMDR With Sex Offenders in Treatment, Ronald J. Ricci & Cheryl Clayton

26.Using EMDR with Religious and Spiritually Attuned clients, Martha S. Jacobi

EMDR Solutions II for Depression, Eating Disorders, Performance and More

Dear Readers,

Excuse me for the dearth of posts this summer. Last night I sent in the the 26 chapters, "Front Matter" and Glossary for the book on which I've been spending 20 or 30 hours each week. I had whittled my practice down to two days each week. I belayed most of my social life. I lived at this computer. I had few other topics of conversation.

This is a big, fat book. Ten chapters more than the last one. Some chapters were easy to edit, on time, about EMDR, and clear. The others took the bulk of my time; some sent in changes until the last possible moment. The writing itself was fun. I've done enough of it that I have a lot of neural networks that light up and interact with each other--when I get going, it's like taking dictation from someone who is smarter and funnier than I am. I actually like editing, it lights up the part of my brain that likes word games and crossword puzzles. I didn't stop when I shut off the computer--I noticed spelling and grammar errors everywhere. In my experience, that function will calm down in a few weeks.

It's weird to send the baby off to its new home in the Norton computers. My brain woke me up at 5 to harangue me about the book. "Let me sleep! It's done!"

Here is the some of the introduction of the book:

 

The real name of this book won’t fit on the cover. It is EMDR Solutions II for Depression, Eating Disorders, Performance, Coaching, Dissociation, Attachment Issues, Complex Trauma, Somatic Therapy, Early Trauma, Medically-based Trauma, Sex Offenders, and Spiritual Issues. As EMDR matures, its clinicians are targeting the trauma at the heart of, or secondary to, nearly every emotional or behavioral malady. As clinical research shows us the confluence of temperament, attachment history, affect, and trauma in every complex client (Siegel, 1999, Schore, 2003 and many more), clinicians have found new ways to direct the EMDR’s Standard Protocol toward their healing. This book contains a broad sample of creative solutions to many clinical conundrums.

In the beginning, I imagined a Depression unit, David Grand’s Performance chapter, and a mixture of unrelated chapters. I put the word out, contacting the writers from EMDR Solutions: Pathways to Healing, online communities, and people whose work I knew about and admired. As the chapters came in, they fell into natural units.

 

Unit I: TREATING Depression

In the last decade, I’ve spent many hours explaining the signs of endogenous, trauma-based, and attachment-based depression to consultees. When I was invited to Boise to do a four hour training about EMDR in the treatment of Depression, the material was right on the top of my brain. I couldn’t go wrong quoting the results of Bessel van der Kolk’s groundbreaking study of the effect of EMDR on trauma-based depression or using Stephen Porges Polyvagal theory (2001) as a starting point. When I brought in my own clinical experience, I had a unit. Jim Knipe offered his Shame-Based Depression chapter and I knew that this master clinician would bring a great new perspective to EMDR treatment. He did. When Katherine Davis sent me her chapter, I thought it would be about Post-Partum depression. Instead, it was about Post-Partum PTSD (often disguised as depression) and it moved to the Medical Trauma unit.

 

UNIT II: TREATING EATING DISORDERS

Andrew Seubert wondered if he could invite the Eating Disorders Special Interest Group (EDSIG) to contribute overlapping chapters. A unit was born. When I read through the Eating Disorder (ED) chapters, I saw that they had applications for any disorders of desire, compulsivity, anxiety, affect dysregulation and affect avoidance, and dissociation. I hope that all of you take in these chapters. Any of them will improve your clinical skills, even if you never plan to work with ED clients. The unit includes DaLene Forester’s clear and elegant overlays of EMDR’s Standard Protocol to treat specific eating/body disorders for her two chapters on Bulimia and Body Dysmorphia. Other chapters deal with diverse pieces of the Eating Disorder (ED) puzzle. Andrew Seubert gives a survey of the etiology of EDs. Janis Sholom addresses early phases of the EMDR Protocol. Linda J. Cooke and Celia Grand dig into the Neurobiology of EDs. They give an illuminating tour of the research showing the physical and neurological bases of the disorders and how to use that knowledge to help clients regulate their affect. Janet McGee writes about how to future pace and contain the inevitable relapses in ED treatment. Catherine Lidov illuminates the nature of Desire and what to do when it goes awry. Andrew Seubert and Judy Lightstone wrote separate sections of the Ego State and ED chapter. They contrast their creative and useful approaches.

