EMDR as a Special Form of Ego State Psychotherapy
Inner Dialogue and EMDR
When there is no movement in the EMDR reprocessing (i.e., a therapeutic impasse or resistance), the cognitive interweave technique is introduced. In this process, the patient is invited to reflect on cognitions coming from a more adult perspective, i.e., addressing issues of guilt or blame; control and power; or hope and possibilities. While reflecting on one of these cognitions, the left/right processing continues. Several different cognitive interweaves may need to be introduced, but eventually a shift occurs.
The adult perspective from which the cognitive interweave is introduced is another ego state — one not available to the patient at the time of the initial trauma. This other ego state can help the patient to let go of the traumatic affect. An integrative process occurs, and the previously isolated problematic ego state becomes connected through new neuronal associations to other ego states so that more options are available to the system.
This is the same integrative process which occurs during the internal dialoguing process described earlier. The cognitive interweave can be formulated in the following ego state terms: The therapeutic impasse requiring the cognitive interweave is caused by a covert “resistant” ego state which is opposed to allowing a therapeutic shift. This resistant ego state has a cognition driving its opposition, a blocking belief. The therapist, without directly identifying that covert, resistant ego state or its cognition, attempts to challenge and shift that ego state by systematically offering it cognitions from adult ego states which hold contrary cognitions. In effect, an implicit dialogue is occurring between the resistant ego state with its negative cognition and a more adult ego state with a positive cognition. The EMDR processing diminishes the dissociative barrier between the cognitive components of these two otherwise previously unconnected ego states. Although the dialogue is not explicit, the EMDR left/right alternations facilitates the integration of these previously unconnected ego states.
Although the EMDR cognitive interweave technique is very powerful, the technique can be improved further through this ego state perspective. The EMDR technique focuses solely on the cognitive component of the ego state system, and this component is certainly powerful and salient. But by broadening the concept to include all components of an ego state (an “ego state interweave”), affective, imagistic, and behavioral internal resources would be used as well. Further, by thinking of the therapeutic impasse as coming from a resistant protector ego state, the therapist could then use EMDR to amplify and explore that particular ego state in a way that is analogous to the processing of the original traumatized ego state. This strategy would open another therapeutic channel, freeing the therapist from having to guess at the appropriate cognitive or ego state interweave.