A Proposal for an EMDR Reverse Protocol

Introduction

As a psychologist for the child welfare system working with severely and chronically traumatized children and families, and as a psychologist for law enforcement, I returned to my office following my EMDR Basic Training I struggled to implement the protocol with my clients. In my 25 year career, I cannot recall ever encountering one client with a single incident trauma. So how then could I use EMDR? Because literature has discussed that EMDR trauma reprocessing (Phases 3-7) must be delayed due to the client’s need for extended resource development and skills to manage intense affect, I initially abandoned case conceptualization with EMDR because time and external resources did not afford my clients the opportunity to complete the entire targeting sequence plan. My clients were consistently presenting with intense and complex trauma histories.

I continued to provide psychotherapy as I had practiced all along, while I also explored opportunities with clients to develop resources to prepare for trauma reprocessing with EMDR. Yet I noticed that many clients still struggled because they had no hope for the future. Many clients had been in therapy and believed that therapy was to help them learn to cope with symptoms. EMDR offered the opportunity for the client to reprocess symptoms so those symptoms no longer would be present in the future; however, most clients could not imagine a future at all, let alone a future with no mental health symptoms.

The children referred from the child welfare system adamantly avoided the past because they were young and their pasts were horrendous. In addition, the future was not something these children could imagine nor was the present a pleasant existence for many of them either. Many clients struggled to exist in the moment and to cope with each day. I struggled to integrate EMDR into my practice even though I was working with severely and chronically traumatized clients who needed EMDR.

So how could I think conceptually through Shapiro’s Adaptive Information Processing (AIP) theory in my treatment approach and yet not focus on reprocessing past events first? Could I help clients with those horrendous past events that were maladaptively stored in the client’s memory thereby preventing the client from seeing any kind of future at all? It was evident to me that many of my clients came to psychotherapy for symptom relief without the expectation of a healthier, happier future. Was it possible for me to assist my clients to reprocess the client’s foreshortened sense of future that was driven by the past events they had experienced?

What is the EMDR Reverse Protocol?

The Reverse Protocol is the EMDR 3-Pronged Approach targeting in reverse order - Future-Present-Past. This protocol uses all 8 phases of the standard protocol. It is not beginning therapy with a future template or resource development (Korn & Leeds, 2002; Leeds, 2001). Some who are familiar with Solution Focused Brief Therapy (SFBT) (de Shazer, Berg, Lipchik, Nunnally, Molnar, Gingerich, & Weiner-Davis, 1982) will recognize a flavor of focusing on the solution rather than the problem in that this EMDR reverse protocol focuses on addressing the client’s negative beliefs about the future before reprocessing past traumas. This reverse protocol reprocesses the anxiety and negative cognitions about the future before reprocessing present triggers followed by reprocessing past events. Many clients with trauma, dissociation and depression exist in survival mode and cannot participate in past trauma reprocessing because they experience life through the lens of trauma with a foreshortened sense of future. These clients need extended psychotherapy focused on skill-building, affect regulation, and developing emotional intelligence in which the client can identify and tolerate intense emotions. Past trauma cannot be reprocessed without significant time in the Preparation Phase of EMDR. Another potential for case conceptualization is to reverse the temporal order of the targeting sequence plan. This idea still considered that maladaptively stored information from the client’s history were driving current symptoms; however, the client was not developmentally capable of focusing on trauma reprocessing about the past until the client could imagine a future.

This is the essential proposal for a Reverse EMDR Protocol

1. The Reverse Protocol is about a beginning therapy by reprocessing future targets before present triggers and past events. Treatment begins with identifying a positive future and the negative cognitions about why the client cannot consider the future and/or does not entertain a future free of symptoms. Future reprocessing is also a resource focused on the client anticipating using replacement behaviors integrated with plans for what to do in the future when you have these symptoms. The therapist might ask the client, “How do you see the future without these symptoms that brought you into treatment? What prevents you from accomplishing this future goal (NC)?”.
   

2. Present symptoms: While reprocessing the future targets, therapy simultaneously monitors triggers, stressors and the use of self-soothing/self-calming skill. After the client has reprocessed negative cognitions, emotions, and body sensations about the future, then present triggers are reprocessed.
   

3. Past events: Past events/targets are reprocessed using the standard protocol. This still includes reprocessing the past target, present triggers and completing the target by installing a positive future template consistent with the standard EMDR protocol. Essentially the temporal order of therapy is future-present-past (reverse protocol) and then past-present-future (standard protocol.) Why use the reverse protocol and the standard protocol? The therapist may consider the Reverse Protocol because the client cannot initially manage the standard protocol.
   

If you are interested in learning more about the Reverse Protocol, please listen to one of my trainings, attend a new one, or look for this complete article to be published.

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