 

UNIT III: PERFORMANCE, COACHING, AND POSITIVE PSYCHOLOGY

I admired David Grand’s performance work for years and was delighted when he agreed to contribute a chapter. His fifteen guidelines will help you guide athletes, performers, and others through the blocks that keep them from doing their best. Ann Marie McKelvey had written a rave review of EMDR Solutions: Pathways to Healing in the second issue of the EMDR Journal of Practice and Research. At the end, she complained that there were no chapters about Coaching or Positive Psychology. So I asked her for one. She gave me two . I paired them with the Performance chapter since all emphasize positive function, rather than dysfunction. I placed this positive unit between the ED and Complex Trauma units in order to give you readers a break from deep, dissociative trauma. Anne Marie became the cheerleader of the entire project. I hope that her enthusiasm infects you, too.

 

UNIT IV: Solutions for Complex Trauma

I asked Katie O’Shea if she would contribute her Early Trauma Protocol. As she began to write she realized that she had two different chapters, the Early Trauma chapter and one on Preparation Techniques, including a thorough and understandable explaination of the EMDR process, affect “containers”, and emotional resetting. Sandra Paulsen and Ulrich Lanius each wanted to write a chapter on Somatic Therapy and Ego States. I had them talk to each other and they decided to collaborate. Sandra is one of the “big names” in Ego State/Dissociation work in EMDR. Ulrich is a master of translating obscure brain research into EMDR-friendly methodology. They are both master clinicians. Their chapter is a brilliant synthesis of research, somatic therapy, and treatment of dissociation. Elizabeth Massiah works with Canadian soldiers. She shows us how to work with clients who suffer extremely intrusive images. And I write about treating Obsessive Compulsive Personality Disorder, a disorder of affect-tolerance and avoidance. If I had seen the Preparation Techniques and the Embodied Self/Somatic chapters earlier in editing process, I would have put them at the beginning of the book. I suggest that you read them first, since many of the other chapters refer to “containers” (Preparation) or “ego states” (Embodied Self).

 

UNIT V: TREATING BODILY AND MEDICALLY-BASED TRAUMA

 

Bodies get sick, get injured, and sometimes have babies. EMDR can clear the PTSD that arises from illness, developmental body processes, giving birth, injuries, and the medical treatment for them. I wrote a chapter about treating a variety of medical traumas. Katherine Davis contributed one about clearing traumatic stress from the birth process. And I present a protocol for using EMDR to treat Multiple Chemical Sensitivity. It’s amazing what EMDR can undo!

 

UNIT VI: MORE EMDR SOLUTIONS

Ronald J. Ricci and Cheryl Clayton share their experience and advice about working with Sex Offenders. If you don’t plan to work with this population, read it anyway. You will learn even more about affect tolerance, denial, and working with other clinicians and systems.

Martha S. Jacobi’s chapter about Religious and Spiritually Attuned Clients shows us how to elegantly navigate through issues of belief and spiritual community. It takes a broad topic and gives us precise interventions.

 

Using Solutions II

 

 

This book is a manual for doing EMDR with diverse client populations. If you took both parts of the EMDR training and have experience and knowledge of a specified client population, you should be able to use the procedures with few problems. If you aren’t schooled in EMDR (the Basic training is at least 50 hours long), get the training before you mess up your clients with this powerful psychotherapy! If you know what you’re doing, know your client well and remember that the therapeutic relationship must be strong before you try any technique, you will find uses for many of the solutions in this book.

You might think about reading about your specialties and skipping the rest of the chapters. Yet, I hope you read them all. There are gems in every chapter. Even if you don’t work with eating disorders, you can use many of the techniques in that unit with other addicted, dissociated, or complex clients. If you don’t work with offenders, Ricci and Clayton’s chapter speaks to trauma treatment in complex cases, impulse control and other issues that are germane to many clients.

