This is something I hear from consultation groups from time to time: Sometimes my client will have an intense session and then call to say they need a break from EMDR, or even want to skip session that week and want to meet the following week.
Yep. Makes sense. This happens sometimes, and I usually advise a more thorough Phase 7.
Remember clients have been managing their trauma symptoms, for the most part, on their own. Additionally, if you’re targeting a childhood trauma then they’ve been managing for most of their lives. Keep treating your client like they matter. Remind them that they don’t have to do this on their own anymore. They have support. They don’t need to white knuckle situations anymore, just deal with it, or convince themselves they’re making a big deal out of nothing.
Phase 7 is so crucial with helping your clients understand how processing continues in between sessions. I often tell my clients their brain might be “tired,” after an EMDR session. Just like a your body may be tired or sore after you exercise EMDR can be similar to the brain. I’ll use the analogy of how our bodies can feel sore after exercising, but we know the movement is good for our bodies and is helpful in the long run. EMDR has similar effects for the brain. I know as a helping professional we want our clients to experience as little adverse reactions as possible, but we have to allow our clients the space to heal. Physical Therapists can’t rush in and do the exercises for their patients. The patient needs to do them-despite the discomfort. Yeah, sometimes clients leave your office mentally sore, but they may have stretched their brain to a point that was unobtainable before. Just like someone in PT may have been able to stretch their knee farther than before. Sometimes accomplishments are painful. Marathon runners are sore and exhausted at the end of their race. But they finished the race.
Of course, we want to be sure our client leaves in as much as unadaptive state as possible. They should never be in a high level of disturbance or in the middle of an abreaction. Remember to use your clinical judgement so the client leaves your office stable. If the client is still showing obvious signs of distress at the end of the session use those Phase 2 resources, such as the Calm Place or the Container, to return the client to a state of ease. Be sure to remind the client of these resources and to use them if necessary.
It is also okay if a client needs to come and see you sooner than the next scheduled session to complete processing, or address any adverse side effects that occurred afterwards. We remind our clients that processing continues in between sessions and we want our clients to be able to integrate the new material that was processed, but if they are experiencing high distress there is no harm to meet with them sooner to complete a session. We absolutely do not want to stop EMDR because we know processing will increase stability.
I also remind clients that whatever they don’t reprocess they continue to take with them. EMDR can be difficult, but if they follow through they can find a safe place to lay their distress to rest. “Processing the dysfunctional memories means that they will no longer be triggered in everyday life and buffeted by the high-intensity disturbing affects that were stored at the time of the traumatic event” (Shapiro, EMDR 3rd Edition, page 156).
Finally, absolutely remind your clients that the incomplete target will be readdressed at the next session. We want to be sure our clients continue to notice things and encourage them not to categorize as good or bad. Just simply notice and we will reassess at the next session. If they notice anything disturbing then they can use their resources, and ask them to write it down. These notices will assist in directing treatment and what the next target could be. Asking the client to notice these things increase their level of awareness and helps the client to realize that any future distress is part of the healing process (such as a sore body at the end of exercising). We emphasize Phase 7 not to scare our clients, but to establish realistic expectations.
By setting up a thorough debrief it helps the client understand, regardless of the nature of the distress, that it is a continuation of EMDR processing. The client can continue to allow whatever happens to happen; just like we advise in Phase 4. This way the client can observe their distress rather than be overwhelmed by it. All in all continue to treat your client like they are good enough and that they matter.