Research considerations

 

 

                EMDR’s Standard Protocol has stood the test of peer-reviewed research and hundreds of thousands of individual clinical experiences. EMDR’s full protocol is empirically validated when used on Post-Traumatic Stress Disorder (PTSD). Most chapters in EMDR Solutions focus on trauma targets and thus conform to the research. Some of the uses in this book must be labeled “experimental”. When the writers point EMDR toward a non-trauma target, it may work very well or even be the most efficacious use of EMDR in a specific circumstance. Any readers who would like to do research on any of the topics should talk to the writers. 

 

Case histories

 

            Every case history in EMDR Solutions is either a composite or is here with the client’s permission. All names and life circumstances are changed in order to preserve anonymity.

 

Chapter conventions

 

 

            What the therapist says or should say to a client is in italics, with or without quotation marks. Occasionally, italics are used for other emphases, and I’ll leave it to you to know the difference. Numbers are written out, unless they refer to SUD, VoC, NAS, dates or dosage levels. Common EMDR terms are capitalized, especially those referring to a step of the Standard Protocol. If you’ve forgotten some of the terms, there’s a glossary near the end of this book.

 

Attribution

 

 

Francine Shapiro created and named EMDR, the Standard Protocol and most of the common EMDR terms. (For which we are forever grateful.) Assume attribution to her and her invention in every chapter. Her definitive guide to EMDR is Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (Second Edition). If you are an EMDR clinician and you haven’t read it; go get it now!

 

REFERENCES

Porges, S.W. (2001) The Polyvagal theory: Phylogenetic substrates of a social nervous system. Physiology & Behavior, 79, 503-513

 

Schore, Alan. 2003. Affect Regulation and Disorders of the Self. New York. W.W. Norton & Company

 

Shapiro, Francine. 2001. Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (Second Edition)

 

Siegel, Daniel. 1999. The Developing Mind. New York. Guilford Press

Why I Love Doing Psychotherapy

I love doing therapy. I'm two weeks back from vacation and I've seen the whole caseload, from a brand new person to clients returning to treatment after years away, to people in the midst of the muck, and one person who is over her debilitating anxiety and done with the process.

What do I love?

• Relationship! I get paid to intimately connect with people in truth. According to all meta-research the better the relationship, the better the outcome, even with whiz-bang techniques like EMDR. As I tell my consultees, "You need to fall in love with every single client. If you aren't doing therapy in that space, you need to see that as a therapeutic issue." (And no, I don't mean romance.) So I sit in love and relationship all day long. And they pay me.
• Healing! It is so fun to watch people move forward. Whether it's the dramatic stuff, like using EMDR/Brainspotting/EgoState work to clear PTSD or watching a "part" integrate; or watching someone be able to tolerate their anger/grief/heart-opening for the very first time; or seeing them really get that "it" wasn't about them, it's my privelege to be the witness and facilitator.
• Presence! My practice in my practice is about being 100% present to the person across from me. I can feel their cut off feelings arise in me. (Lots of us do it, few talk about, except the Object Relation folks.) I'm watching, listening, processing the whole time. And after 30 years in the field, my brain has built itself huge neural networks for presence and processing and being there interacting. And I keep learning more ways to be present and to interact and to add to the neural nets. It feels good to fire up the brain to do the work.
• Learning! There is something new to see in every person that walks into the office. I'm a mastery junkie, and I'm given new things to master every day that I work.

I'm 1/2 way through the editing process on the new book. Many chapters are a month late. Some are going through painful and even contentious rewrites. And while writing uses the therapy brain, and editing other people's chapters gives me a chance to learn new techniques and material, the actual line-by-line edits aren't as fun. And it's only vaguely relational to rewrite someone's sentence, and somewhat emotionally risky. (Not everyone likes their sentences rewritten.) After 4 to 6 hours of editing for 2 to 4 days in a row, I "escape" to work, where I get to fall in love once an hour, and collaborate with my attachment objects to create healing. And I think of what Hillel's words: "If you save one person, you save the world." I don't think of what I do as "saving", but doing this work helps me deal with the great injustice the world over. Hillel thinks I'm doing my part.

Why Book Editing Is Like Doing Psychotherapy

The Book has a title now: EMDR Solutions II, for Depression, Eating Disorders, Performance and More. It has a cover photograph, too. and the photo has a story. (Full disclosure--the photographer is my husband.) See it and read it at http://www.dougplummer.com/archives/ireland2/fall9.html

I'm in full-blown editing mode: going through each chapter, attaching a header, reformatting it, and reading for sense, structure, and grammar. All the writers are talented psychotherapists. Some of them are good writers. Some had lousy English teachers. In an attempt to solve the he/she dilemma, a few of my writers have turned "they" into a singular pronoun. "When I talk to a client, I tell them . . ."  Some, even without using "they" can't keep their subjects and verbs in agreement. Or the verb tense in agreement in one sentence. Some of the sentences are like puzzles. I work hard to understand what the writer means and to make it cogent and "correct". Mostly, I like the process. Sometimes, I whine about it.

Editing seems natural to me because, as a therapist, I listen intently to people. I notice tone, meaning, coherence of narrative, posture, breathing, and monitor my own human reaction to all of it. When I see a discrepancy between, for instance, affect and content, I might intervene. "What do you feel, inside, when you're talking about the bad thing?" Or "I notice you look kind of hunkered down while you're talking about something good that happened. What's going on?" Therapists, the good ones, anyway, sift through a pile of complex information every moment and help bring clarity to murky responses. Through questions and other techniques we help clients create coherent narratives, acknowledge and process affect, and build the neural networks that come only from human response. In the mean time, we see the clients through the eyes of our editors' brains.

April Steele's New Book

April Steele has updated her self-published book, and every therapist should have it. You don't have to know EMDR to use her techniques. Her CD's are wonderful, too. She's a treasure, and since she's "practicing for retirement", she's no longer teaching workshops. If you want her materials, order them from her. Get the whole toolkit. It's worth it!

Here's the blurb:

The Book

Developing a Secure Self: An Attachment-Based Approach to Adult Psychotherapy (2007) presents an approach that evolved out of my search to find a focused way in which to address directly the needs of my clients that are rooted in early insecure attachment relationships - a way that is as direct as EMDR is in processing traumas. This approach has three components:

- an attuned therapeutic relationship seen as being one of attachment

- Imaginal Nurturing - ego state work that includes guided imagery

- emotional skills strengthening

Developing a Secure Self (DSS) creates an attachment-focused context for EMDR trauma processing without compromising the integrity of EMDR protocols.

The 175 pages of this handbook include principles, dozens of clinical examples, sample Imaginal Nurturing scripts and organizational tools. It is in a convenient three-ringed binder so pages can be readily removed for clinical use, personal notes can be added, and pages delineating any further developments in this approach can be added eliminating the need to purchase an up-dated edition.

A table of contents can be seen at http://www.april-steele.ca/handbook.php.

Differences between editions

The first two editions came out in 2004. The changes in the second edition were primarily editorial, making the book more reader-friendly. Both were written for EMDR therapists. The 2007 edition is for all therapists, but maintains the references to EMDR and the section specifically on incorporating Imaginal Nurturing into EMDR trauma work.

In the past few years, I have provided both consultation and therapy for EMDR therapists who have taken my training or read my book. That experience allowed me to bring to the new edition an awareness of what people did not seem to be getting about this approach which is primarily how to weave it through the therapy rather than doing periodic Imaginal Nurturing interventions. Therefore, in this version, there are more examples of how this ego state work is woven into the therapy as a whole.

If you already have an earlier edition... 

there is an 11-page update available for a nominal charge of $5. There is no need to buy the new edition.

Developing a Secure Self Therapeutic Toolkit

The toolkit is comprised of the book and all four Imaginal Nurturing CDs. It provides you with an opportunity to expand the learning from the book to experience Imaginal Nurturing guided imagery yourself. The CDs were developed for clients to use between sessions and can be loaned, given, or sold to them. Information about the CDs including a sound clip is available at http://www.april-steele.ca/tapes.php.

To purchase

Books, CDs, and toolkits can be purchased at  http://www.april-steele.ca/purchase-products.php using PayPal or credit card.

The Instinct To Heal

My new favorite book is Instinct to Heal by David Servan-Schrieber (Rodale, 2003). It is simple enough for most clients and innovative and interesting enough for most clinicians. I recommend it to psychiatrists, any kind of physician or "alternative" medical practitioner and all psychotherapists.

Why? Instinct to Heal gives clear explanations, references to good research and, in many cases, directions for many mood-altering treatments including guided imagery to shift heart-rate coherence; justification and dosage for Omega 3/Fish oil supplements; sufficient exercise to change mood; dawn simulation lights; EMDR & acupuncture (no self-help instructions included) some Gottman-researched communication protocols; and the Stuart & Lieberman's BATHE questions--to help doctors and others quickly and efficiently connect, get the information, and validate and strengthen their patients. It's all good stuff. It follows research, Servan-Schrieber's clinical experience, and common sense. He made it clear, concise, and practical; my favorite kind of clinical book.

I've been hearing many researchers speak about heart-rate variability and coherence for many years. Simply, our heart-rates are constantly changing depending on changes in our activities, thoughts, state of digestion and other physiological changes, moods, and arousal states. According to research if you want to live a long time, avoid heart attacks, and avoid depression and anxiety, your heart rate should vary in a smooth, regular way, instead of a jerky, erratic way. There is tons of research to back this up. Do a search online, or buy Servan-Shreiber's book if you want the citations. You can buy computer software, with a little hardware to test your or your clients' heart-rate variability, and get slightly more complicated software to use your computer as a biofeedback device to create smooth "coherence" in heart-rate variability. Or you can simply, with or without high-tech help, use Servan-Shrieber's guided imagery for heart rate coherence. I've modified it a bit. Here it is from pages 53 and 54:

• "Take two deep, slow breaths. . . Keep your attention focused on your breath right up until you have finished exhaling and then let your breathing pause for a few seconds before the next in-breath begins of its own accord. The point is to let your mind float with out-breath right up to the point where it lightens up, becoming mellow and buoyant inside your chest.
• . . .In about 15 seconds after your breathing stabilizes, center your attention on the region of your heart. Imagine that you are breathing through your heart (or the center of your chest, if you don't feel or "see" your heart). As you continue breathing slowly and deeply (but effortlessly), visualize--and really feel--each inhalation-exhalation passing through that key part of your body. Imagine that each intake of oxygen nourishes your body and each exhalation rids it of the waste it no longer needs. Imagine the slow and supple movements of inhalation and exhalation that bathe the body in this purifying and soothing air. Imagine that they are helping your body make the most of the gift of attention and respite it is receiving from you. . .
• Become aware of the sensation of warmth or expansiveness that is developing in your chest, and in fostering and encouraging it with your thoughts and your breath. (This feeling may not come immediately, with more practice, it will.) One way to encourage the heart is to draw on a feeling of gratitude or of love for another being. You might think of a beloved person or a pet or a peaceful scene from nature. Or you might think of when you were in the "zone" in a sport: swinging a golf club or running, or doing a downhill run on skis. You may notice yourself smiling or feel lightness or warmth or expansion in your chest."

Servan-Schreiber suggests people do this daily. He says that people can enhance heart-rate coherence in other ways. Exercise or yoga or meditation can do the trick. He says, "Coherence in heart rhythm affects the emotional brain, fostering stability and signaling that everything is working order, physiologically. The emotional brain reacts to this message by reinforcing coherence in the heart. Coherence in the heart and the emotional brain stabilizes the autonomic nervous system, both sympathetic and parasympathetic." He talks about depressed or anxiety-disordered clients who lost all their bad symptoms with this technique. And he says that it doesn't do the complete trick for everyone. Some people need light, Omega-3's, better relationship, and even medication before they turn the corner. But isn't this a sweet place to start?

Buy the book, recommend it to appropriate clients. And use some of his practical techniques yourself.